BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CHRISTINE LANMAN,
 
         
 
              Claimant,
 
         
 
         VS.
 
                                               File Nos. 793562 & 710341
 
          EVERCO INDUSTRIES,
 
                                               A R B I T R A T I 0 N
 
               Employer,
 
                                                  D E C I S I O N
 
          and
 
          
 
          WESTCHESTER FIRE & MARYLAND
 
          CASUALTY CO.,
 
          
 
               Insurance Carrier,
 
               Defendants.
 
          
 
          
 
                                   INTRODUCTION
 
         
 
              These are arbitration proceedings brought by Christine 
 
         Lanman, claimant, against EVERCO Industries, employer and its 
 
         insurance carriers, Westchester Fire and Maryland Casualty Co., 
 
         defendants.  The cases were heard by the undersigned on November 
 
         9, 1989, in Ottumwa, Iowa.
 
         
 
              The record consists of the testimony of claimant.  The 
 
         record also consists of the testimonies of Berna Coons, Jesse 
 
         Garrett, Doug Chambers, Mike Burkert and Joann Spencer.  The 
 
         record is also comprised of Exhibits 1-17.
 
         
 
                                      ISSUES
 
         
 
              As a result of the prehearing report and order submitted 
 
         and approved on the ninth day of November, 1989, the issues 
 
         presented by the parties are:
 
         
 
              With respect to file number 710341 there is only one issue 
 
         remaining.  A ruling on a motion for partial summary judgment was 
 
         filed by Deputy Industrial Commissioner Michael G. Trier.  The 
 
         ruling determined that:
 
         
 
              This matter comes before the undersigned upon the Motion for 
 
              Partial Summary Judgment filed by defendants on September 
 
              23, 1988.  The file does not contain a resistance.  The 
 
              materials submitted with the motion
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES 
 
         Page 2
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
              clearly show that claimant was last paid weekly compensation 
 
              on December 16, 1983, a date more than three years prior to 
 
              the.time the petition was filed on December 18, 1987.  The 
 
              record also reflects that defendants have not filed a denial 
 
              of compensability for the injury of August 4, 1982, the one 
 
              for which weekly compensation benefits have been paid up to 
 
              and including December 16, 1983.
 
              
 
              IT IS THEREFORE ORDERED that defendants' Motion for Partial 
 
              Summary Judgment is sustained and claimant's only claim with 
 
              regard to the injury of August 4, 1982 is for section 85.27 
 
              benefits.  This claim, file number 710341, remains open and 
 
              pending for purposes of determination of the claimant's 
 
              entitlement [sic] to section 85.27 benefits which are 
 
              related to the alleged injury of August 4, 1982.
 
         
 
              With respect to file number 793562, the issues presented by 
 
         the parties are:
 
         
 
              1. Whether there is a casual relationship between the 
 
         injury and any permanent disability;
 
         
 
              2. Whether claimant is entitled to temporary 
 
         disability/healing period benefits or permanent partial or total 
 
         disability benefits;
 
         
 
              3. Whether claimant is entitled to medical benefits under 
 
         section 85.27; and,
 
         
 
              4. Whether claimant is entitled to penalty benefits under 
 
         section 86.13 (4).
 
         
 
                                   STIPULATIONS
 
         
 
              Prior to the hearing, the parties entered into a number of 
 
         stipulations.  The stipulations are as follows:
 
         
 
              1. The existence of an employer-employee relationship 
 
         between claimant and employer at the time of the alleged injury;
 
         
 
              2. That claimant sustained an injury on April 1, 1985, 
 
         which arose out of and in the course of employment with employer;
 
         
 
              3. The time off work for which claimant now seeks either 
 
         temporary total disability or healing period benefits, is 
 
         stipulated to be from July 6, 1985; September 23, 1986 through 
 
         October 3, 1986; and July 18, 1988 through February 28, 1989 
 
         (33.2 weeks after credit of 2.1 weeks referenced in section 10 is 
 
         given);
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Page 3
 
         
 
         
 
              4. That the type of permanent disability, if the injury is 
 
         found to be a cause of permanent disability, is stipulated to be 
 
         an industrial disability to the body as a whole and the 
 
         commencement date for permanent partial disability, in the event 
 
         such benefits are awarded, is stipulated to be the first day of 
 
         March, 1989;
 
         
 
              5. In the event of an award of weekly benefits, the rate of 
 
         weekly compensation is stipulated to be $212.29 per week;
 
         
 
              6. Sick pay/disability income in the amount of $1,950.00, 
 
         medical hospitalization expenses in the amount of $17,120.86; 
 
         and,
 
         
 
              7. Defendants paid claimant 17 4/7 weeks (2 1/2 represents 
 
         overpayment) of compensation at the rate of $212.29 per week 
 
         prior to hearing.
 
         
 
                                 FACTS PRESENTED
 
         
 
              Claimant is 40 years old.  She commenced her employment 
 
         with defendant in 1981 as a Grade I laborer.  Several years 
 
         later, claimant bid into a Grade 1A job.  According to claimant, 
 
         this position was more skilled and claimant held it until the end 
 
         of 1984.  Then claimant was transferred to Department 1300 where 
 
         she was required to perform overhead work but no heavy lifting.
 
         
 
              Claimant testified that on the date of the injury, she was 
 
         working in the packing department as a Grade II laborer.  She 
 
         related she was moving barrels and while she was moving the first 
 
         barrel, she felt a hard, burning stabbing pain in her lower back 
 
         at the waistline.  Claimant indicated she reported the injury to 
 
         her supervisor, Kenny Paxton, and that she left work on April 1, 
 
         1985.  She returned to work on the second and continued working 
 
         through September 23, 1986.  Claimant testified she eventually 
 
         had back surgery on July 7, 1988 and that she returned to work on 
 
         March 1, 1989, as a Grade I order filler.  Further, claimant 
 
         reported that on April 1, 1985, she was earning $8.37 per hour, 
 
         and that as of the date of the hearing, she was making $8.79 per 
 
         hour.  Claimant also related she had not missed any work because 
 
         of her back since her return on March 1, 1989.
 
         
 
              Berna Coons testified for claimant.  Ms. Coons indicated 
 
         claimant's physical condition appeared much worse after April 1, 
 
         1985, than before that date.  The witness stated she observed 
 
         claimant and claimant appeared stiff after April 1, 1985.
 
         
 
              Jesse Garret also testified for claimant.  He testified he 
 
         observed claimant lifting parts both before and after April 1, 
 
         1985, and that claimant needed assistance with lifting after the 
 
         injury date.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 4
 
         
 
         
 
              Doug Chambers testified.  He also reported he observed 
 
         claimant during the summer of 1985.  He stated claimant appeared 
 
         to be in pain.
 
         
 
              Mike Burkert testified for defendants EVERCO and Maryland 
 
         Casualty.  He stated he had-been employed by Maryland Casualty 
 
         for five years and that he was a senior claims representative.  
 
         Mr. Burkert reported he had handled claimant's file.  Mr. Burkert 
 
         reported weekly benefits were paid intermittently to claimant 
 
         because William R. Boulden, M.D., initially determined in March 
 
         of 1987 that claimant's alleged disability was not related to the 
 
         April 1, 1985 incident.  Mr. Burkert testified that Dr. Boulden 
 
         later changed his opinion and then determined claimant's alleged 
 
         disability was work related.  However, Mr. Burkert, according to 
 
         his testimony, decided the insurance carrier would use Dr. 
 
         Boulden's initial opinion in paying benefits.
 
         
 
              Joann Spencer testified for defendant EVERCO.  She stated 
 
         she had been employed by EVERCO for five years as the company 
 
         nurse.  Ms. Spencer testified she instituted first aid cards for 
 
         each employee and that she had first seen claimant at the nurse's 
 
         station on October 31, 1984.  The witness related that claimant 
 
         visited the nurse's station on April 1, 1985, because of "an old 
 
         back injury."  Ms. Spencer also reported she had had contacts 
 
         with Mr. Burkert relative to this claim.
 
         
 
                                  APPLICABLE LAW
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              Claimant has the burden of proving by a preponderance of 
 
         the evidence that she received an injury on April 1, 1985, which 
 
         arose out of and in the course of her 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 claimant has the burden of proving by a preponderance 
 
         of the evidence that the injury of April 1, 1985, is casually 
 
         related to the disability on which she now bases her claim.  
 
         Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965). 
 
         Lindahl v. L. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The question of casual 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 casual connection.
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES 
 
         Page 5
 
         
 
         
 
         Burt, 247 Iowa 691,  73 N.W.2d 732.   The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 
 
         N.W.2d 128 (1967).
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-61 
 
         (1956).  If the claimant had a preexisting condition or 
 
         disability that is aggravated, accelerated, worsened or lighted 
 
         up so that it results in disability, claimant is entitled to 
 
         recover. Nicks v. Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 
 
         812, 815 (1962).
 
         
 
              When an aggravation occurs in the performance of an 
 
         employer's work and a casual connection is established, claimant 
 
         may recover to the extent of the impairment.  Ziegler v. United 
 
         States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591, 595 (1960).
 
         
 
              The Iowa Supreme Court cites, apparently with approval, the 
 
         C.J.S. statement that the aggravation should be material if it is 
 
         to be compensable.  Yeager v. Firestone Tire & Rubber Co., 253 
 
         Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. Workmen's 
 
         Compensation sec. 555(17)a.
 
         
 
              Our supreme court has stated many times that a claimant may 
 
         recover for a work connected aggravation of a preexisting 
 
         condition.  Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 
 
         N.W. 35 (1934).  See also Auxier v. Woodward State Hosp. 
 
         Sch., 266 N.W.2d 139 (Iowa 1978); Gosek v. Garmer and Stiles 
 
         Co., 158 N.W.2d 731 (Iowa 1968); Barz v. Oler, 257 Iowa 508, 133 
 
         N.W.2d 704 (1965); Olson v. Goodyear Service Stores, 255 Iowa 
 
         1112, 125 N.W.2d 251 (1963); Yeager, 253 Iowa 369, 112 N.W.2d 299 
 
         (1961); Ziegler, 252 Iowa 613, 106 N.W.2d 591 (1960).
 
         
 
              An employer takes an employee subject to any active or 
 
         dormant health impairments, and a work connected injury which 
 
         more than slightly aggravates the condition is considered to be a 
 
         personal injury.  Ziegler, 252 Iowa 613, 620, 106 N.W.2d 591 
 
         (1960), and cases cited.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              An employee is not entitled to recover for the results of a 
 
         preexisting injury or disease but can recover for an aggravation 
 
         thereof which resulted in the disability found to exist.  Olson,
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 6
 
         
 
         
 
         255 Iowa 1112, 125 N.W.2d 251 (1963); Yeager,,253 Iowa 369, 112 
 
         N.W.2d 299 (1961); Ziegler, 252 Iowa 613, 106 N.W.2d 591 (1960). 
 
         See also Barz, 257 Iowa 508, 133 N.W.2d 704 (1965) ; Almquist, 
 
         218 Iowa 724, 254 N.W. 35 (1934).
 
         
 
              When a worker sustains an injury, later sustains another 
 
         injury, and subsequently seeks to reopen an award predicated on 
 
         the first injury, he or she must prove one of two things: (a) 
 
         that the disability for which he or she seeks additional 
 
         compensation was proximately caused by the first injury, or (b) 
 
         that the second injury (and ensuing disability) was proximately 
 
         caused by the first injury.  DeShaw v. Energy Manufacturing 
 
         Company, 192 N.W.2d 777, 780 (Iowa 1971).
 
         
 
              If a claimant contends he has industrial disability he has 
 
         the burden of proving his injury results in an ailment extending 
 
         beyond the scheduled loss.  Kellogg v. Shute and Lewis Coal Co., 
 
         256 Iowa 1257, 130 N.W.2d 667 (1964).
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson, 
 
         255 Iowa 1112, 125 N.W.2d 251 (1963).  Barton v. Nevada Poultry, 
 
         253 Iowa 285, 110 N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  This 
 
         is so as impairment and disability are not synonymous.  Degree of 
 
         industrial disability can in fact be much different than the 
 
         degree of impairment because in the first instance reference is 
 
         to loss of earning capacity and in the latter to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         These are
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 7
 
         
 
         
 
         matters which the finder of fact considers collectively in 
 
         arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 
         motivation - five percent; work experience - thirty percent, etc.  
 
         Neither does a rating of functional impairment directly correlate 
 
         to a degree of industrial disability to the body as a whole.  In 
 
         other words, there are no formulae which can be applied and then 
 
         added up to determine the degree of industrial disability.  It 
 
         therefore becomes necessary for the deputy or commissioner to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, 
 
         February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, 
 
         March 26, 1985).
 
         
 
              For example, a defendant employer's refusal to give any 
 
         sort of work to a claimant after he suffers his affliction may 
 
         justify an award of disability.  McSpadden v. Big Ben Coal Co., 
 
         288 N.W.2d 181 (Iowa 1980).
 
         
 
              Similarly, a claimant's inability to find other suitable 
 
         work after making bona fide efforts to find such work may 
 
         indicate that relief would be granted.  McSpadden, 388 N.W.2d 181 
 
         (Iowa 1980).
 
         
 
                                     ANALYSIS
 
         
 
              The first issue to address is whether the injury of August 
 
         4, 1982, gave rise to medical benefits under section 85.27.  It 
 
         is the determination of the undersigned that defendant insurance 
 
         carrier, Westchester Fire, is not liable for any section 85.27 
 
         benefits.  Claimant has not proven by a preponderance of the 
 
         evidence there is a connection between the 1982 injury and the 
 
         medical treatment incurred subsequent to the April 1, 1985 injury 
 
         date.
 
         
 
              Dr. Boulden, the medical expert, did not opine that the 
 
         1982 injury gave rise to the medical treatment received after 
 
         April 1, 1985.  Dr. Boulden determined there were both epidural 
 
         fibrosis and spinal stenosis after the surgery in 1982.  However, 
 
         the fibrosis and stenosis were asymptomatic until the injury on 
 
         April 1, 1985.  The injury on April 1, 1985, was an intervening 
 
         cause.  Dr. Boulden stated in his deposition relative to the 
 
         April 1, 1985 injury date:
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              A.  The -- basically we went -- I went into the fact
 
              that -- that the preexisting problem's there, the
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES 
 
         Page 8
 
         
 
         
 
              underlying condition was there but that the trauma made it 
 
              symptomatic, and we were referring to the trauma of April 1 
 
              of 1985.
 
              
 
                 I felt that she had an increased disability rating 
 
              because the persistent-recurrent nature of her symptom 
 
              complex because the symptoms had not stayed suppressed.  In 
 
              other words, if she only had an aggravation, then the 
 
              symptoms shouldn't come back.  However, her sy-mptoms waxed 
 
              and waned, as we've used that term before in this context.
 
              
 
                 I felt that five percent increase in disability was on 
 
              and above the disability that she had had in relation to the 
 
              previous disk surgery.
 
         
 
         (Exhibit 13, page 20, lines 3-19)
 
         
 
              According to Dr. Boulden's testimony, the 1985 injury 
 
         aggravated the preexisting 1982 injury. (Ex. 13, pp. 26-27, 11. 
 
         15-5) Additionally, Dr. Boulden determined there were problems 
 
         other than the fibrosis and stenosis.  He expanded his diagnosis 
 
         to include a degenerating disk at L3-4 and a herniated disk at 
 
         T10-11 on the left side.  Dr. Boulden opined to a reasonable 
 
         degree of medical certainty that these problems were also caused 
 
         by the April 1, 1985 injury. (Ex. 13, pp. 26-27, 11. 15-5).  Dr. 
 
         Boulden did not believe the expanded diagnosis was causally 
 
         related to the 1982 injury.  Nor did any other expert establish 
 
         there was a casual connection between the 1982 injury and the 
 
         medical treatment sustained after April 1, 1985.  Therefore, 
 
         defendant Westchester Fire is not liable for any section 85.27 
 
         benefits.
 
         
 
              For the same reasons as stated above, it is determined that 
 
         claimant has sustained the requisite casual connection between 
 
         the injury of April 1, 1985 and claimant's claimed disability.  
 
         The injury of April 1, 1985, has given rise to medical benefits 
 
         under section 85.27.  It is the determination of the undersigned 
 
         that defendant Maryland Casualty is liable for the following 
 
         medical expenses:
 
         
 
          Dr. Mietzner                         $    80.00
 
          Dr. Boulden                           6,169.00
 
          Surgery Center of Des Moines          1,625.00
 
          Dr. Berg                                 90.00
 
          Des Moines Anesthesiologists          1,128.00
 

 
         
 
 
 
 
 
 
 
 
 
 
 
          Iowa Lutheran Hospital               10,607.28
 
                                               19,699.28
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 9
 
         
 
         
 
              Also claimant is entitled to mileage for trips to Des 
 
         Moines in the amount of 502 miles at the rate of .21 per mile.  
 
         This totals $105.42.
 
         
 
              The next issue to address is whether claimant is entitled 
 
         to permanent partial disability benefits.  Dr. Boulden opined 
 
         claimant was functionally impaired.  He assigned an impairment 
 
         rating of 15 percent to the body as a whole.  Five percent of the 
 
         impairment rating was assigned to the injury of April 1, 1985.  
 
         The remaining 10 percent impairment rating was attributable to 
 
         the 1982 injury. (As an aside, 10 percent permanent partial 
 
         disability benefits have previously been paid to claimant per 
 
         Westchester Fire and these are not at issue).
 
         
 
              Dr. Boulden did release claimant to return to work on March 
 
         1, 1989.  However, the physician placed various restrictions upon 
 
         claimant.  She is restricted from repetitive bending and twisting 
 
         and from using her back to lift.  Claimant is also restricted 
 
         from repetitive lifting of no more than 25 or 30 pounds, but she 
 
         is able to engage in occasional lifting of objects weighing 
 
         greater than 30 pounds.
 
         
 
              Claimant has returned to her employment.  She is 40 years 
 
         old.  She is a Grade I order filler.  According to claimant's own 
 
         testimony, she is "getting along fairly well."  She has a lighter 
 
         job than the one she had on April 1, 1985.  Claimant testified 
 
         she has never bid into a Grade 2 position which is at a higher 
 
         rate of pay.  Claimant is currently earning $8.79 per hour. she 
 
         has also received a $400.00 bonus.  At the time of her injury, 
 
         claimant was earning $8.37 per hour.  Claimant indicated she has 
 
         received all raises pursuant to the collective bargaining 
 
         agreement.
 
         
 
              There is no evidence defendant employer has downgraded 
 
         claimant because of her back condition, or that claimant has been 
 
         refused an upgrade.  Clai-mant's refusal to bid into a Grade 2 
 
         position is a personal decision.  No medical expert has 
 
         determined claimant is incapable of handling a Grade 2 job. 
 
         Claimant's earnings are greater now than before the April 1, 
 
         1985, injury date.  However, claimant's earning capacity is 
 
         somewhat reduced given the permanent restrictions placed upon 
 
         her.  Therefore, it is the determination of the undersigned that 
 
         claimant has an industrial disability of 20 percent.  Ten percent 
 
         of the disability is attributable to her injury in 1982.  The 
 
         remaining 10 percent is attributable to the April 1, 1985 injury 
 
         date.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              It is also the determination of the undersigned that 
 
         claimant is entitled to healing period benefits.  The parties 
 
         have stipulated to the dates in question.  The total time period
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES 
 
         Page 10
 
         
 
         
 
         reflects 35.3 weeks as stipulated less 2.1 weeks for stipulated 
 
         overpayment.
 
         
 
              The final issue to address is whether claimant is entitled 
 
         to penalty benefits from defendant-Maryland Casualty.
 
         
 
              Section 86.13 of the Iowa Code provides in relevant portion:
 
              
 
              If a delay in commencement or termination of benefits occurs 
 
              without reasonable or probable cause or excuse, the 
 
              industrial commissioner shall award benefits in addition to 
 
              those benefits payable under this chapter, or chapter 85, 
 
              85A, or 85B, up to fifty percent of the amount of benefits 
 
              that were unreasonably delayed or denied.
 
         
 
              Under section 86.13, benefits are not awarded for medical 
 
         expenses.  The section 86.13 benefits are only applicable to 
 
         weekly compensation benefits.  Zahn v. Iowa State Men's 
 
         Reformatory, IV Iowa Industrial Commissioner Report 409 (1983).
 
         
 
              If it is alleged that an employer wrongfully withholds 
 
         weekly compensation benefits from a claimant, the claimant must 
 
         establish the benefits were withheld unreasonably in order for 
 
         the claimant to receive additional benefits under section 86.13.  
 
         Curtis v. Swift Independent Packing, IV Iowa Industrial 
 
         Commissioner Report 88 at 93 (1984).  In a previous decision 
 
         before the Division of Industrial Services, a hearing deputy has 
 
         ruled that it was reasonable for an employer to withhold benefits 
 
         when the employer was not alerted to occurrences which would 
 
         notify a reasonable person that benefits would be due or when 
 
         there was no work time lost.  McCormack v. Sunsprout, I-1 Iowa 
 
         Industrial Commissioner Decisions 142 at 144 (1984).
 
         
 
              In a separate decision before the Division of Industrial 
 
         Services, the same deputy industrial commissioner awarded 
 
         benefits under section 86.13.  Here there was an unreasonable 
 
         delay since there were no contradictions in the claimant's claim.  
 
         Willis v. Ruan Transport Corporation, IV Iowa Industrial 
 
         Commissioner Report 395 at 396 (1984).  In the Willis case at 396 
 
         the deputy wrote:
 
         
 
              ...Reports and letters from the doctor are consistent with 
 
              claimant's statements regarding his injury.
 
              
 

 
              
 
 
 
 
 
 
 
 
 
 
 
              There were no ambiguities and inconsistencies in claimant's 
 
              claim.  Withholding benefits was arbitrary and unreasonable.  
 
              The five percent award based on Iowa Code section 86.13 will 
 
              be attached to healing period only.  Although the evidence 
 
              presented clearly relates claimant's permanent impairment to 
 
              his injury, defen-
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES 
 
         Page 11
 
         
 
         
 
              dants will be given the benefit of the doubt as to whether 
 
              or not a failure to pay permanent disability also was 
 
              unreasonable.. Claimant had prior back troubles and 
 
              conceivably some portion of his impairment might have been 
 
              related to those difficulties or to a preexisting arthritis 
 
              rather than to his injury.
 
         
 
              See also Walter L. Peterman v. American Freight 
 
         System, File No. 747931 (Arbitration Decision August 10, 1988).
 
         
 
              Claimant has met her burden of proving that defendant 
 
         Maryland Casualty did unreasonably withhold her weekly 
 
         compensation benefits.  Initially, it would not have been 
 
         unreasonable for defendant Maryland Casualty to deny weekly 
 
         compensation.  Dr. Boulden, in his letter of November 25, 1986, 
 
         wrote:
 
         
 
              I am writing this letter in reference to Christine Lanman 
 
              for recent treatment of her epidural fibrosis and spinal 
 
              stenosis.
 
              
 
              This is a continuation from her first surgery and is 
 
              directly related to that surgery for the disc.  Therefore, I 
 
              hope this clears up any confusion.
 
         
 
         (Ex. 11, p. 134)
 
         
 
              Later, Dr. Boulden modified his opinion of November 25, 
 
         1986.  Mike Burkert, claims representative, testified that on 
 
         March 26, 1987, he and the company attorney met with Dr. Boulden 
 
         for the purpose of discussing claimant's condition.  Mr. Burkert 
 
         stated that Dr. Boulden informed them that the injury on April 1, 
 
         1985, was only a temporary aggravation of claimant's preexisting 
 
         condition.  Dr. Boulden, in his deposition, testified he had no 
 
         reason to doubt that was what Mr. Burkert assumed was said, but 
 
         that what his opinion really reflected was:
 
         
 
              A.  I don't know if I really changed my opinion.  I'm saying 
 
              that, as I've said earlier today, she's now developed a 
 
              chronic recurrent cyclic pain response and that April 1 of 
 
              '85 aggravated it.  It's aggravated the preexisting 
 
              condition.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
         (Ex. 13, p. 62)
 
         
 
              Then in his letters of May 1, 1987 and July 8, 1987, Dr. 
 
         Boulden opined:
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES 
 
         Page 12
 
         
 
         
 
              5-1-87 ...
 
              
 
              It is my feeling that the injury of April 1, 1985 aggravated 
 
              an underlying condition of spinal stenosis and epidural 
 
              fibrosis.
 
              
 
              If I can be of.any further help, please feel free to contact 
 
              me.
 
              
 
                 ...
 
              
 
              It is my feeling that the epidural fibrosis and spinal 
 
              stenosis has added a 5% increase to her disability that she 
 
              had at the time that she had a simple discectomy.
 
              
 
              Many times this spinal stenosis is as a result of the 
 
              previous disc surgery and may not be caused by further 
 
              trauma.  However in this case I feel the trauma has made the 
 
              symptom complex symptomatic even though the underlying 
 
              condition may have occurred without the trauma and probably 
 
              was existing before the trauma.
 
              
 
              Therefore my conclusion would be that this 5% disability 
 
              increase is based on the fact that the underlying spinal 
 
              stenosis and epidural fibrosis which is more than likely 
 
              pre-existing is now symptomatic.
 
              
 
              If I could be of any further help, please feel free to 
 
              contact me.
 
         
 
              Additionally, as of June 28, 1988, Dr. Boulden signed 
 
         claimant's application for long term disability payments.  On the 
 
         face of the application Dr. Boulden wrote:
 
         
 
              Is condition due to injury or sickness arising out of 
 
              patient's employment?
 
              (If "Yes" explain).   x Yes No
 
              developed back pain while moving a barrel at work.
 
         
 
              The same application was also signed by the company nurse, 
 
         Joann Spencer, RN.  At this juncture, defendant Maryland Casualty 
 
         should have reviewed its position.  Defendant did not look into 
 
         the rationale behind Dr. Boulden's modified opinion.  Nor did 
 
         defendant seek a second opinion.  The company unreasonably 
 
         withheld benefits.  Therefore, it is the decision of the 
 
         undersigned that claimant is entitled to penalty benefits in the 
 
         amount of 50 percent of the benefits from March 1, 1989, the date 
 
         the permanent partial disability benefits were to commence.  
 
         Interest on the section 86.13 benefits is awarded from the date 
 
         of this decision.  See also: Raymond Denning v. Hyman 
 
         Freightways, Inc. and Excalibur Insurance Co., File No. 751584 
 
         (filed on May 23,
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 13
 
         
 
         
 
         1989), and Barbara S. Stanley v. Wilson Foods Corporation, File 
 
         No. 753405 (filed on May 30, 1989).
 
         
 
                     FINDINGS OF FACT AND CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based upon the stipulations, the evidence 
 
         presented, the previous arbitration decision and the principles 
 
         of law previously stated, the following findings of fact and 
 
         conclusions of law are made:
 
         
 
              Finding 1. Claimant's back injury on April 1, 1985, was an 
 
         intervening event which aggravated claimant's condition from a 
 
         previous work injury on August 4, 1982.
 
         
 
              Conclusion A. Claimant's back injury on April 1, 1985, 
 
         materially aggravated claimant's condition from her preexisting 
 
         work injury of August 4, 1982.
 
         
 
              Conclusion B. Defendant Westchester Fire is not liable to 
 
         claimant for any benefits under section 85.27.
 
         
 
              Conclusion C. Claimant takes nothing additional as a result 
 
         of her injury on August 4, 1982.
 
         
 
              Finding 2. Claimant's injury on April 1, 1985, resulted in 
 
         an additional functional impairment of five percent of the body 
 
         as a whole.
 
         
 
              Conclusion D. Claimant has proven by a preponderance of the 
 
         evidence that the injury of April 1, 1985, is casually related to 
 
         claimant's claimed disability.
 
         
 
              Conclusion E. Claimant has met her burden of proving she 
 
         has a 10 percent permanent partial disability attributable to her 
 
         work injury of April 1, 1985, and that she is entitled to healing 
 
         period benefits.
 
         
 
              Finding 3. Claimant has incurred medical expenses and 
 
         mileage as a result of her work injury on April 1, 1985.
 
         
 
              Conclusion F. Medical expenses in the sum of $19,699.28 and 
 
         mileage in the sum of $105.42 are due under section 85.27.
 
         
 
              Finding 4. Defendant Maryland Casualty denied benefits 
 
         unreasonably to claimant.
 
         
 
              Conclusion G. Claimant has met her burden of proving she is 
 
         owed penalty benefits under section 86.13 in the amount of 50 
 
         percent of the permanent partial disability benefits due from 
 
         March 1, 1989.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 14
 
         
 
         
 
                                      ORDER
 
         
 
              THEREFORE, with respect to file number 710341, claimant 
 
         will take no additional benefits from EVERCO and Westchester 
 
         Fire.
 
         
 
              THEREFORE, with respect to file number 793562, defendants 
 
         are to pay unto claimant fifty (50) weeks of permanent partial 
 
         disability benefits at the stipulated rate of two hundred twelve 
 
         and 29/100 dollars ($212.29) per week as a result of the injury 
 
         on April 1, 1985.
 
         
 
              Defendants are to also pay unto claimant thirty-five point 
 
         three (35.3) weeks of healing period benefits at the rate of two 
 
         hundred twelve and 29/100 dollars ($212.29) per week as a result 
 
         of the injury on April 1, 1985.
 
         
 
              Defendant Maryland Casualty is to also pay unto claimant 
 
         fifty (50) weeks of section 86.13 penalty benefits at fifty 
 
         percent (50%) of the rate or one hundred six and 15/100 dollars 
 
         ($106.15) per week and with interest from the date of this 
 
         decision.
 
         
 
              Defendants EVERCO and Maryland Casualty are responsible for 
 
         medical benefits in the sum of nineteen thousand six hundred 
 
         ninety-nine and 28/100 dollars ($19,699.28) and mileage in the 
 
         sum of one hundred five and 42/100 dollars ($105.42).
 
         
 
              Payments that have accrued shall be paid in a lump sum 
 
         together with statutory interest thereon pursuant to Iowa Code 
 
         section 85.30.
 
         
 
              Defendants are to be given credit for all benefits 
 
         previously paid claimant as stipulated by the parties.
 
         
 
              Costs of file number 710341 are assessed to claimant.
 
         
 
              Costs of file number 793562 are assessed to defendants 
 
         EVERCO and Maryland Casualty.
 
         
 
              Defendants shall file a claim activity report upon payment 
 
         of this award.
 
         
 
         
 
              Signed and filed this 23rd day of March, 1990.
 
         
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
                                               MICHELLE A. McGOVERN
 
                                               DEPUTY INDUSTRIAL 
 
         COMMISSIONER
 
         
 
         
 
         
 
         LANMAN V. EVERCO INDUSTRIES
 
         Page 15
 
         
 
         
 
         Copies To:
 
         
 
         Mr. J. Nicholas Russo
 
         Attorney at Law
 
         615 Iowa State Bank Bldg
 
         Iowa City IA 52240
 
         
 
         Mr. Harry W. Dahl
 
         Attorney at Law
 
         974 73rd, Suite 16
 
         Des Moines IA 50312
 
         
 
         Ms. Dorothy L. Kelley
 
         Attorney at Law
 
         500 Liberty Bldg
 
         Des Moines IA 50309
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                                               1803; 2500; 4000
 
                                               Filed March 23, 1990
 
                                               MICHELLE A. McGOVERN
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CHRISTINE LANMAN,
 
         
 
              Claimant,
 
         
 
         VS.
 
                                               File Nos. 793562 & 710341
 
          EVERCO INDUSTRIES,
 
                                               A R B I T R A T I 0 N
 
                Employer,
 
                                               D E C I S I 0 N
 
          and
 
          
 
          WESTCHESTER FIRE & MARYLAND
 
          CASUALTY CO.,
 
          
 
                Insurance Carrier,
 
                Defendants.
 
         
 
         
 
         
 
         2500
 
         
 
              Defendants were not liable for medical benefits for a 1982 
 
         work injury when there was an intervening work injury in April of 
 
         1985.
 
         
 
              Defendants liable for medical benefits and mileage because 
 
         of work injury which occurred in April of 1985 and which 
 
         aggravated preexisting condition.
 
         
 
         
 
         1803
 
         
 
              Claimant was awarded a 10 percent permanent partial 
 
         disability attributable to an April of 1985 work injury.  
 
         Claimant returned to work as a laborer.  According to her own 
 
         testimony she was "getting along fairly well." Claimant had a 
 
         lighter position than the one she had on the day of the April 
 
         1985 injury.  Claimant was earning greater wages and a bonus upon 
 
         her return to work and she had received all raises pursuant to 
 
         the collective bargaining agreement.
 
         
 
         
 
         
 
         4000
 
         
 
              Benefits under section 86.13 were awarded to claimant from 
 
         a defendant insurance carrier.  The carrier had unreasonably 
 
         withheld benefits after the only physician involved modified his 
 
         opinion and found a casual relationship between the April 1985 
 
         work injury and claimant's alleged condition.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         JOHN E. HUSTON,
 
         
 
              Claimant,
 
         
 
         VS.
 
                                                  FILE NOS. 794131 & 
 
                                                            774965
 
         THE WALDINGER CORPORATION and
 
         NATIONAL SHEET METAL CO.,                  A R B I T R A T I 0 N
 
         
 
              Employers,                               D E C I S I 0 N
 
         
 
         and
 
         
 
         FIREMAN'S FUND INSURANCE
 
         COMPANIES and ARGONAUT
 
         INSURANCE COMPANIES,
 
         
 
              Insurance Carriers,
 
              Defendants.
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This involves two arbitration proceedings brought by John E. 
 
         Huston, the first against Waldinger Corporation and Fireman's 
 
         Fund, its insurance carrier; the second is against National Sheet 
 
         Metal and Argonaut, its insurance carrier.  Claimant seeks 
 
         benefits based upon an injury that occurred September 6, 1984 and 
 
         an alleged injury of April 16, 1985.
 
         
 
              The case was heard in Des Moines, Iowa on November 13, 1986 
 
         and was fully submitted upon conclusion of the hearing.  The 
 
         record in this proceeding consists of testimony from John E. 
 
         Huston, claimant's exhibits 1 through 3, defendant Waldinger's 
 
         exhibits B, F and G and defendant National Sheet MetalOs exhibits 
 
         A and B.
 
         
 
                                      ISSUES
 
         
 
              The issues presented by the parties are determination of 
 
         whether claimant sustained an injury that arose out of and in the 
 
         course of his employment on April 16, 1985.  Further issues deal 
 
         with whether claimant is entitled to compensation for permanent 
 
         partial disability based upon either or both of the alleged dates 
 
         of injury, claimant's entitlement to benefits under section 85.27 
 
         from either of the respective defendants and costs.  The rate of 
 
         compensation is an issue with regard to the September 6, 1984 
 
         injury but it is stipulated to be $309.29 per week with regard to 
 
         the April 16, 1985 injury.
 
         
 
                               SUMMARY OF EVIDENCE
 
         
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   2
 
         
 
         
 
              The following is only a brief summary of pertinent evidence. 
 
          All evidence received at hearing was considered when deciding 
 
         the case.
 
         
 
              John E. Huston is a construction supervisor for the State of 
 
         Iowa who was formerly employed as a sheet metal worker through 
 
         the union.  On September 6, 1984, while working for the Waldinger 
 
         Corporation, a punch press was accidentally activated and 
 
         punctured claimant's left hand at a point between and proximate 
 
         to the knuckles.  X-rays showed a spiral fracture of the midshaft 
 
         of the fifth metacarpal without displacement, angulation or other 
 
         deformity (Exhibit 1, page 7).  Surgical debridement, irrigation, 
 
         exploration and closure of the laceration was performed by John 
 
         Ganske, M.D., (Ex. 1, p. 4).  Claimant went through a relatively 
 
         unremarkable period of recovery.  On October 29, 1984, Dr. Ganske 
 
         noted claimant to have a grip strength in his left hand that was 
 
         about 10 to 15 percent less than the right hand.  On that date 
 
         claimant still had some impairment in flexion of his little 
 
         finger at the M.P. joint.  On November 30, 1984, Dr. Ganske noted 
 
         that claimant had almost complete return of motion, no external 
 
         deformity and a normally maturing scar.  He felt that the grip 
 
         strength in claimant's left hand was probably back to normal.  
 
         Claimant was then released from treatment (Ex. 1, pp. 12 & 13).
 
         
 
              Claimant testified that he went back to perform light duty 
 
         work after having been released by Dr. Ganske.  Defendant 
 
         Waldinger's exhibit F indicates that claimant returned to work 
 
         December 12, 1984.
 
         
 
              After returning to work claimant returned to Dr. Ganske on 
 
         December 26, 1984 and January 11, 1985.  He voiced complaints of 
 
         decreased strength and pain in his left hand (Ex. 1, p. 13).  
 
         Claimant testified that he had experienced increasing problems 
 
         with the hand in early 1985 and saw Dr. Pakiam on one occasion 
 
         when Dr. Ganske was out of town.  Claimant testified that he left 
 
         Waldinger for a period of time and then obtained employment with 
 
         National Sheet Metal.  Claimant did not disagree with an entry on 
 
         Waldinger exhibit G which indicated that he was laid off from 
 
         Waldinger on March 29, 1985.  Claimant testified that he obtained 
 
         employment with National Sheet Metal on April 3, 1985 through the 
 
         union hall.  Defendant National exhibit B confirms that 
 
         testimony.  Claimant stated that he had pain and loss of strength 
 
         in the hand when he began working for National.  He stated that 
 
         his job involved bench work cutting out lines and fitting metal 
 
         from sheets.  He testified that while using both hands to cut 
 
         through three thicknesses of metal material it felt as though his 
 
         left hand popped and he experienced the onset of
 
         pain.  Claimant drove to the Mercy Medical Center Emergency Room 
 
         where he was treated by Dr. Bell and advised to place ice packs 
 
         on the hand and see Dr. Ganske on the following day.  Claimant 
 
         testified that he was unable to see Dr. Ganske for two or three 
 
         days and that he was then sent to Lutheran Hospital for 
 
         additional x-rays.  Claimant testified that he incurred and paid 
 
         expenses in the amount of $35 with Dr. Bell, $43 for the Lutheran 
 
         Hospital x-rays, $23 from the Mercy Hospital Emergency Room.
 
         
 
              Claimant testified that after reviewing the x-rays from 
 
         Lutheran, Dr. Ganske told him to return to work.  Claimant 
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   3
 
         
 
         
 
         related that he told Dr. Ganske that he was unable to do so and 
 
         Dr. Ganske then advised that claimant obtain a second opinion.  
 
         The x-ray report, Waldinger exhibit B, shows the x-ray to have 
 
         been taken on April 19, 1985.  Dr. Ganske's office notes found at 
 
         exhibit 1, page 14 show claimant to have been seen by Dr. Ganske 
 
         on April 19, 1985.  A report from Dr. Ganske which is undated but 
 
         appears to have been issued in late April, 1985, states that he 
 
         examined claimant on April 18 and obtained x-rays on April 18, 
 
         1985.  The date of this report is believed to be incorrect since 
 
         it is inconsistent with the other records concerning those 
 
         activities (Ex. 1, p. 18).  Dr. Ganske indicated in the report 
 
         that he felt claimant was capable of performing substantially the 
 
         same work that he was doing in September, at the time of injury.  
 
         The progress note of April 19, 1985, indicates that Dr. Ganske 
 
         felt no new injury had occurred.
 
         
 
              Claimant testified that he knows something happened to his 
 
         hand on April 16, 1985 because that night it became swollen.  He 
 
         felt that the Waldinger injury was serious, very painful and 
 
         characterized it as more serious than any injury he had 
 
         previously suffered.  He stated that the sensation loss and pain 
 
         in the left hand started at the time of the Waldinger injury but 
 
         that the complaints worsened and became more severe when he 
 
         returned to work following the injury.
 
         
 
              The claimant testified that he left employment with National 
 
         Sheet Metal on April 26, 1985 due to lack of work and the fact 
 
         that layoffs were starting.  This is confirmed by defendant 
 
         National's exhibit B.   Claimant testified that two to three 
 
         months later he commenced employment with the State of Iowa.  
 
         This is confirmed by Waldinger exhibit G which shows payment of 
 
         unemployment benefits through July 23, 1985.
 
         
 
              Claimant sought a second opinion from Arnis B. Grundberg, 
 
         M.D.  Dr. Grundberg, upon examining x-rays, appeared to be 
 
         uncertain with regard to the age of the fracture of the fifth 
 
         metacarpal neck but in his impression indicates that it is 
 
         healed.  He diagnosed claimant as having compression of the ulnar 
 
         nerve in his left wrist and left carpal tunnel syndrome (Ex. 1, 
 
         pp. 21 & 22).  Dr. Grundberg indicated that claimant should be 
 
         off work from May 17, 1985 until Friday, May 24, 1985 (Ex. 1, p. 
 
         19).  Dr. Ganske concurred with Dr. Grundberg's diagnosis and 
 
         recommendation for surgery for left carpal and cubital tunnel 
 
         syndromes (Ex. 1, pp. 14 & 23).  Claimant testified that the 
 
         charges in the amount of $135 with Physiatry Associates were for 
 
         nerve conduction tests used in diagnosing the carpal tunnel 
 
         syndrome.
 
         
 
              On March 19, 1986, claimant underwent left carpal tunnel 
 
         surgery performed by Dr. Ganske.  On April 16, 1986, Dr. Ganske 
 
         indicated that claimant would be totally healed in approximately 
 
         two additional weeks.  Reference to a calendar shows that date to 
 
         be April 30, 1986 (Ex. 1, p. 49).
 
         
 
              Claimant testified that after the surgery had been performed 
 
         it seemed to have provided improvement but that now the two small 
 
         fingers on his left hand still lose sensation, become numb and 
 
         are more sensitive to cold than his right hand.  He complained 
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   4
 
         
 
         
 
         that he has difficulty feeling and gripping with his left hand.  
 
         He complained of pain in the long finger on his left hand.  
 
         Claimant stated that the carpal tunnel surgery was paid by the 
 
         state group insurance plan, Share.
 
         
 
              In the report from late April, 1985 (Ex. 1, p. 18) Dr. 
 
         Ganske indicated that any impairment in claimant's left arm or 
 
         hand would be minimal.  In a report dated April 16, 1986, issued 
 
         following the carpal tunnel surgery, Dr. Ganske indicated that he 
 
         did not expect claimant to have any permanent impairment.  The 
 
         record does not reflect ratings from any other physicians on the 
 
         issue of permanent impairment.
 
         
 
              Claimant testified that the hours worked as shown in 
 
         Waldinger exhibit F were abnormal.  He stated that work was slow 
 
         and the number of hours he had worked were unusually low during 
 
         that period.
 
         
 
              Claimant testified that he was married and has four 
 
         daughters and one step-son but that none of the children were 
 
         dependent on him at the time of the injury.
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              The employer, Waldinger, admits the occurrence of the punch 
 
         press injury.  National Sheet Metal does not, however, admit that 
 
         any injury occurred on April 16, 1985.
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received an injury on April 16, 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).
 
         
 
         
 
              Claimant's appearance and demeanor were observed when he 
 
         testified.  He is found to be a credible witness.  It is found 
 
         that he did sustain an injury that arose out of and in the course 
 
         of his employment with National Sheet Metal on April 16, 1985 in 
 
         the manner which claimant described.
 
         
 
              The Waldinger Corporation urges that claimant's healing 
 
         period ran from the date of injury through December 11, 1984.  
 
         This computes to a span of 13 5/7 weeks.  Review of the evidence 
 
         shows that claimant did return to work on December 12, 1984 which 
 
         therefore terminates the healing period provided by section 
 
         85.34(l).  Claimant's brief period of layoff between his 
 
         employments with Waldinger and National Sheet Metal is not shown 
 
         to be related to disability.
 
         
 
              Claimant was then injured while employed by National Sheet 
 
         Metal on April 16, 1985.  He was off work under medical 
 
         authorization until seen by Dr. Ganske on April 19, 1985.  The 
 
         injury with National Sheet Metal is found to have simply been a 
 
         temporary aggravation of the preexisting condition that resulted 
 
         from the punch press injury.  Accordingly, claimant's 
 
         compensation is limited to one day of temporary total disability.  
 
         Since the claimant was injured while employed by National Sheet 
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   5
 
         
 
         
 
         Metal he is also entitled to the expenses of treatment for that 
 
         injury.  These include the expenses incurred with Lutheran 
 
         Hospital ($49), Dr. Bell ($35) and Mercy Hospital ($23).  In 
 
         accordance with exhibit 3, National Sheet Metal and Argonaut are 
 
         likewise responsible for payment of 20 miles in transportation 
 
         expenses for the travel to Methodist Hospital on April 16, 1985 
 
         and the travel to Dr. Ganske on April 19, 1985.  This amounts to 
 
         $4.80.  The total medical expenses are therefore $111.80.
 
         
 
              As previously indicated the injury at National Sheet Metal 
 
         was found to be only a temporary aggravation of the preexisting 
 
         condition that resulted from the punch press injury.  The only 
 
         evidence in the record that suggests that the injury of April 16, 
 
         1985 was a significant injury is found at Waldinger exhibit B, an 
 
         x-ray report which states that the irregularity of the head of 
 
         the fifth metacarpal probably represents an acute or recent 
 
         fracture.  Dr. Ganske, who is found to be the most familiar with 
 
         claimant's hand injuries, was of a contrary opinion.  Dr. 
 
         Ganske's impression of the injury of April 16, 1985 as being 
 
         quite minor is accepted as correct.  Dr. Ganske expressed the 
 
         opinion that the carpal tunnel syndrome was related to the punch 
 
         press injury (Ex. 1, pp. 24 & 50).  The record contains no 
 
         conflicting opinions.  Dr. Ganske's opinion is reasonable and is 
 
         accepted as correct.  The expenses claimant incurred with Dr. 
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   6
 
         
 
         
 
         Pakiam and Younkers Rehabilitation (also referred to in the 
 
         record as Physiatry Associates), are the responsibility of 
 
         Waldinger and Fireman's Fund.  The total of those charges is 
 
         $144.49. The record shows claimant to have been off work from the 
 
         date surgery was performed on March 19, 1986 and that healing 
 
         would have been substantially completed on April 30, 1986.  This 
 
         is a span of six and one-seventh weeks for which Waldinger and 
 
         Fireman's Fund are responsible for payment of healing period 
 
         compensation.
 
         
 
              During the time claimant was having the carpal tunnel 
 
         syndrome diagnosed, Dr. Grundberg indicated that he should be off 
 
         work from May 17 through May 24, 1985.  This is an additional 
 
         span of one and one-seventh weeks from which the defendant 
 
         Waldinger and Fireman's Fund are responsible.  The services 
 
         provided by Dr. Grundberg are found to be related to the carpal 
 
         tunnel syndrome rather than the National Sheet Metal injury.
 
         
 
              Claimant seeks compensation for permanent partial disability 
 
         involving his left hand.  He suggests a rating of 10 percent.  
 
         The only evidence in the record which supports his contention 
 
         must be gleaned from the statement of Dr. Ganske found at exhibit 
 
         1, page 18 which states that "...there should be minimal, if any, 
 
         impairment of the function of his hand or arm.O  On April 16, 
 
         1986 (Ex. 1, p. 49), Dr. Ganske indicated "I do not expect that 
 
         he will have any permanent impairment.O  It is uncertain whether 
 
         the second statement from Dr. Ganske refers only to the carpal 
 
         tunnel syndrome for which treatment had just been completed or 
 
         whether it referred to the condition of the entire left hand.
 
         
 
              Division of Industrial Services Rule 343-2.4 makes the 
 
         Guides to the Evaluation of Permanent Impairment published by the 
 
         American Medical Association a prima facie indication of 
 
         permanent partial disability for scheduled member disabilities.  
 
         The Guides are not, however, the exclusive method of rating 
 
         disabilities.  The claimant's testimony and demonstrated 
 
         difficulties may be considered in determining the actual loss of 
 
         use which is compensable so long as loss of earning capacity is 
 
         not considered.  Soukup v. Shores Co., 222 Iowa 272, 268 N.W. 598 
 
         (1936).  Claimant left the sheet metal trade for lower paying 
 
         work with the state.  When claimant's credibility and 
 
         demonstrated difficulties are considered it is found that he has 
 
         a permanent partial disability of five percent of the left hand.  
 
         As previously indicated, that disability is found to be related 
 
         to the punch press injury and not the injury of April 16, 1985.  
 
         He is therefore entitled to receive nine and one-half weeks of 
 
         compensation for permanent partial disability of the left hand 
 
         payable commencing December 12, 1984.
 
         
 
              Defendant Waldinger exhibit F shows claimant's earnings 
 
         during the 13 weeks preceding the week that contained September 
 
         6, 1984 to be $6,194.83.  This computes to an average of $474.22 
 
         per week.  When applied to the appropriate benefit schedule and 
 
         considering claimant to be married with two exemptions, the rate 
 
         of compensation for the Waldinger injury is found to be $288.45 
 
         per week.
 
              In accordance with claimant's testimony Waldinger and 
 
         Fireman's Fund are also responsible for payment of transportation 
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   7
 
         
 
         
 
         expenses which claimant described as 20 to 24 miles each for two 
 
         trips to see Dr. Grundberg and one trip each to Lutheran 
 
         Hospital, Mercy Hospital and Methodist Hospital.  This computes 
 
         to 100 miles and allowance of $24.  Claimant's testimony at 
 
         hearing is adopted over the mileage statements shown in exhibit 
 
         3. It should also be noted that the employer, Waldinger, 
 
         stipulated that claimant was entitled to $36 in mileage payments 
 
         in addition to the $24 which is hereby awarded.  The total would 
 
         therefore be $60.
 
         
 
         
 
         
 
         
 
              The rule of law announced in McKeever v. Smith Custom 
 
         Cabinets, 379 N.W.2d 368 (Iowa 1985) is not applicable to the 
 
         injury of April 16, 1985.  It has not been shown to have been a 
 
         cumulative trauma injury.  To the contrary, claimant testified 
 
         regarding a specific event of trauma.  He had not been 
 
         asymptomatic immediately prior to the time of that trauma.  His 
 
         symptoms stemmed from the punch press injury of September 6, 
 
         1984.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  On April 16, 1985, claimant was injured while cutting 
 
         sheet metal in the employ of National Sheet Metal Company.
 
         
 
              2.  Following the injury claimant was medically incapable of 
 
         performing work in employment substantially similar to that he 
 
         performed when insured until April 19, 1985 when Dr. Ganske 
 
         released claimant to return to work.
 
         
 
              3.  The injury of April 16, 1985 was a temporary aggravation 
 
         of a preexisting condition that had its origin in the punch press 
 
         injury claimant suffered while employed by the Waldinger 
 
         Corporation on September 6, 1984.
 
         
 
              4.  In obtaining care for the injury of April 16, 1985, 
 
         claimant traveled 20 miles and incurred expenses for treatment in 
 
         the total amount of $107.  The treatment claimant received is 
 
         found to be reasonable and necessary treatment for the injury and 
 
         the charges made therefore are found to be fair and reasonable.
 
         
 
              5.  The injury claimant sustained while employed by the 
 
         Waldinger Corporation on september 6, 1984 made claimant 
 
         incapable of performing work in employment substantially similar 
 
         to that he performed at the time of injury from the date of 
 
         injury through December 11, 1984.  Thereafter, he was again being 
 
         medically incapable of performing such substantially similar work 
 
         from May 17 through May 24, 1985.  He was similarly disabled a 
 
         third time from March 19, 1986 through April 30, 1986.
 
         
 
              6.  Claimant currently experiences pain, discomfort, 
 
         numbness, loss of strength and loss of motion in his left hand.  
 
         The punch press injury with the Waldinger Corporation is a 
 
         substantial factor in bringing about that condition.  The 
 
         condition constitutes a five percent loss of use of claimant's 
 
         left hand.
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   8
 
         
 
         
 
         
 
              7.  Claimant obtained care from Dr. Pakiam and Younkers 
 
         Rehabilitation (also referred to as Physiatry Associates), where 
 
         he incurred charges in the amount of $144.49.  The treatment is 
 
         found to be reasonable and necessary and the charges made are 
 
         fair and reasonable.
 
         
 
              8.  In obtaining treatment for the injury claimant traveled 
 
         100 miles for which he is entitled to recover $24 in addition to 
 
         the $30 which Waldinger and Fireman's Fund stipulated was due.  
 
         The total is therefore $60.
 
         
 
              9.  Claimant has previously been paid $6,415.53 in weekly 
 
         compensation by the Waldinger Corporation and Fireman's Fund.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              1.  The injury claimant sustained on September 6, 1984 is a 
 
         proximate cause of the carpal tunnel syndrome for which he has 
 
         been treated and of a five percent permanent partial disability 
 
         of his left hand for which he is entitled to receive nine and 
 
         one-half weeks of compensation under the provisions of section 
 
         85.34 (2)(1).
 
         
 
              2.  Claimant is entitled to receive 21 weeks of compensation 
 
         for healing period from the Waldinger Corporation and Fireman's 
 
         Fund with 13 5/7 weeks thereof payable commencing September 7, 
 
         1984, with one and one-seventh weeks thereof payable commencing 
 
         May 17, 1985 and with six and one-seventh weeks thereof payable 
 
         commencing March 19, 1986.
 
         
 
              3.  Claimant is entitled to recover benefits under section 
 
         85.27 from the Waldinger Corporation and Fireman's Fund in the 
 
         amount of $204.49.
 
         
 
              4.  Claimant's rate of compensation with regard to the 
 
         injury of September 6, 1984 is $288.45 per week.
 
         
 
              5.  Claimant is entitled to receive from National Sheet 
 
         Metal Company and the Argonaut Insurance Company one-seventh week 
 
         of compensation for temporary total disability at the stipulated 
 
         rate of $309.39 per week and section 85.27 benefits in the total 
 
         amount of $111.80.
 
         
 
         
 
                                        
 
         
 
         
 
                                      ORDER
 
         
 
             IT IS THEREFORE ORDERED that the defendant National Sheet 
 
         Metal Company and the Argonaut pay claimant one-seventh (1/7) 
 
         week of compensation for temporary total disability commencing 
 
         April 19, 1985 at the rate of $309.29 per week.
 
         
 
              IT IS FURTHER ORDERED that the defendant National Sheet 
 
         Metal and Argonaut pay claimant section 85.27 benefits in the 
 
         total amount of one hundred eleven and 80/100 dollars ($111.80).
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page   9
 
         
 
         
 
         
 
              IT IS FURTHER ORDERED that the Waldinger Corporation and 
 
         Fireman's Fund pay claimant twenty-one (21) weeks of compensation 
 
         for healing period at the rate of two hundred eighty-eight and 
 
         45/100 dollars ($288.45) with thirteen and five-sevenths (13 5/7) 
 
         weeks thereof payable commencing September 7, 1984, with one and 
 
         one-seventh (1 1/7) weeks thereof payable commencing May 15, 1985 
 
         and with six and one-seventh (6 1/7) weeks thereof payable 
 
         commencing March 19, 1986.
 
         
 
              IT IS FURTHER ORDERED that defendants Waldinger Corporation 
 
         and Fireman's Fund pay claimant nine and one-half (9 1/2) weeks 
 
         of compensation for permanent partial disability at the rate of 
 
         two hundred eighty-eight and 45/100 dollars ($288.45) payable 
 
         commencing December 12, 1984.
 
         
 
              IT IS FURTHER ORDERED that defendants Waldinger Corporation 
 
         and Fireman's Fund receive credit in the amount of six thousand 
 
         four hundred fifteen and 53/100 dollars ($6,415.53) for weekly 
 
         benefits previously paid and that all past due amounts which were 
 
         not paid as ordered herein be paid in a lump sum together with 
 
         interest pursuant to section 85.30.
 
         
 
              IT IS FURTHER ORDERED that defendants Waldinger Corporation 
 

 
         
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL 
 
         CO.
 
         Page  10
 
         
 
         
 
         and Fireman's Fund pay claimant two hundred four and 49/100 
 
         dollars ($204.49) in medical expenses and travel expenses under 
 
         section 85.27.
 
         
 
              IT IS FURTHER ORDERED that the costs of this proceeding in 
 
         accordance with Rule 343-4.33 are assessed equally among the 
 
         defendants.
 
         
 
              Defendants are ordered to file claim activity reports as 
 
         requested by this agency.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
              Signed and filed this 3rd day of March, 1987.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                        MICHAEL G. TRIER
 
                                        DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Robert W. Pratt
 
         Attorney at Law
 
         1913 Ingersoll Avenue
 
         Des Moines, Iowa 50309-3320
 
         
 
         Mr. Harry W. Dahl
 
         Attorney at Law
 
         974 73rd St., Suite 16
 
         Des Moines, Iowa 50312
 
         
 
         Ms. Dorothy L. Kelley
 
         Attorney at Law
 
         1000 Des Moines Bldg.
 
         Des Moines, Iowa 50309-2462
 
         
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 1402.20; 1402.40; 1801
 
                                                 1802; 1804; 2206; 2209
 
                                                 Filed March 3, 1987 
 
                                                 MICHAEL G. TRIER
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         JOHN E. HUSTON,
 
         
 
              Claimant,
 
         
 
         VS.                                      File NOS. 794131 & 
 
                                                            774965
 
         
 
         THE WALDINGER CORPORATION and             A R B I T R A T I O N
 
         NATIONAL SHEET METAL CO.,
 
                                                       D E C I S I O N
 
              Employers,
 
         
 
         and
 
         
 
         FIREMAN'S FUND INSURANCE
 
         COMPANIES and ARGONAUT
 
         INSURANCE COMPANIES,
 
         
 
              Insurance Carriers,
 
              Defendants.
 
         
 
         
 
         1402.20; 1402.40; 1801; 1802; 1804; 2206; 2209
 
         
 
              Claimant, a sheet metal worker, suffered a punch press 
 
         injury to his left hand.  He testified that the symptoms never 
 
         completely resolved but that he did return to work in his trade 
 
         with difficulty.  A few weeks later he experienced a sensation 
 
         that he described as a "pop" in the hand while using shears to 
 
         cut several thicknesses of sheet metal.  The physicians who 
 
         treated him were of the opinion that the more recent incident did 
 
         not produce any significant injury but they did diagnose him as 
 
         having carpal tunnel syndrome and ulnar nerve compression.  
 
         Approximately one year later claimant underwent surgical 
 
         decompression.  The only medical evidence in the record related 
 
         the nerve compression conditions to the punch press injury.  That 
 
         opinion was accepted as correct.  The case involved two files and 
 
         two different employers for the two injuries.  The first 
 
         employer's contention that McKeever applied to make the second 
 
         employer responsible for the carpal tunnel syndrome was rejected 
 
         since the injuries were distinct acute traumas and were not 
 
         cumulative trauma in nature.  Claimant had no ratings from any 
 
         physicians which showed him to have a permanent physical 
 
         impairment.  The most favorable statement from a physician was 
 
         that his impairment
 
         
 
         
 
         HUSTON V. THE WALDINGER CORPORATION and NATIONAL SHEET METAL CO.
 
                                                
 
                                                         
 
         Page 2
 
         
 
         
 
         
 
         was minimal, if any.  Claimant's testimony regarding pain, loss 
 
         of grip strength and the fact that he left the relatively high 
 
         pay of the sheet metal trade in order to enter other employment 
 
         which did not require strenuous use of the left hand was found to 
 
         be sufficient to establish that he had suffered a five percent 
 
         loss of use of the left hand due to the punch press injury.
 
 
 
         
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                                          :
 
            VICKI DENEKAS,                :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File Nos. 794353/823077
 
            AALFS MANUFACTURING COMPANY,  :
 
                                          :            A P P E A L
 
                 Employer,                :
 
                                          :          D E C I S I O N
 
            and                           :
 
                                          :
 
            THE HARTFORD INSURANCE        :
 
            COMPANY and EMPLOYERS MUTUAL  :
 
            COMPANIES,                    :
 
                                          :
 
                 Insurance Carriers,      :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            _____
 
            
 
            STATEMENT OF THE CASE
 
            Defendants appeals from an arbitration decision awarding 
 
            benefits.
 
            The record on appeal consists of the transcript of the 
 
            arbitration hearing; joint exhibits 1 through 77; claimant's 
 
            exhibits 5, 6, and 8 through 10; and Second Injury Fund's 
 
            exhibits A and  B.  All parties filed briefs on appeal.
 
            issues
 
            Defendants state the issues on appeal are:
 
            
 
                    Whether substantial evidence supports a finding 
 
                 of 65% permanent partial disability relating to 
 
                 the shoulder injury of April 14, 1986.
 
            
 
                    A.  The medical evidence shows a number of
 
                   preexisting conditions resulting in 
 
            substantial
 
                   disability for which the defendants cannot 
 
            be
 
                   held responsible.
 
            
 
                    B.  The claimant's functional impairment, lack 
 
                 of
 
                   motivation and credibility do not support a
 
                   finding of 65% permanent partial 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            disability.
 
            findings of fact
 
            The findings of fact contained in the arbitration decision 
 
            adequately and accurately reflect the pertinent evidence and 
 
            will not be set forth herein, except that claimant is found 
 
            to have sustained a loss of 45 percent of her earning 
 
            capacity as a result of her work injury.
 
            conclusions of law
 
            The conclusions of law in the arbitration decision are 
 
            adopted herein, as modified by the following additional 
 
            analysis:
 
            Defendants are not entitled to an apportionment from the 
 
            award for claimant's preexisting knee condition.  The award 
 
            is limited to the industrial disability caused by the 
 
            shoulder injury.  An apportionment is appropriate only where 
 
            a prior condition is lighted up, accelerated, or aggravated 
 
            by a work injury.  Varied Enters., Inc. v. Sumner, 353 
 
            N.W.2d 407, 411 (Iowa 1984); Rose v. John Deere Ottumwa 
 
            Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-61 (1956).
 
            Even if apportionment of a prior condition unrelated to the 
 
            present injury were appropriate, there is no indication that 
 
            the knee injury caused claimant any industrial disability, 
 
            as opposed to functional impairment.  Tussing v. Hormel & 
 
            Co., 461 N.W.2d 450 (Iowa 1990); Bearce v. FMC Corporation, 
 
            465 N.W.2d 531 (Iowa 1991). 
 
            Although claimant's functional impairment is not high, the 
 
            other factors of industrial disability indicate that 
 
            claimant has lost a substantial portion of her earning 
 
            capacity.  Claimant has shown motivation to return to work.  
 
            Claimant's intellectual faculties limit the job 
 
            opportunities available to her.  Claimant cannot return to 
 
            her prior job.  Based on these and all other factors of 
 
            industrial disability, claimant's industrial disability is 
 
            found to be 45 percent.
 
            WHEREFORE, the decision of the deputy is affirmed and 
 
            modified.
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            ORDER
 
            THEREFORE, it is ordered in file number 794353:
 
            That defendants Aalfs Manufacturing Company and Employers 
 
            Mutual Insurance Companies shall pay unto claimant 
 
            twenty-one point one four three (21.143) weeks of temporary 
 
            total disability benefits commencing May 7, 1985 at the 
 
            stipulated rate of one hundred eleven and 53/100 dollars 
 
            ($111.53) per week and totalling two thousand three hundred 
 
            fifty-eight and 08/100 dollars ($2,358.08).
 
            That defendants shall have credit for all payments made 
 
            voluntarily prior to hearing.
 
            That as all benefits have accrued, they shall be paid in a 
 
            lump sum with interest pursuant to Iowa Code section 85.30.
 
            That the costs of this action, including the costs of 
 
            appeal, shall be assessed to defendants pursuant to 343 IAC 
 
            4.33.
 
            
 
                 That defendants file claim activity reports as 
 
            requested by this agency pursuant to rule 343 IAC 3.1.
 
            FURTHER, it is ordered in case number 823077:
 
            That claimant shall take nothing from defendant Second 
 
            Injury Fund of Iowa.
 
            That defendants Aalfs Manufacturing Company and The Hartford 
 
            Insurance Company shall pay unto claimant eighty-eight point 
 
            one four three (88.143) weeks of healing period benefits 
 
            commencing April 14, 1986 at the stipulated rate of one 
 
            hundred seventeen and 04/100 dollars ($117.04) per week and 
 
            totalling ten thousand three hundred sixteen and 26/100 
 
            dollars ($10,316.26).
 
            That those defendants shall also pay unto claimant two 
 
            hundred twenty-five (225) weeks of permanent partial 
 
            disability benefits commencing March 4, 1988 at the 
 
            stipulated rate of one hundred seventeen and 04/100 dollars 
 
            ($117.04) per week and totalling twenty-six thousand three 
 
            hundred thirty-four and 00/100 dollars ($26,334.00).
 
            That defendants shall have credit for all payments made 
 
            voluntarily prior to hearing.
 
            That all accrued benefits shall be paid in a lump sum with 
 
            interest pursuant to Iowa Code section 85.30.
 
            That the costs of this action including, the costs of 
 
            appeal, shall be assessed to defendants pursuant to 343 IAC 
 
            4.33.
 
            
 
     
 
            
 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            That defendants file claim activity reports as requested by 
 
            this agency pursuant to rule 343 IAC 3.1.
 
            Signed and filed this ____ day of December, 1991.
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                               BYRON K. ORTON
 
                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Thomas J. Hoffman
 
            Attorney at Law
 
            19 First Avenue NW
 
            P.O. Box 528
 
            Le Mars, Iowa 51031
 
            
 
            Mr. James M. Cosgrove
 
            Attorney at Law
 
            1109 Badgerow Building
 
            P.O. Box 1828
 
            Sioux City, Iowa 51102
 
            
 
            Mr. Brian L. Campbell
 
            Attorney at Law
 
            801 Grand Ave., Ste 3700
 
            Des Moines, Iowa 50309
 
            
 
            Ms. Shirley Ann Steffe
 
            Assistant Attorney General
 
            Tort Claims Division
 
            Hoover State Office Bldg.
 
            Des Moines, Iowa 50319
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
         1803  1806
 
         Filed December 31, 1991
 
         Byron K. Orton
 
         DRR
 
         before the iowa industrial commissioner
 
         _________________________________________________________________
 
                                       :
 
         VICKI DENEKAS,                :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :      File Nos. 794353/823077
 
         AALFS MANUFACTURING COMPANY,  :
 
                                       :            A P P E A L
 
              Employer,                :
 
                                       :          D E C I S I O N
 
         and                           :
 
                                       :
 
         THE HARTFORD INSURANCE        :
 
         COMPANY and EMPLOYERS MUTUAL  :
 
         COMPANIES,                    :
 
                                       :
 
              Insurance Carriers,      :
 
                                       :
 
         and                           :
 
                                       :
 
         SECOND INJURY FUND OF IOWA,   :
 
                                       :
 
              Defendants.              :
 
         _________________________________________________________________
 
         
 
         1806
 
         Affirmed deputy's conclusion that apportionment was not 
 
         appropriate where claimant's present work injury is an injury to 
 
         the shoulder, and the prior injury was to the knee.  
 
         Apportionment under Varied Enterprises, Inc. v. Sumner, 353 
 
         N.W.2d 407 (Iowa 1984); Rose v. John Deere Ottumwa Works, 247 
 
         Iowa 900, 76 N.W.2d 756 (1956); and other cases contemplates an 
 
         apportionment when a prior condition of the same body part or 
 
         area is lighted up or aggravated by a work injury.  Claimant's 
 
         knee condition was not affected by the work injury to her 
 
         shoulder.  The deputy's award of industrial disability was for 
 
         the results of this work injury only and apportioning out a prior 
 
         condition not reflected in the award would not be appropriate.  
 
         
 
         1803
 
         Award of industrial disability modified to 45 percent where 
 
         claimant had a low impairment rating, had lost substantial 
 
         earnings, shown good motivation to return to work, had limited 
 
         intellectual faculties, and could not return to her prior job.
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         RONDA MEFFERD,
 
         
 
              Claimant,
 
                                                   File Nos.  794522
 
         VS.                                                  762119
 
         
 
         FARMLAND FOODS, INC.,                   A R B I T R A T I 0 N
 
         
 
              Employer,                             D E C I S I 0 N
 
         
 
         and
 
         
 
         AETNA CASUALTY AND SURETY
 
         COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by Ronda 
 
         Mefferd, claimant, against Farmland Foods, employer, and Aetna 
 
         Casualty and Surety, insurance carrier, to recover benefits under 
 
         the Iowa Workers' Compensation Act.  The original notice and 
 
         petition in this matter was filed on behalf of claimant on June 
 
         4, 1985, alleging "various" injury dates with the "last one on or 
 
         about April 26, 1985."  At the time of hearing, the original 
 
         notice and petition was amended to add April 9, 1984 as an injury 
 
         date and to specify that the injuries claimed may be the result 
 
         of cumulative trauma.  Defendants had no objection to the 
 
         amendments and the same were granted. (It should be noted 
 
         claimant presented testimony of an alleged arthritic condition as 
 
         a result of alleged injuries in January 1984 and January 1985.  
 
         These dates have not been pled, there is an absence of medical 
 
         verification of the condition, and an absence of medical 
 
         testimony concerning causal connection.  Claimant also presents 
 
         no argument in her post-hearing statement on these allegations.  
 
         This office is not omniscient and the issues generated as a 
 
         result of this testimony will not be addressed.)  This matter 
 
         came on for hearing before the undersigned deputy industrial 
 
         commissioner December 2, 1987.  The record was considered fully 
 
         submitted at the close of the hearing.  The record in this case 
 
         consists of the testimony of the claimant and joint exhibits 1 
 
         through 23, inclusive.
 
         
 
         
 
                                   ISSUES
 
         
 
              Pursuant to the prehearing report and order submitted and 
 
         approved December 2, 1987, the following issues are presented for 
 
         determination:
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   2
 
         
 
         
 
              1.  Whether or not claimant sustained an injury arising out 
 
         of and in the course of her employment;
 
         
 
              2.  Whether the alleged work injury is the cause of the 
 
         disability on which claimant now bases her claim;
 
         
 
              3.  The extent of claimant's entitlement, if any, to 
 
         permanent partial disability benefits; and,
 
         
 
              4.  The appropriate rate of compensation for the alleged 
 
         injury of April 9, 1984.
 
         
 
              It has been stipulated claimant has received all the 
 
         temporary total disability/healing period benefits to which she 
 
         is entitled with the exception of a few days in 1984.  However, 
 
         claimant's request for this additional temporary total 
 
         disability/healing period benefits has been withdrawn as an issue 
 
         as claimant was unable to specify the dates involved. (See 
 
         claimant's posthearing statement, page 2)
 
         
 
                                 FACTS PRESENTED
 
         
 
              Claimant began working for defendant employer in May 1983 
 
         first arranging bacon and later as a bacon slicer where she 
 
         lifted bacon bellies off of a skid and fed the slabs into a 
 
         slicing machine.  Claimant testified that from September to 
 
         November 1983, she experienced tendonitis in her right hand; that 
 
         on January 25, 1984, she dropped a box onto her toe; and that in 
 
         March or April 1984, she felt something "pop" in her back while 
 
         she was trying to pry apart two frozen bacon bellies.  Claimant 
 
         explained she was off work as a result of this last incident for 
 
         approximately three weeks and then returned to light duty work 
 
         although she was still experiencing pain.  Claimant explained she 
 
         had a "flareup" in her toe when she picked up a box and ran into 
 
         a skid on January 25, 1985.  Claimant testified that for at least 
 
         two weeks prior to April 25, 1985, she was experiencing increased 
 
         pain in her fingers, wrist, elbow, arms and back and returned to 
 
         see her physician the following day.  Claimant could not cite any 
 
         particular incident which precipitated her pain.
 
         
 
              Claimant explained that throughout the next year she 
 
         continued experiencing problems with her back and arms although 
 
         she had "been to all different doctors."  She testified she began 
 
         to see a chiropractor again,,had gone through physical therapy 
 
         and had seen a specialist in Omaha.  Claimant quit her job with 
 
         defendant employer in June 1986 when her physician advised she 
 
         leave the cold environment and repetitive work of a packing
 
         plant.  Claimant testified she continues to experience constant 
 
         sharp pains in her back, arms and left foot which has gotten 
 
         worse, but she cannot engage in recreational sports and that she 
 
         has problems sleeping.  Claimant has moved to the State of 
 
         Washington where, along with her husband, she secured work as an 
 
         apartment manager.  Claimant quit that job because the hours and 
 
         working conditions were inconvenient and acknowledged that she is 
 
         not now actively seeking employment.
 
         
 
              The medical records submitted into evidence reveal claimant 
 
         has been seen by a multitude of doctors.  Following the incident 
 
         on April 9, 1984 which involved the Opop" to claimant's back, 
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   3
 
         
 
         claimant was seen by her family physician, R. Mason, M.D., who 
 
         instructed her to remain off work until April 23, 1984.  Claimant 
 
         saw a Dr. TanCreti after stubbing her toe on January 25, 1985, 
 
         whom she also saw after complaining of pain in her arms on April 
 
         26, 1985.  Claimant was thereafter released to light duty work 
 
         but continued to complain of cramping in her arms and back.  
 
         Claimant was referred to John Hennessey, M.D., who saw claimant 
 
         on May 3, 1985 and opined claimant had back strain and tendonitis 
 
         due to her work as a bacon slicer which required her to do 
 
         frequent stooping and lifting.
 
         
 
              Claimant saw Dr. William R. Hamsa on May 17, 1985 whose 
 
         impression was that claimant had recurrent muscular and 
 
         ligamentous pain in the cervical spine, shoulders and elbows 
 
         secondary to employment and recurrent low back pain secondary to 
 
         employment superimposed upon lumbar lordorsis and transitional 
 
         vertebrae.  Dr. Hamsa stated in his report of May 17, 1985 that:
 
         
 
                 Nothing is indicated except conservative treatment.  
 
              The patient has basically normal neurological findings 
 
              in the upper and lower extremities, so I don't feel any 
 
              further studies are indicated.  I think she is either 
 
              going to have to accept her symptoms and get along as 
 
              best she can with her job or change her employment to 
 
              something; that doesn't boter [sic] her.  She was given 
 
              a return to work release for Monday, May 20, 1985.
 
         
 
         (Joint Exhibit 20)
 
         
 
              In June 1985, claimant saw Dr. Ronald Soll on referral from 
 
         Dr. Donald Soll and stated:
 
         
 
              I feel that the patient most likely has severe 
 
              proprpioceptive [sic] loss which is causing her to over 
 
              stress her extremities when doing any kind of 
 
              significant physical labor.  Conceivably, this may be a 
 
              circulatory problem that has its underlying basis in 
 
              her dietary habits but other factors also may be 
 
              involved.
 
         
 
         (Jt. Ex. 18)
 
              Claimant was evaluated April 16, 1986 by Behrouz Rassekh, 
 
         M.D., who found claimant's physical and neurological examinations 
 
         to be normal.  Dr. Rassekh opined claimant has a mechanical back 
 
         problem due to musculature ligamentous injury with no disc 
 
         herniation.  Claimant was advised on a program of exercise and 
 
         released to return to her usual occupation as of April 16, 1986.
 
         
 
              Claimant was evaluated by Joel T. Cotton, M.D., on June 17, 
 
         1986 in reference to pain and numbness.  Dr. Cotton opined 
 
         claimant's discomfort was not on a neurological basis and he 
 
         neither placed claimant on any mode of treatment or medication 
 
         nor did he find any reason to restrict her activity.
 
         
 
              After claimant quit her employment, she was evaluated by 
 
         Anil K. Agarwal, M.D., F.A.C.S., diplomat of orthopedic surgery, 
 
         who stated on November 12, 1986:
 
         
 
                 Examination of the cervical spine showed good range 
 
              of motion.  Biceps and triceps reflexes were normal 
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   4
 
         
 
              with no motor or sensory losses.  There was no 
 
              paravertebral spasm present.
 
         
 
                 Examination of the lumbar spine also showed good 
 
              range of motion.  Straight leg raising was unimpressive 
 
              and there was no paravertebral spasm.  Toe and heel 
 
              gait was normal, and knee and ankle reflexes were also 
 
              normal.  Extensor hallucis longus strength was within 
 
              normal limits.  There was no gross motor or sensory 
 
              loss.
 
         
 
                 There was no neurological deficit present in the 
 
              upper or lower extremities.
 
         
 
                 X-rays of the cervical spine are within normal 
 
              limits....
 
         
 
                 ....
 
         
 
                 The patient lacks any significant objective 
 
              findings.
 
         
 
         (Jt. Ex. 2-1)
 
         
 
              Claimant was seen for evaluation by Horst G. Blume, M.D., on 
 
         February 11, 1987.  It appears from his report that Dr. Blume saw 
 
         the previous medical reports and did a CT scan on claimant which 
 
         revealed a minimal bulging disc on the right side at the 
 
         neuroforamen of mild degree. (The actual CT scan report was not 
 
         submitted into evidence and claimant had testified she never had 
 
         a CT scan because defendants would not pay for it.) Dr. Blume 
 
         opined:
 
         
 
                 It is my opinion within reasonable medical 
 
              probability that the patient has sustained an injury to 
 
              the low back with irritation of the rami dorsalis of 
 
              the posterior nerve roots of the intervertebral joints 
 
              at the levels of L4/5 and L5/Sl on the right side and 
 
              at L5/Sl on the left side of mild degree.  The 
 
              osteoarthritis of the facet joint at L5/Sl on the right 
 
              side either is also the result of the accident of April 
 
              9, 1984, or was a pre-existing condition that 
 
              aggravated this abnormal condition of the facet joints 
 
              due the accident in April 1984.  One also has to make 
 
              the presumption that the disc pathology found can very 
 
              well be as the result of previous work activity at 
 
              Farmland Foods pre-existing from 1983 and became 
 
              aggravated with the accident in 1984.
 
         
 
         (Jt. Ex. 1, pp. 1-2)
 
         
 
              It appears the last physicians to see claimant were Irving 
 
         Tobin, M.D., orthopedic surgeon, and Robert F. Hood, M.D., 
 
         neurologist, of Seattle and Tacoma, Washington, on June 12, 1987.  
 
         Their report of the same date includes a complete history of 
 
         claimant's treatment and symptoms and shows that a complete 
 
         physical and neurological examination were done.  The report 
 
         concludes:
 
         
 
              RECOMMENDATIONS AND DISCUSSION: The patient has a 
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   5
 
         
 
              multiplicity of complaints which apparently began 
 
              shortly after she went to work at Farmland Foods as a 
 
              bacon slicer.  She apparently initially had a left foot 
 
              injury.  She developed complaints referable to her 
 
              shoulders and forearms.  She then had the injury for 
 
              which we have been specifically requested to examine 
 
              her, that is the injury of April 9, 1984 when she felt 
 
              a popping in her back when she was separating two 
 
              frozen pork bellies.
 
         
 
                 Since that time, she has been seen by a multiplicity 
 
              of medical specialists.  No one has been able to come 
 
              up with a definitive diagnosis.  She reports a recent 
 
              CT scan was found to be abnormal.  It may well have 
 
              been abnormal, but in the opinion of the examiners in 
 
              regard to findings today, there are no findings that 
 
              would suggest a surgically amenable problem in the 
 
              lumbar area.  There is certainly no evidence of nerve 
 
              root compression.
 
         
 
                 We took the liberty of conducting a complete 
 
              neuromuscular as well as neurological  examination of 
 
              the extremities and we do not find evidence of any 
 
              impairment regarding her shoulders, elbows, forearms, 
 
              cervical, dorsal, lumbar spine, hips, knees or ankles.  
 
              We do not find any abnormality other than her voluntary 
 
              restriction of motion because of low back distress.
 
                 We know of no further diagnostic tests or treatment 
 
              to suggest.  We cannot help but feel that there is a 
 
              significant degree of functional overlay and if further 
 
              definitive evaluation considered by the interested 
 
              parties, we would suggest that she undergo 
 
              psychological and/or psychiatric evaluation.
 
         
 
                 From the standpoint of musculoskeletal and 
 
              neurological examinations, her findings are normal.  
 
              Her condition is fixed and static.  No further 
 
              treatment is indicated.  She is capable of gainful 
 
              employment without restrictions so far as the physical 
 
              findings are concerned.  We cannot explain her 
 
              complaints of chronic pain.
 
         
 
         (Jt. Ex. 17)
 
         
 
                                  APPLICABLE LAW
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that she received an injury on April 26, 1985 which 
 
         arose out of and in the course of her 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 words "out of" refer to the cause or source of the 
 
         injury.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 402, 68 
 
         N.W.2d 63 (1955).
 
         
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   6
 
         
 
              The words "in the course of" refer to the time and place and 
 
         circumstances of the injury.  McClure v. Union et al. Counties, 
 
         188 N.W.2d 283 (Iowa 1971); Crowe v. DeSoto Consol. Sch. Dist., 
 
         246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 26, 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. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The question of causal connection is essentially within 
 
         the domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  The 
 
         expert opinion may be accepted or rejected, in whole or in part, 
 
         by the trier of fact.  Id. at 907.  Further, the weight to be 
 
         given to such an opinion is for the finder of fact, and that may 
 
         be affected by the completeness of the premise given the expert 
 
         and other surrounding circumstances.  Bodish, 257 Iowa 516, 133 
 
         N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 N.W.2d 128.
 
         
 
                                     ANALYSIS
 
         
 
              The first issue on appeal is whether claimant sustained an 
 
         injury on April 9, 1984 and and on April 26, 1985 (cumulative) 
 
         which arose out of and in the course of her employment.  
 
         Claimant's testimony that she heard a "pop" in her back on April 
 
         9, 1984 which resulted in immediate pain is unrebutted.  The 
 
         medical reports support claimant's testimony.  Therefore, it is 
 
         determined that claimant has met her burden of proving she 
 
         sustained an injury arising out of and in the course of her 
 
         employment on April 9, 1984.  The issue of the injury occurring 
 
         April 26, 1985 (cumulative) is not necessarily as clear.  
 
         Claimant testified the repeated lifting required of her job 
 
         rather than any one particular incident caused the pain in her 
 
         arms and contributed to the continuing pain in her back.  Again, 
 
         however, claimant's testimony is uncontroverted and is supported 
 
         by the medical evidence. (See e.g. the report of Dr. Hamsa, 
 
         exhibit 20, who finds claimant's recurrent muscular and 
 
         ligamentous pain of the spine, shoulders, elbow and low back 
 
         secondary to employment.) Further, claimant denied any previous 
 
         back injury and was of sufficiently good health to have passed 
 
         her preemployment physical with favorable conclusions as to the 
 
         state of her health.  Defendants have not presented any evidence 
 
         contrary to that presented by the claimant and therefore it is 
 
         accepted claimant's condition arose out of and in the course of 
 
         her employment.
 
         
 
              Since it has been stipulated that claimant has received all 
 
         of the temporary total disability/healing period benefits to 
 
         which she is entitled (noting that the issue of additional 
 
         temporary total disability/healing period benefits has become 
 
         moot based on claimant's failure to identify the disputed 
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   7
 
         
 
         period), the only remaining issue is whether or not claimant is 
 
         entitled to any permanent partial disability benefits as a result 
 
         of the work-related injuries.  Generally, a claim of permanent 
 
         disability invokes an initial determination of whether the work 
 
         injury is the cause of any permanent physical impairment or 
 
         permanent limitation in work activity.  Claimant, during the past 
 
         three years, has consulted a veritable covey of health care 
 
         providers including Doctors Mason, TanCreti, Hennessey, Hamsa, 
 
         Ronald Soll, Donald Soll, Roberts, Edwards, Bendixon, Flood, 
 
         Rassekh, Cotton, Anderson, Oatman, Agarwal and Blume.  None of 
 
         these physicians have provided either any impairment rating for 
 
         the claimant nor have they imposed any permanent restrictions on 
 
         claimant's work activity.  Indeed, it appears that none of the 
 
         physicians (with the possible exception of Dr. Blume who 
 
         tentatively supports claimant's assertions with regard to her 
 
         lower back) can even identify any medical reasons for her 
 
         symptomology.  The last physicians to evaluate claimant, Doctors 
 
         Tobin and Hood, of Seattle-Tacoma, Washington, suggested claimant 
 
         undergo psychological and/or psychiatric evaluation.
 
         
 
              Claimant began her course of medical care seeing Dr. Mason 
 
         who did eventually provide her with a medical certification that 
 
         she was unable to return to work at the packing plant.  Claimant 
 
         explained in her deposition how she got that certification:
 
         
 
         
 
              Q.  Did you ask Dr. Mason to write that note for you?
 
         
 
              A.  No, I didn't.
 
         
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   8
 
         
 
              Q.  How did he come to write that for you?
 
         
 
              A.  Because I had been to different doctors and I went 
 
              back to see her and she said I don't know what else to 
 
              do for you.  She said you have been to all different 
 
              kinds of doctors and she said the only thing I can do 
 
              is to give you a note to disable you from working at a 
 
              packing plant.  And she said would that be all right 
 
              and I said I don't know.  And she said do you want to 
 
              think about it and I said you are the doctor, you tell 
 
              me.  I said I'm here trying to find out what is wrong.  
 
              If you don't think I can do it or shouldn't be doing 
 
              it, you tell me.  And she said that she didn't think 
 
              that I should be in there and disabled me.  And told me 
 
              I should try taking physical therapy, so I have been 
 
              doing that.
 
         
 
         (Claimant's Deposition, pages 9-10)
 
         
 
              From this (since Dr. Mason's medical records have not been 
 
         submitted into evidence), it would seem that Dr. Mason, too, 
 
         could find no medical justification for claimant's symptoms but, 
 
         so long as claimant continued to assert they were caused by her 
 
         work, agreed that claimant should discontinue the work.
 
         
 
              Dr. Blume provides a "disabilityO rating of five percent.  
 
         Initially, it must be noted that it is not within the domain of 
 
         the medical expert to determine disability for it is impairment 
 
         that is this expert's proper subject for comment.  Dr. Blume's 
 
         opinion is therefore given less weight particularly when it is 
 
         weighed against the medical opinions of all the other physicians 
 
         in this matter.  Further, even Dr. Blume as the only physician to 
 
         provide what might even remotely be considered an impairment 
 
         rating, fails to provide any restrictions on claimant's 
 
         employability or on her work activity.
 
         
 
              Claimant argues that there are "myriads of injuries caused 
 
         by repetitious trauma that are not capable of being identified by 
 
         objective symptoms since there are none--only pain--often 
 
         disabling" and that the only possible basis of refusing to honor 
 
         claimant's claim would be if claimant's subjective complaints 
 
         were found to be incredible which none of the doctors have so 
 
         found.  While the undersigned cannot conclude claimant does not 
 
         believe she has pain, it must be concluded that claimant has 
 
         failed to meet her burden that the work injury is the cause of 
 
         any permanent impairment, the cause of any permanent restrictions 
 
         in work activity, or the cause of any permanent disability.  
 
         Therefore, claimant is entitled to nothing further from these 
 
         proceedings and the other issue need not be addressed.
 
         
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Wherefore, based on all the evidence presented, the 
 
         following facts are found:
 
         
 
              1.  On April 9, 1984, while trying to pry apart two frozen 
 
         bacon bellies, claimant felt something "popO in her back 
 
         resulting in pain.
 
         
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page   9
 
         
 
              2.  For at least two weeks prior to April 25, 1985, claimant 
 
         experienced increasing pain in her fingers, wrist, elbow, arms 
 
         and back.
 
         
 
              3.  Claimant had no medical history of back pain or pain in 
 
         her arms prior to her employment with Farmland Foods.
 
         
 
              4.  Claimant's pain was caused by her employment.
 
         
 
              5.  Claimant continued to experience pain and although she 
 
         saw a number of physicians none were able to relieve her symptoms 
 
         nor were they able to find any definite medical justification for 
 
         those symptoms.
 
         
 
              6.  Claimant quit her employment in June 1986 after securing 
 
         medical certification that she was unable to return to work in 
 
         packing plant.
 
         
 
              7.  Claimant continues to perceive pain.
 
         
 
              8.  Claimant has no permanent impairment as a result of her 
 
         work injuries.
 
         
 
              9.  Claimant has no permanent work restrictions as a result 
 
         of her work injuries.
 
         
 
             10.  Claimant has no permanent disability as a result of her 
 
         work injuries.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Wherefore, based on the principles of law previously stated, 
 
         the following conclusions of law are made:
 
         
 
              1.  Claimant has established she sustained an injury which 
 
         arose out of and in the course of her employment on April 9, 
 
         1984.
 
         
 
              2.  Claimant has established she sustained an injury which 
 
         arose out of and in the course of her employment as a result of a 
 
         cumulative injury on April 26, 1985.
 
         
 
              3.  Claimant has not established that her work injuries are 
 
         the cause of any permanent disability.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That claimant, having been paid for all the temporary total 
 
         disability to which he is entitled, shall take nothing further 
 
         from these proceedings.
 
         
 
              That each party is assessed its own costs pursuant to 
 
         Division of Industrial Services Rule 343-4.33.
 
         
 
         
 
              Signed and filed this 28th day of March, 1988.
 
         
 
         
 

 
         
 
         
 
         
 
         MEFFERD V. FARMLAND FOODS, INC.
 
         Page  10
 
         
 
         
 
         
 
         
 
         
 
                                           DEBORAH A. DUBIK
 
                                           DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. Harry Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City, Iowa 51102
 
         
 
         Ms. Lorraine May
 
         Attorney at Law
 
         4th Floor, Equitable Bldg.
 
         Des Moines, Iowa 50309
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                  1100; 1402.30; 1402.40
 
                                                  Filed March 28, 1988
 
                                                  Deborah A. Dubik
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         RONDA MEFFERD,
 
         
 
              Claimant,
 
                                                   File Nos. 794522
 
         VS.                                                 762119
 
         
 
         FARMLAND FOODS, INC.,                 A R B I T R A T I 0 N
 
         
 
              Employer,                           D E C I S I 0 N
 
         
 
         and
 
         
 
         AETNA CASUALTY AND SURETY COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         1100; 1402.30
 
         
 
              Claimant's testimony concerning how her injuries occurred 
 
         was uncontroverted and supported by medical evidence.  Claimant 
 
         therefore established she sustained injuries which arose out of 
 
         and in the course of her employment.
 
         
 
         1402.40
 
         
 
              Although claimant was seen by a veritable covey of doctors, 
 
         none could provide any impairment rating, and permanent 
 
         restrictions or limitations in work activity, or identify any 
 
         medical reasons for her symptomology.  Held, claimant failed to 
 
         establish the work injuries were the cause of any permanent 
 
         partial disability.