u         3202 5-3203
 
                      Filed May 24, 1991
 
                      CLAIR R. CRAMER
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            VIRGINIA PUTZIER,   :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File Nos. 804582/835165
 
            WILSON FOODS CORPORATION,     :
 
                      :           A P P E A L
 
                 Employer, :
 
                 Self-Insured,  :         D E C I S I O N
 
                      :
 
            and       :
 
                      :
 
            SECOND INJURY FUND OF IOWA,   :
 
                      :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            3202
 
            Claimant's first injury was a laceration injury to the right 
 
            hand.  Claimant later had bilateral carpal tunnel syndrome.  
 
            On appeal, the Second Injury Fund's argument that claimant 
 
            was not entitled to Second Injury Fund benefits because the 
 
            second injury also affected the same member as the first 
 
            injury was rejected.  Although Anderson v. Second Injury 
 
            Fund, 262 N.W.2d 789 (Iowa 1978) states that the second 
 
            injury must be to another member, this does not preclude 
 
            Second Injury Fund liability where the first member is again 
 
            affected, as long as the second injury also results in loss 
 
            to another member as well.  Thus, here, where claimant's 
 
            first injury resulted in a loss to the right hand, and the 
 
            second injury resulted in a loss to both the right hand and 
 
            the left hand, Fund liability was established. 
 
            
 
            5-3203
 
            Other arguments raised by the Second Injury Fund have been 
 
            resolved by the Supreme Court in Neelans and Braden.
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         TERRY GLIENKE,
 
         
 
              Claimant,                              File No. 804586
 
         
 
         vs.                                           A P P E A L
 
                                                      
 
         WILSON FOODS CORPORATION,                   D E C I S I O N
 
         
 
              Employer,                                 F I L E D
 
              Self-Insured,
 
              Defendant.                               JUL 27 1989
 
              
 
                                                   INDUSTRIAL SERVICES
 
              
 
              
 
                              STATEMENT OF THE CASE
 
         
 
              Defendant appeals from an arbitration decision granting 
 
         permanent partial disability benefits as a result of an alleged 
 
         injury on September 3, 1985.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration hearing and joint exhibits 1 through 6.  Both parties 
 
         filed briefs on appeal.  The defendant filed a reply brief.
 
         
 
                                      ISSUE
 
         
 
              The defendant states the following issue on appeal:  1) 
 
         Whether there is a permanent partial disability owing.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be set forth herein.
 
         
 
                                  APPLICABLE LAW
 
         
 
              The citations of law in the arbitration decision are 
 
         appropriate to the issue and the evidence.
 
         
 
                                     ANALYSIS
 
         
 
              The analysis of the evidence in conjunction with the law is 
 
         adopted.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant sustained severe burns to the left hand, wrist, 
 
         arm, back, lower left abdomen and upper left thigh on September 
 
         3, 1985.
 
         
 
              2.  As a result of these burns, claimant's left hand, wrist 
 
         and arm become stiff and numb in cold weather and form water 
 
         blisters in hot weather.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              3.  Due to all of these injuries, claimant's whole body has 
 
         become sensitized to hot and cold temperatures and that claimant 
 
         has developed an intolerance for extreme hot and cold 
 
         environments, and develops blisters from exposure to direct 
 
         sunlight.
 
         
 
              4.  Albert E. Cram, M.D., verified these facts and found 
 
         that claimant sustained a one percent permanent functional 
 
         impairment due to permanent skin changes and intolerance to hot 
 
         and cold.
 
         
 
              5.  Claimant sustained an industrial disability of 10 
 
         percent of the body as a whole.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              The injury of September 3, 1985 was the cause of permanent 
 
         disability.
 
         
 
              The injury caused industrial disability to the body as a 
 
         whole.
 
         
 
              Claimant is entitled to 50 weeks of permanent partial 
 
         disability benefits based upon a 10 percent industrial disability 
 
         to the body as a whole.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendant pay to claimant fifty (50) weeks of permanent 
 
         partial disability benefits at the rate of one hundred eighty and 
 
         51/100 dollars ($180.57) per week in the total amount of nine 
 
         thousand twenty-eight and 50/100 dollars ($9,028.50) commencing 
 
         oft October 22, 1985 which is the commencement date stipulated to 
 
         by the parties.
 
         
 
              That this amount is to be paid to claimant in a lump sum.
 
         
 
              That interest will accrue pursuant to Iowa Code section 
 
         85.30.
 
         
 
              That defendant is charged with the costs of this action 
 
         including transcription of the arbitration hearing pursuant to 
 
         Division of Industrial Services Rule 343-4.33.
 
         
 
              That defendant file claim activity reports as required by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
              Signed and filed this 27th day of July, 1989.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
                                            
 
         
 
         
 
         
 
         
 
         
 
                                               DAVID E. LINQUIST
 
                                            INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City, Iowa  51102
 
         
 
         Mr. David L. Sayre
 
         Attorney at Law
 
         223 Pine St.
 
         P.O. Box 535
 
         Cherokee, Iowa  51012
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
                                            
 
 
 
 
 
 
 
 
 
 
 
                                            1800 - 1803
 
                                            Filed July 27, 1989
 
                                            DAVID E. LINQUIST
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         TERRY GLIENKE,
 
         
 
              Claimant,                              File No. 804586
 
         
 
         vs.
 
                                                       A P P E A L
 
         WILSON FOODS CORPORATION,
 
         
 
              Employer,                              D E C I S I 0 N
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
         1800 - 1803
 
         
 
              The deputy's decision granting claimant permanent partial 
 
         disability as a result of burns to claimant's left hand, wrist, 
 
         arm, back, lower left abdomen and upper left thigh was affirmed 
 
         on appeal.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         TERRY GLIENKE,
 
         
 
              Claimant,
 
                                                  File No. 804586
 
         vs.
 
         
 
         WILSON FOODS CORPORATION,             A R B I T R A T I O N
 
         
 
               Employer,
 
               Self-Insured,                      D E C I S I 0 N
 
               Defendant.
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Terry 
 
         Glienke, claimant, against Wilson Foods Corporation, employer, 
 
         and self-insured defendant, for benefits as a result of an injury 
 
         that occurred on September 3, 1985.  A hearing was held in Storm 
 
         Lake, Iowa on November 3, 1988 and the case was fully submitted 
 
         at the close of the hearing.  The record consists of the 
 
         testimony of Terry Glienke, claimant, Rhonda Glienke, claimant's 
 
         wife, and joint exhibits 1 through 6.  Both attorneys submitted 
 
         excellent briefs.
 
         
 
                                   STIPULATIONS
 
         
 
              The parties stipulated to an employer-employee relationship, 
 
         injury arising out of and in the course of employment on 
 
         September 3, 1985, entitlement to temporary disability benefits 
 
         from September 4, 1985 to October 21, 1985, commencement date of 
 
         permanent disability benefits of October 22, 1985, a rate of 
 
         $180.57 per week, and that all medical bills have been paid.  
 
         Defendant claimed no credits for the prior payment of any 
 
         benefits and there no bifurcated claims.
 
         
 
                                      ISSUES
 
         
 
              The parties submitted the following issues for determination 
 
         at the time of the hearing.
 
         
 
              1.  Whether the injury was the cause of permanent 
 
         disability; and,
 
         
 
              2.  Whether claimant is entitled to permanent disability 
 
         benefits and, if so, whether claimant is entitled to a 
 
         scheduled member disability or industrial disability to the 
 
         body as a whole.
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   2
 
         
 
         
 
                             SUMMARY OF THE EVIDENCE
 
         
 
              The following is a summary of the evidence most pertinent to 
 
         this decision.
 
         
 
              Claimant is 36 years of age.  He graduated from high school 
 
         in 1970.  He completed two years of formal education at Western 
 
         Iowa Tech and graduated with a degree in police science in 1972. 
 
          He worked as a police officer for three months.  Late in 1984, 
 
         he took an eight week refresher course sponsored by the Joint 
 
         Training Partnership Act (JTPA) to improve his English, 
 
         mathematics and job seeking skills.  Prior employments include 
 
         working at a grain elevator, retail sales work, convenience store 
 
         manager, wood fabricator and metal fabricator in the construction 
 
         of commercial trucks.
 
         
 
              Claimant started to work for employer in March 1985.  He was 
 
         injured on September 3, 1985.  At the time of his injury, he was 
 
         earning $9.10 per hour, working days on the kill floor as a neck 
 
         breaker.  The neck breaker is the first one to open the hog with 
 
         a giant pair of mechanically operated scissors.  The hogs come to 
 
         him hanging upside down shackled by the hind feet traveling on an 
 
         overhead rail.  Using both hands, he operates the giant scissors 
 
         and makes a cut in the back of the neck of the hog and snaps the 
 
         neck.  The hog then moves on to the next station and a few 
 
         seconds later the next hog comes to him on the rail.
 
         
 
              On September 3, 1985, a hog got twisted on the rail and fell 
 
         off the hook into the sterilizing tank which contains water 
 
         heated to a temperature of 180 degrees.  The hog splashed hot 
 
         water on his body before he could jump back far enough to avoid 
 
         it. It burned his left hand and arm up to his shoulder, his back 
 
         and waist.  Other employees helped him remove his clothing (his 
 
         belt buckle was so hot he could not touch it) and hosed him down 
 
         with cold water.  The foreman took him to the nurse who applied 
 
         towels and sent him to the Cherokee Clinic.  The clinic applied 
 
         cream to keep the air off the burns and transferred him to the 
 
         burn unit at St. Luke's Hospital in Sioux City where he was 
 
         hospitalized for two weeks and treated by L. D. Foster, M.D.  His 
 
         treatment required him to be submerged in a solution every day 
 
         until most of the burned skin came off.  The treatment did not 
 
         permit him to take pain medication.  He had to suffer the pain.  
 
         Two photographs were taken of the burned area within a few hours 
 
         after he arrived at the hospital in Sioux City (Exhibit 5).  The 
 
         photographs show blisters on the back of his left hand, left 
 
         lower abdomen, and left upper hip.  Some of the blisters are 
 
         quite large.  The largest blisters appear to be approximately 
 
         three inches long and raised approximately one-half inch over the 
 
         surface of the skin.  After he was discharged, claimant returned 
 
         to the hospital for one to one and one-half months for continued 
 
         outpatient care of sitting in the tank and having new pads 
 
         applied.
 
         
 
              Claimant testified to four residual problems which he said 
 
         were caused by this injury:  (1) Since the injury his left arm 
 
         and shoulder gets sore.  If his left arm gets cold it gets stiff 
 
         and numb.  The company doctor gave him some pills to take but 
 
         they were too strong and he had to quit them.  They made him go 
 
         to the bathroom all of the time. (2) Since the injury his body is 
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   3
 
         
 
         very sensitive to hot and cold temperatures.  In cold weather his 
 
         left hand quickly becomes stiff and numb.  In hot weather he gets 
 
         water blisters on his left hand.  The stiffness and numbness 
 
         affect his left hand, wrist and arm up to his shoulder.  Claimant 
 
         alleged that the doctor told him that he would be sensitive to 
 
         hot and cold temperatures.  Claimant further related that since 
 
         the injury he is cold all of the time.  He has to wear more 
 
         clothes all of the time because his body feels cold. (3) The 
 
         burning left a scar mark on his thigh. (4) Claimant alleged that 
 
         he also has nodes or nodules on the back of his left hand since 
 
         this injury.  These nodules are readily visible by simply looking 
 
         at the hand.  Claimant testified that his wedding ring will not 
 
         slide on or off due to a large nodule on the knuckle of his ring 
 
         finger.
 
         
 
              Claimant testified that two months after the injury he 
 
         returned to work and performed his old job of neck breaker.  He 
 
         was reluctant to do it, but his foreman insisted and claimant did 
 
         perform the job.  Claimant then worked until a layoff which 
 
         occurred around Thanksgiving of 1986.
 
         
 
              When claimant was called back to work he performed a job 
 
         called pace boning.  The temperature was 350 to 400 and it made 
 
         his left hand ache and get stiff.  His foreman said he was doing 
 
         alright, but claimant found the job too difficult for him to do 
 
         because he was not able to keep up.  Claimant admitted that he 
 
         did not ask the employer to try to find him a job that he could 
 
         do.
 
         
 
              Claimant testified that his current employment status is one 
 
         of temporary suspension.  Claimant said that the union was trying 
 
         to find a job for him with the employer that he could do.  The 
 
         company's position was that claimant did not respond to calls to 
 
         return to work and was therefore placed on the status of 
 
         temporary suspension.
 
         
 
              Claimant was employed at the time of hearing in a very 
 
         strenuous job for another employer as a steel fabricator sheering 
 
         large sheets of flat steel to construct truck bodies at  $5.35 
 
         per hour.  At the same time, he testified that he was looking for 
 
         more suitable employment and that he had used up all of his 
 
         vacation in this pursuit.  He testified that he was taking post 
 
         office employment tests and State of Iowa employment tests.  He 
 
         testified that he has applied for police work and a department of 
 
         transportation job as a blue coat driving a state car and 
 
         stopping trucks in all kinds of weather.  Claimant testified that 
 
         he needs to find a job that he can perform within his 
 
         limitations.  Other than the limitations in his left arm and his 
 
         sensitivity to hot and cold temperature, he is a physically fit 
 
         person otherwise.
 
         
 
              Claimant testified that he went to the University of Iowa 
 
         Hospitals and Clinics at the request of his attorney.  He was 
 
         examined and evaluated just once.  He last saw Dr. Foster, the 
 
         treating physician, on October 28, 1988 for a current evaluation 
 
         of his condition.  Claimant conceded that he had no statement 
 
         from a doctor saying that he was not to perform any specific 
 
         job.
 
         
 
              Rhonda Glienke, claimant's wife, confirmed that there was a 
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   4
 
         
 
         conflict between employer and the union about whether claimant 
 
         could or should return to work for employer.  Claimant was 
 
         following the advice of his union in this matter and as a result 
 
         the employer was threatening to fire him.  Mrs. Glienke also 
 
         confirmed her husband's sensitivity to hot arid cold 
 
         temperatures.  In the summer he doesn't go outside for fear of 
 
         heat exhaustion.  In the winter he is always much colder than her 
 
         and needs much more heat.
 
         
 
              A review of the medical evidence shows that Dr. Garner 
 
         recorded this injury on September 3, 1985.  He said that claimant 
 
         received second degree and third degree burns from scalding water 
 
         in the vat when a hog fell from a hanger into the vat.  He said 
 
         that claimant had third degree burns with a complete loss of skin 
 
         from his left hand.  He had second degree burns four inches above 
 
         his wrist and second degree burns of the entire posterior chest 
 
         wall.  Claimant had third degree burns of the left anterior thigh 
 
         and buttock (Exhibit 4).
 
         
 
             Dr. Foster reported on September  3, 1985 that claimant was 
 
         splashed with 180 degree water which caused burns over 15 percent 
 
         of his body surface--his back, left arm and hand, left thigh and 
 
         buttock (Exhibit 3, page 1).  When claimant was discharged on 
 
         September 12, 1985 Dr. Foster said he felt that the burns were 
 
         superficial and deep partial thickness wounds.  He stated 
 
         claimant was nearly completely healed on discharge with two areas 
 
         still open in the left groin and upper thigh (Exhibit 3, page 2).  
 
         On October 2, 1985, Dr. Foster said he still had ,three open 
 
         areas in the groin and low abdomen.  Everything else was doing 
 
         well.  He was still totally disabled.  He hoped that claimant 
 
         could return to work in eight weeks (Exhibit 3, page 3).
 
         
 
              Claimant was examined and evaluated at the University of 
 
         Iowa Hospitals and Clinics one time on September 24, 1987 by 
 
         Albert E. Cram, M.D., director of Plastic and Reconstruction 
 
         Surgery, in the Department of Surgery.  Dr. Cram said that the 
 
         burns involved the left hand, arm, wrist, back and a portion of 
 
         the left thigh.  He said that the burns did not require skin 
 
         grafting and healed up with only topical therapy.  This doctor 
 
         said that his physical examination showed a few pigment changes 
 
         secondary to the burn injury primarily on the upper left thigh.  
 
         He added that these were permanent changes but the quality and 
 
         consistency of the skin was good.  He stated that claimant had a 
 
         full range of motion of both upper and lower extremities.
 
         
 
              Dr. Cram related that claimant's primary problem was a 
 
         continuing intolerance to heat and cold.  Last summer exposure to 
 
         direct sunlight caused some small blisters on the dorsum of the 
 
         hand and wrist.  In 400 degree temperatures claimant's burned 
 
         portions of his body experienced more discomfort than his 
 
         unburned portions.
 
         
 
              Dr. Cram assessed a 1 percent disability (permanent 
 
         functional impairment) secondary to the burn injury.  He said 
 
         that this disability is due to permanent skin changes and 
 
         intolerance to hot and cold (Exhibit 1).
 
         
 
              Dr. Cram said that claimant does not require medication but 
 
         that he may need to apply sun screen or moisturizer lotion from 
 
         time to time to prevent further injury to the burned area 
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   5
 
         
 
         (Exhibit 2).
 
         
 
              Dr. Foster reexamined and evaluated claimant on October 28, 
 
         1988 just a few days prior to hearing.  He said the burns healed 
 
         completely and everything looks good.  Dr. Foster said that the 
 
         nodules on the back of the left hand and claimant's generalized 
 
         condition of coldness were not related to his burn injuries.  Dr. 
 
         Foster continued that there was no cosmetic or functional defect 
 
         in the left arm.
 
         
 
              There was definite cosmetic defect in the groin, but no 
 
         functional defect.  The burn line on his back was imperceptible. 
 
          Dr. Foster saw no long-term defects either cosmetic or 
 
         functional except for the cosmetic defect in the left groin 
 
         (Exhibit 6).
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of September 3, 1985 is causally 
 
         related to the disability on which he now bases his claim.  
 
         Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  
 
         Lindahl v. L.O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The question of causal connection is essentially within 
 
         the domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              Claimant did sustain the burden of proof by a preponderance 
 
         of the evidence that he sustained a permanent impairment.  Dr. 
 
         Cram, the director of plastic and reconstructive surgery, at the 
 
         University of Iowa, verified that claimant had a 1 percent 
 
         disability which is interpreted to mean more correctly a 
 
         permanent functional impairment due to permanent skin changes and 
 
         intolerance to hot and cold.  Dr. Cram's opinion is accepted over 
 
         the opinion of Dr. Foster.  Dr. Foster's qualifications were not 
 
         made a matter of record other than the fact that he was the 
 
         treating physician.  Dr. Cram is the director of Plastic and 
 
         Reconstruction Surgery at the University of Iowa Hospitals and 
 
         Clinics.  Rockwell Graphic Systems, Inc. v. Prints, 366 N.W.2d 
 
         187, 192 (Iowa 1985).  A doctor's expertise may accord his 
 
         testimony greater weight.  Reiland v. Palco, Inc., 32nd Biennial 
 
         Report of Industrial Commissioner 56 (1975); Dickey v. ITT 
 
         Continental Baking Company, 34th Biennial Report of the 
 
         Industrial Commissioner 89 (1979).
 
         
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   6
 
         
 
              Claimant testified in detail that in the heat of summer his 
 
         left arm formed water blisters.  This testimony was corroborated 
 
         by his wife.  In the cold his left hand, wrist and arm get stiff 
 
         and numb up to his shoulder.
 
         
 
              Claimant testified that he is sensitized to extremes of hot 
 
         or cold.  He related that his body feels generally cold all of 
 
         the time.  Dr. Cram verified that claimant related to him that he 
 
         experienced more discomfort on the burned portions of his body 
 
         than the unburned portions of his body.  Dr. Cram apparently 
 
         believed this statement to be true and presented it in his report 
 
         as if it were true (Exhibit 1).  Claimant's testimony was 
 
         credible and reasonable based on the evidence of the injury he 
 
         received.  Claimant's testimony is considered to be honest and 
 
         true.  Therefore, from the foregoing evidence it is determined 
 
         that claimant has sustained his burden of proof by a 
 
         preponderance of the evidence that he sustained a permanent 
 
         impairment.
 
         
 
             The right of a worker to receive compensation for injuries 
 
         sustained which arose out of and in the course of employment is 
 
         statutory.  The statute conferring this right can also fix the 
 
         amount of compensation to be paid for different specific 
 
         injuries, and the employee is not entitled to compensation except 
 
         as provided by the statute.  Soukup v. Shores Co., 222 Iowa 272, 
 
         268 N.W. 598 (1936).
 
         
 
              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).
 
         
 
              Claimant has also sustained his burden of proof by a 
 
         preponderance of the evidence that he has sustained an industrial 
 
         disability to the body as a whole.  Although the bulk of 
 
         claimant's disability is in the left arm, claimant also sustained 
 
         burns on his body on his left lower abdomen and left upper thigh 
 
         and back.  Claimant testified that since the injury he is cold 
 
         all of the time, all over his body.  Dr. Cram appeals to believe 
 
         that this is a reasonable result of claimant's burn injuries.  He 
 
         confirms claimant's testimony by stating that claimant is 
 
         intolerant to heat and cold generally.  He confirmed claimant 
 
         developed small blisters when exposed to direct sunlight.  Dr. 
 
         Cram's opinion speaks to the whole person rather than any certain 
 
         extremity or scheduled member.  Therefore, it is determined that 
 
         claimant has sustained an injury to the body as a whole and is 
 
         entitled to industrial disability.
 
         
 
              As a claimant has an impairment to the body as a whole, an 
 
         industrial disability has been sustained. industrial disability 
 
         was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 
 
         593, 258 N.W. 899, 902 (1935) as follows:  "It is therefore plain 
 
         that the legislature intended the term 'disability' to mean 
 
         'industrial disability' or loss of earning capacity and not a 
 
         mere 'functional disability' to be computed in the terms of 
 
         percentages of the total physical and mental ability of a normal 
 
         man."
 
         
 
              Functional disability is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   7
 
         
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 1121 125 N.W.2d 251, 
 
         257 (1963).
 
         
 
              Claimant's industrial disability is not great due to his 
 
         young age, retrainability, adaptability and wide employment 
 
         experience -in past employments.  Becke v. Turner-Busch, Inc., 
 
         34th Biennial Report of the industrial commissioner 34, 36 
 
         (1979), Conrad v. Marquette School, Inc., IV Iowa Industrial 
 
         Commissioner Reports 74,78 (1984).  Claimant is intelligent, 
 
         ambitious and has demonstrated that he can be successful in 
 
         either the educational environment or the work environment.
 
         
 
              The fact that claimant has worked without loss of wages or 
 
         demotion is some indication that claimant has retained a 
 
         substantial portion of his earning capacity.  At the same time, a 
 
         loss of earning capacity can occur without a loss in actual 
 
         earnings.  Larson, Workers Compensation Law, SS 57.21(c) at 
 
         10-101 and SS 57.21(d) at 10-113 and 10-125.  Claimant could 
 
         probably return to work for employer if he chose to do so and 
 
         employer was still willing to employ him.  Claimant's chief 
 
         limitation is in his sensitivity to hot and cold.  This will 
 
         eliminate or restrict claimant from doing a large number of 
 
         outdoor jobs that require outdoor work in the heat of summer and 
 
         the cold of winter.  Many of the jobs that are easiest to get and 
 
         pay a reasonable amount of money are outdoor jobs in all kinds of 
 
         weather.  Claimant also has limitations in his left arm caused by 
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   8
 
         
 
         numbness, stiffness, aching and pain.  He testified that he was 
 
         not able to keep up on the pace boning job due to this 
 
         condition.
 
         
 
              No allowance is made for the scarring on the left inner 
 
         thigh for the reason that the statute permits compensation only 
 
         for permanent disfigurement of the face or head which shall 
 
         impair the future usefulness an(i earnings of the employee in the 
 
         employee's occupation at the time of receiving the injury.  Iowa 
 
         Code section 85.34(2)(t).
 
         
 
              No allowance is made for the nodules on the back of the left 
 
         hand for the reason that claimant did not establish that they 
 
         were caused by this injury.
 
         
 
              Based on the foregoing considerations and all the factors 
 
         that are used to determine industrial disability, it is 
 
         determined that claimant has sustained a 10 percent industrial 
 
         disability to the body as a whole.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Wherefore, based upon the evidence presented, the following 
 
         findings of fact are made:
 
         
 
              1.  That claimant sustained severe burns to the left hand, 
 
         wrist, arm, back, lower left abdomen and upper left thigh on 
 
         September 3, 1985.
 
         
 
              2.  That as a result of these burns, claimant's left hand, 
 
         wrist and arm become stiff and numb in cold weather and form 
 
         water blisters in hot weather.
 
         
 
              3.  That due to all of these injuries, claimant's whole body 
 
         has become sensitized to hot and cold temperatures and that 
 
         claimant has developed an intolerance for extreme hot and cold 
 
         environments, and develops blisters from exposure to direct 
 
         sunlight.
 
         
 
              4.  That Dr. Cram verified these facts and found that 
 
         claimant sustained a 1 percent permanent functional impairment 
 
         due to permanent skin changes and intolerance to hot and cold.
 
         
 
              5.  That claimant sustained an industrial disability of 10 
 
         percent of the body as a whole.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Wherefore, based upon the evidence presented and the 
 
         foregoing principles of law, the following conclusions of law are 
 
         made:
 
         
 
              That the injury of September 3, 1985 was the cause of 
 
         permanent disability.
 
         
 
              That the injury caused industrial disability to the body as 
 
         a whole.
 
         
 
              That claimant is entitled to 50 weeks of permanent partial 
 
         disability benefits based upon a 10 percent industrial disability 
 

 
         
 
         
 
         
 
         GLIENKE V. WILSON FOODS CORPORATION
 
         PAGE   9
 
         
 
         to the body as a whole.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That defendants pay to claimant fifty (50) weeks of 
 
         permanent partial disability benefits at the rate of one hundred 
 
         eighty and 51/100 dollars ($180.57) per week in the total amount 
 
         of nine thousand twenty-eight and 50/100 dollars ($9,028.50) 
 
         commencing on October 22, 1985 which is the commencement date 
 
         stipulated to by the parties.
 
         
 
              That this amount is to be paid to claimant in a lump sum.
 
         
 
              That interest will accrue pursuant to Iowa Code section 
 
         85.30.
 
         
 
              That defendants are charged with the costs of this action 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              That defendants file claim activity reports as required by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
         
 
              Signed and filed this 15th day of December, 1988.
 
         
 
         
 
         
 
         
 
                                         WALTER R. McMANUS, JR.
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies to:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City, IA 51102
 
         
 
         Mr. David L. Sayre
 
         Attorney at Law
 
         223 Pine St
 
         P.O. Box 535
 
         Cherokee, IA 51012
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                        1401; 1402.40; 1803; 1803.10
 
                                        Filed December 15, 1988
 
                                        WALTER R. McMANUS, JR.
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         TERRY GLIENKE,
 
         
 
              Claimant,
 
                                                File No. 804586
 
         vs.
 
         
 
         WILSON FOODS CORPORATION,           A R B I T R A T I 0 N
 
         
 
              Employer,
 
              Self-Insured,                     D E C I S I 0 N
 
              Defendant.
 
         
 
         
 
         
 
         1401; 1402.40; 1803; 1803.10
 
         
 
              Claimant awarded 10 percent industrial disability after 
 
         severe 2nd and 3rd degree burns over his left arm, abdomen and 
 
         back that left him sensitive to heat, cold and direct sunlight 
 
         and caused numbness and stiffness in his left arm in colder 
 
         temperatures.  Claimant's treating physician awarded no 
 
         impairment.  Claimant's evaluation at University of Iowa 
 
         confirmed his complaints and awarded 1 percent permanent 
 
         impairment.  Injury was determined to be body s a whole.  No 
 
         allowance was made for scar on thigh [Iowa Code section 
 
         85.34(2)(t)]. Nodules on fingers were not proven to be causally 
 
         connected.
 
 
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                           
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         PEGGY L. BETTS,
 
         
 
              Claimant,
 
                                                    File No. 804631
 
         VS.
 
         
 
         ALEXANDER MANUFACTURING                  A R B I T R A T I 0 N 
 
         COMPANY,
 
                                                     D E C I S I 0 N
 
              Employer,
 
         
 
         and
 
         
 
         KEMPER GROUP,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Peggy L. 
 
         Betts, claimant, against Alexander Manufacturing Company, 
 
         employer, and Kemper Group, insurance carrier, for the recovery 
 
         of benefits as a result of an alleged injury on September 16, 
 
         1985.
 
         
 
              The record consists of the testimony of claimant, Larry 
 
         Fuller, and Georia Franks; claimant's exhibits 1 through 24; and 
 
         defendants' exhibits A through E.  The record was considered 
 
         fully submitted at the conclusion of the hearing.  On December 4, 
 
         1986, however, the parties jointly submitted an additional 
 
         exhibit in the form of a disability report by R. L. Emerson, M.D.  
 
         That report is accepted into the record and is hereby designated 
 
         claimant's exhibit 25.
 
         
 
                             STIPULATIONS AND ISSUES
 
         
 
              Pursuant to the prehearing report and order approving the 
 
         same, the parties stipulated to the following:
 
         
 
              1.  At the time of the alleged injury there was in existence 
 
         an employer-employee relationship between claimant and the 
 
         employer.
 
         
 
              2.  Claimant sustained an injury arising out of and in the 
 
         course of her employment on September 16, 1985.
 
              
 
              3.  As a result of the injury, claimant was temporarily 
 
         totally disabled.
 
         
 
              4.  If claimant suffered permanent disability, then such 
 
         disability is to the body as a whole.
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   2
 
         
 
         
 
         
 
              5.  If claimant is entitled to permanent disability 
 
         benefits, the commencement date thereof is February 17, 1986.
 
         
 
              6.  Claimant is single and entitled to one exemption.
 
         
 
              7.  All medical expenses requested by claimant have been or 
 
         will be paid by defendants, however, claimant's application for 
 
         an independent medical examination remains to be determined.
 
         
 
              8.  Defendants have previously paid claimant for the period 
 
         from September 16, 1985 through February 16, 1986 (except for 
 
         three weeks) at a rate of $125.79.
 
         
 
              9.  Each party has actually paid any expenses which they now 
 
         to seek have taxed as cost.
 
         
 
                                EVIDENCE PRESENTED
 
         
 
              Claimant testified she is forty-three years old, has two 
 
         adult children, and resides in Swaledale, Iowa.  Claimant 
 
         completed the eighth grade.  She has no further specialized 
 
         training or education.
 
         
 
              Claimant advised that prior to 1972 she worked as a 
 
         homemaker.  Since 1972 and prior to her injury claimant has 
 
         worked as a full-time employee.  She described most of her jobs 
 
         as heavy to medium heavy labor.  Her work experience includes 
 
         work as an assembler, punch press operator, packager, school 
 
         cafeteria worker, and bookkeeper and sales work.  Claimant's 
 
         bookkeeping and sales work covered a five year period from 1976 
 
         to 1981 while she and her husband operated a rental business.
 
         
 
              Claimant recalled that she began working for defendants in 
 
         1982 or 1983 packaging batteries for radio and medical equipment. 
 
          She next was assigned to solder and package batteries and then 
 
         to the "sonic welder."  The sonic welding required claimant to 
 
         put the batteries on flats and then stack them on a pallet.  
 
         Claimant said that lifting the flats was the most difficult 
 
         aspect of her job.  She also said the job required a lot of 
 
         twisting and bending.
 
         
 
              Claimant indicated that she first began to experience low 
 
         back pain in June 1983.  She said she did not recall any problems 
 
         prior to that time.  She experienced a problem again in August 
 
         1983 which developed at home while canning.  She went to the 
 
         hospital to see a doctor concerning this problem, then was 
 
         instructed to remain at bedrest for about seven days.  Claimant 
 
         returned to work in September 1983.  She indicated that she 
 
         recovered from this problem and continued working, without 
 
         difficulty until September 1985.
 
         
 
              On September 16, 1985 claimant was working on the sonic 
 
         welder when she noticed that her back was beginning to hurt.  She 
 
         did not report this to her supervisor because she thought the 
 
         pain would go away.  When she went home she had planned to go to 
 
         bed but received a call to go to the hospital with her mother.  
 
         When claimant returned to work the next day she reported her back 
 
         pain to her foreman.  Shortly thereafter, claimant was taken to 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   3
 
         
 
         
 
         see the company doctor.  Claimant said she could not recall any 
 
         specific incident which brought about her back pain.
 
         
 
              Claimant said the pain she experienced in September 1985 was 
 
         not the same as she had suffered earlier because she had pain 
 
         radiating down her left leg and part of the way down her right 
 
         leg.
 
         
 
              The company doctor, Samuel R. Hunt, M.D., placed claimant in 
 
         the hospital.  While in the hospital she was seen by another 
 
         doctor as well.  Claimant advised that after she was released 
 
         from the hospital she returned to work on October 1, 1985.  She 
 
         was not, however, able to do the work a full day.  Because of 
 
         continued problems she was referred to Timothy C. Mead, M.D.  She 
 
         was shortly thereafter referred to Paul H. Gislason, M.D., who 
 
         again hospitalized her and treated her with steroid injections.  
 
         Claimant reported that Dr. Gislason's treatment program improved 
 
         her condition somewhat.  Dr. Gislason had hospitalized claimant 
 
         in December 1985.  After claimant's release from the hospital 
 
         claimant sought to have her care and treatment moved from Dr. 
 
         Gislason who is in Mankato, Minnesota, to Mason City.  Claimant 
 
         explained that because of the condition of her automobile she had 
 
         difficulty getting to Mankato to see Dr. Gislason.  After she 
 
         missed a January 7, 1986 appointment with Dr. Gislason because 
 
         her car would not start she said the insurance carrier suspended 
 
         her compensation payments.  The industrial commissioner ordered 
 
         the insurance carrier to provide claimant with alternative 
 
         medical care closer to her home by a decision filed June 3, 
 
         1986.
 
         
 
              Claimant advised that Dr. Gislason released her to return to 
 
         work on February 17, 1986.  She did return to her packaging job 
 
         at that time.  She was unaware of any restrictions imposed upon 
 
         her and asked her supervisor if there were any restrictions.  The 
 
         supervisor told her she did not know.  Claimant added, however, 
 
         that she was given lighter work to do upon her return which 
 
         continued until she left work in May 1986.  Claimant testified 
 
         that she seemed to get along okay on her job with light duty 
 
         work.
 
         
 
              Claimant recalled that in May she was called into the office 
 
         and asked about statements by coworkers that she had 
 
         intentionally hurt her back.  Claimant denied this.  Claimant 
 
         said that some of her coworkers made light of her back condition.  
 
         On May 30, 1986 claimant quit her job stating as a reason that 
 
         she was going to start her own business.  She contended at 
 
         hearing, however, that this was neither the sole nor primary 
 
         reason for quitting.  Claimant said her main reasons for leaving 
 
         was a feeling that she was being put down because of her back 
 
         injury.  She also said that working was causing her continuous 
 
         pain.
 
         
 
              Claimant did, in fact, start her own business in June 1986. 
 
          She described in detail the nature of this business which was 
 
         making figurines, plaques, and other similar items.  She said she 
 
         was able to get Wal-Mart to market the items.  Claimant stated 
 
         that she hired an individual to help her in this business as well 
 
         as received the assistance of her friend, Larry Fuller.  Claimant 
 
         said she used her savings funds to start this business.
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   4
 
         
 
         
 
         
 
              Claimant reported that the business was successful at first, 
 
         but by the first of August she had to cease doing business.  She 
 
         stated that she had problems because her accounts were in 
 
         different states and the physical stress of traveling from one 
 
         place to another increased her back pain.  She said she was 
 
         unable to keep the business going due to money shortages.
 
         
 
              Claimant disclosed that in June 1986 she was involved in an 
 
         auto accident with a deer while returning from Wisconsin.  She 
 
         said she sought medical attention for pain in her chest where she 
 
         struck a steering wheel.  She also experienced low back pain 
 
         later on.  Claimant stated that the auto accident aggravated her 
 
         back pain for a while but it subsided within a few days.  She 
 
         said she believed she was in the same condition after the 
 
         accident as she was before it.
 
         
 
              Claimant said she continues to see Dr. Emerson, who had 
 
         placed her in the hospital a third time where she received 
 
         physical therapy, bedrest and medication.  She has not had 
 
         surgery on her back.  She said Dr. Emerson had released her for 
 
         part-time work and she is presently waiting for restrictions to 
 
         be established.  Claimant has also been examined by John Walker, 
 
         M.D.
 
         
 
              Claimant indicated that she has looked for employment in 
 
         several different places and is willing to undergo vocational 
 
         rehabilitation.
 
         
 
              Claimant stated that at the time of her injury her wages 
 
         were $4.93 per hour for what was a standard forty hour work week. 
 
          She explained that her itemization of travel expenses included 
 
         meals and added that Dr. Walker is still unpaid.
 
         
 
         
 
              Claimant reported that since her injury she has been 
 
         restricted somewhat in that she no longer sweeps floors, makes 
 
         beds, goes bowline, and has been instructed to limit twisting and 
 
         bending.  She said there are a lot of general household chores 
 
         she can no longer do.  She stated that she was uncertain whether 
 
         she could continue in factory work and was uncertain whether she 
 
         could do the job she was doing at the time of her injury.  
 
         Claimant reported that she has not been paid workers' 
 
         compensation since she returned to work on February 17, 1986.
 
         
 
              On cross-examination, claimant was questioned concerning her 
 
         job applications and prior work history.  She was also 
 
         extensively examined concerning her prior health history and 
 
         revealed several injuries she had suffered in the past.  Claimant 
 
         revealed that she had on occasion been treated for arthritic 
 
         problems.
 
         
 
              Claimant was questioned concerning the extent of and nature 
 
         of the examination conducted by Dr. Walker.  She indicated that 
 
         perhaps her back condition was worse at the time she saw Dr. 
 
         Walker because of the long drive to his office.
 
         
 
              Claimant stated that when she returned to work on February 
 
         17, 1986 she continued to do sonic welding but was not required 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   5
 
         
 
         
 
         to do any lifting.  She said at the time she quit defendants she 
 
         was not required to do any lifting.
 
         
 
              On redirect examination, claimant denied that any of her 
 
         prior accidents had caused back problems.
 
         
 
              Larry Fuller testified that he started living with claimant 
 
         in December 1984.  He said that at that time there was no 
 
         indication that claimant suffered any back problems and he was 
 
         not aware of the problems which had occurred in 1983.  Mr. Fuller 
 
         said he became aware of claimant's injury of September 16, 1985 
 
         after she came home from work and said she had hurt her back at 
 
         work.  He said he has continued to live with claimant since and 
 
         on some days claimant does not have pain but on other days she 
 
         appears to move around cautiously.  He said he does not believe 
 
         claimant tells him when her back is bothering her.  Mr. Fuller 
 
         reported that claimant had no limit on her lifting prior to the 
 
         injury, but now her lifting ability is somewhat limited.
 
         
 
              Mr. Fuller advised that it was his observation that sitting 
 
         seems to bother claimant if she has to do so for long.  He 
 
         reported that he was involved in the figurine business with 
 
         claimant and attributed the failure of that business to lack of 
 
         capital.  He reported that neither he nor claimant had any 
 
         expectation of receiving operating capital in the near future.
 
         
 
              On cross-examination, Mr. Fuller testified that they had 
 
         purchased a bus for $100 so claimant could lie down in the back 
 
         while they were traveling to distant places in connection with 
 
         their business.  He also described the severe mechanical problems 
 
         with claimant's automobile.
 
         
 
              Georgia Franks testified that she has been employed by 
 
         defendants since 1970.  She said she had held positions as 
 
         production worker, personnel manager, production manager, general 
 
         manager, and is now the plant manager.  She said defendants now 
 
         employ 185 people.  She reported that she was not claimant's 
 
         immediate supervisor at the time of the injury.
 
         
 
              Ms. Franks testified that claimant began employment with 
 
         defendants on February 14, 1983.  She reported that claimant did 
 
         well at the job for which she was initially employed.  Overall, 
 
         she described claimant as a very good worker and said she always 
 
         did her job very well.  She stated, however, that claimant was Oa 
 
         complainer" about a number of physical complaints prior to 
 
         September 1985.  She said she first became aware of the injury of 
 
         September 16, 1985 on the following day.  Ms. Franks stated that 
 
         claimant returned to work briefly on October 1, 1985 and then was 
 
         off work again.
 
         
 
              She said claimant did return to work on February 17, 1986 
 
         and was instructed not to lift any flats at that time.  The only 
 
         lifting required of claimant was about a ten ounce battery. she 
 
         said claimant stayed at that job for two weeks.  She said 
 
         claimant was then switched to soldering because they thought 
 
         claimant might like that position better.  She said claimant did 
 
         not make complaints of back problems after February 17, 1986.
 
         
 
              Ms. Franks testified that claimant worked until May 30, 1986 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   6
 
         
 
         
 
         when she quit.  She reported that claimant came into the office 
 
         and gave two weeks notice that she was leaving.  She said they 
 
         did not go into details at that time about her reasons for 
 
         leaving.  Claimant later came in and said that she wanted to 
 
         leave earlier because her business was going so well she needed 
 
         to be there to operate the business.  Ms. Franks said claimant 
 
         gave no indication she was quitting because of her back 
 
         condition.
 
         
 
              Ms. Franks testified that she observed claimant from her 
 
         return to work in February 1986 until the time she quit on May 
 
         30, 1986 . She reported that she saw no indication that claimant 
 
         was suffering from back pain.  Ms. Franks testified that based on 
 
         her observations of claimant, claimant would be able to do a 
 
         variety of  different jobs at defendants.  On cross-examination, 
 
         Ms. Franks testified that claimant's gross weekly wage was 
 
         $197.20.  She stated that prior to claimant's returning to work 
 
         they had a verbal release from the doctor that claimant could 
 
         return.  She said that when claimant returned in February 1986 
 
         there was no written release, but there was a verbal release and 
 
         a lifting limit of twenty pounds.  Ms. Franks testified, however, 
 
         that they did not want claimant to lift anything.  She stated 
 
         that the defendants could accept claimant with one hour sitting 
 
         restrictions, no lifting, bending or twisting.  She reported that 
 
         defendants have several sedentary type jobs.  She said defendants 
 
         would consider rehiring claimant depending upon her medical 
 
         restrictions and the qualifications of other applicants.  She 
 
         denied that defendants were angered at claimant because of the 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   7
 
         
 
         
 
         workers' compensation proceeding.  On rebuttal, claimant 
 
         testified that she did have complaints of pain between February 
 
         1986 and May 30, 1986.  She said she did report these problems 
 
         with other employees.  She said she did not report them to Ms. 
 
         Franks because she was told not to be complaining about her back.  
 
         She admitted, however, that she did leave her employment early 
 
         after telling Ms. Franks that her business was going well.
 
         
 
              Georgia Franks retook the stand and denied that she had told 
 
         claimant not to complain about her back.
 
         
 
              Claimant's exhibit 1 is a copy of the progress notes from 
 
         Park Clinic in Mason City, Iowa, concerning claimant.  A review 
 
         of these notes indicate that in June 1983 claimant was suffering 
 
         from a low back ache.  There is some notation that claimant 
 
         suffered arthritis and cramping in her hips and knees.  A 
 
         September 6, 1983 progress note indicates that claimant was again 
 
         suffering low back pain for which she was placed on Motrin and 
 
         Valium.  Apparently, the pain improved and claimant was released 
 
         to return to work.  Further review of the reports indicate that 
 
         claimant did suffer various ailments through and portions of 1984 
 
         primarily dealing with her blood sugar levels and upper 
 
         respiratory problems.  There is no indicated of back pain 
 
         reappearing until the note of October 7, 1985.  The diagnosis 
 
         given at that time indicates probable L5 radiculopathy.
 
         
 
              Claimant's exhibit 2 is a medical record from St. Joseph 
 
         Mercy Hospital dated August 30, 1983.  According to that report, 
 
         claimant reported with low lumbar back discomfort radiating down 
 
         the left buttock.  There is no indicated of any specific injury. 
 
          There is some indication that the pain extended into the left 
 
         leg.  The diagnosis at that time was low back strain.
 
         
 
              Claimant's exhibit 3 is progress notes from the North Iowa 
 
         Medical Center dated September 29, 1984.  This report concerns 
 
         claimant's complaint of chest pain.
 
         
 
              Claimant's exhibit 4 is Dr. Hunt's progress notes from 
 
         September 17, 1985 through October 2, 1985.  These reports 
 
         indicate that claimant was suffering from lower back discomfort 
 
         with pain down her left leg to her heel.  It also indicates some 
 
         right thigh discomfort.  It further indicates that there was no 
 
         specific incident of injury.  Diagnosis on September 17 was acute 
 
         back injury with left leg weakness.   Claimant was to see Dr. 
 
         Fisher.  Dr. Hunt's diagnosis was acute back strain with left 
 
         sciatica.  Dr. Hunt notes that while claimant was admitted to the 
 
         hospital a lumbosacral spine x-ray series revealed degenerative 
 
         disc disease at L4-L5 and L5-Sl with moderate scoliosis.  
 
         Included in the exhibit is a release to return to work for 
 
         claimant dated September 19, 1985 indicating that she could 
 
         return on September 23 with a fifteen pound lifting limit.
 
         
 
              Claimant's exhibit 5 is records from St. Joseph Mercy 
 
         Hospital concerning claimant's admission there from September 17, 
 
         1985 through September 19, 1985.  The history reflected in these 
 
         reports is consistent with that which has been previously 
 
         disclosed.  The admitting diagnosis was acute back strain with 
 
         left leg weakness, expect ruptured or bulging disc L3-Sl.  
 
         Discharge diagnosis was acute back strain with possible, L5 nerve 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   8
 
         
 
         
 
         root entrapment.  Claimant was given several instructions upon 
 
         discharge.
 
         
 
              Claimant's exhibit 6 contains some return to work slips 
 
         indicating that claimant would return to work certain 
 
         restrictions in 1985.  It also includes a physician's report by 
 
         T. C. Mead, M.D., dated October 6, 1985.  According to that 
 
         report, claimant suffered a herniated disc at L4-L5 which was 
 
         related solely to her injury.  Dr. Mead's progress notes are also 
 
         attached which cover the period from October 14, 1985 to December 
 
         16, 1985.  A review of these notes indicate that claimant 
 
         continued to suffer rather severe pain over that entire period of 
 
         time.  Claimant's exhibit 7 is an October 29, 1985 letter from 
 
         Dr. Mead to the insurance carrier.  According to that letter, Dr. 
 
         Mead felt that conservative therapy would be successful in 
 
         treating claimant.
 
         
 
              Claimant's exhibit 8 is a letter dated December 13, 1985 
 
         from Dr. Gislason and attached radiographic reports.  Dr. 
 
         Gislason indicates that claimant did have positive right leg 
 
         raising, but felt that conservative treatment would be 
 
         successful.  He also recommended steroidal injections to get her 
 
         started on a physical therapy program.  Dr. Gislason indicated 
 
         that it was his impression that claimant did have some sciatica 
 
         probably secondary to a good strain of her low back.  Claimant's 
 
         exhibit 9 also contains a letter from Dr. Gislason dated December 
 
         24, 1985 with an attached discharge summary.  His diagnosis was 
 
         degenerative disc disease L4-L5.  Claimant apparently had 
 
         negative straight leg raising at the time of her discharge.  
 
         Claimant's exhibit 10 is a letter dated January 28, 1986 from an 
 
         associate of Dr. Gislason, Elmer W. Lippmann, Jr., M.D., to the 
 
         insurance carrier.  Dr. Lippmann reported claimant had a full 
 
         range of motion and that his neurological examination was within 
 
         normal limits.  Claimant's exhibit 11 is a letter dated February 
 
         11, 1986 from Dr. Gislason to the insurance carrier.  According 
 
         to that letter, Dr. Gislason had last seen claimant on December 
 
         14.  He indicated that claimant continued to suffer many 
 
         complaints.  There were some positive findings, however, the 
 
         doctor indicated that he believed claimant could return to work 
 
         on Monday, February 17, 1986.  He said that her work schedule 
 
         should be tempered so she can handle it on an increasing basis.  
 
         Attached to claimant's exhibit 11 is an April 18, 1986 report 
 
         from Dr. Gislason to the insurance carrier which reports the 
 
         results of his examination on April 15, 1986.  Dr. Gislason 
 
         indicated that degenerative disc disease does not result from a 
 
         single isolated incident, however, stated that her disability did 
 
         commence on September 16, 1985, and that it was the result of her 
 
         injury.  Dr. Gislason assessed a ten percent permanent partial 
 
         disability to the claimant as a result of her back condition.
 
         
 
              Claimant's exhibit 12 is a copy of a report dated June 23, 
 
         1986 which concerns claimant's automobile accident with the deer. 
 
          This reports that claimant did have muscle spasms in the upper 
 
         and lower back.  X-ray examinations, however, indicated that 
 
         there was no significant change from her prior examination.
 
         
 
              Claimant's exhibit 13 is a letter dated July 10, 1986 from 
 
         T. C. Mead, M.D., to the insurance carrier.  This letter very 
 
         briefly reviews Dr. Mead's treatment of the claimant.  Dr. Mead 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page   9
 
         
 
         
 
         indicates that although claimant did have some preexisting 
 
         degenerative disc disease, it was his opinion that the symptoms 
 
         were initiated as a result of her employment at the defendants.  
 
         Claimant's exhibit 14 is a letter dated July 15, 1986 from Dr. 
 
         Gislason discussing whether or not the September 16, 1985 injury 
 
         materially aggravated the underlying disc disease suffered by 
 
         claimant.  It also includes an August 26, 1986 letter from Dr. 
 
         Gislason.  Read together, these indicate that it is Dr. 
 
         Gislason's opinion that while the injury did not cause the 
 
         degenerative disc problem, it did aggravate it.  He said that if 
 
         a division of percentage is necessary he would estimate 75 
 
         percent of the disability due to the industrial accident with 25 
 
         percent being the result of the preexisting condition.
 
         
 
              Claimant's exhibit 15 is a detailed report from John R. 
 
         Walker, M.D., dated July 18, 1985.  Dr. Walker's findings are set 
 
         forth in considerable detail.  He concludes that claimant did 
 
         have a preexisting problem.  At the same time, however, he points 
 
         out that claimant did not have symptoms of her preexisting 
 
         condition prior to the work injury for which he concludes that 
 
         the cause of her problem was the work-related injury.  Dr. Walker 
 
         assessed claimant's total permanent disability at 20 percent of 
 
         the body as a whole and indicated that 10 percent was the result 
 
         of a preexisting condition and 10 percent was added because of 
 
         her work-related injury.  He recommended that claimant not return 
 
         to heavy work.  Claimant's exhibit 16 is reports from Dr. Emerson 
 
         dated August 14, 1986.  There is a detailed review of claimant's 
 
         history and a finding that claimant has low back and bilateral 
 
         leg symptoms perhaps secondary to protruded intervertebral disc 
 
         at L4-5.  Dr. Emerson estimated claimant's permanent partial 
 
         impairment to be 10 percent of the body as a whole.
 
         
 
              Claimant's exhibit 17 is medical records from St. Joseph 
 
         Mercy Hospital concerning her admission on August 29, 1986.  Her 
 
         attending physician was R. McCoy, M.D.  There is again a 
 
         considerable history set forth.  Dr. McCoy indicates that 
 
         claimant has a very difficult problem to resolve.  He indicated 
 
         that he was not able to find evidence of neurological deficit or 
 
         evidence of definite nerve root irritation.  The final diagnosis 
 
         was severe low back pain with bilateral sciatica, right greater 
 
         than left.  The report also contains a psychological evaluation 
 
         of the claimant.  The principal discharge diagnosis from Mercy 
 
         Hospital was low back pain probably secondary to a herniated L4-5 
 
         disc.  Claimant's exhibit 18 is a letter dated September 26, 1986 
 
         from Raymond L. Emerson, M.D., in which Dr. Emerson indicates 
 
         that the motor vehicle accident on June 23, 1986 was not a 
 
         contributing problem to claimant's present disability, and 
 
         further indicated that he believed claimant suffered a 10 percent 
 
         body as a whole injury as a result of her work-related incident.  
 
         Claimant's exhibit 19 is a list of unpaid medical bills incurred 
 
         by claimant.  These will be set forth in the findings of fact.  
 
         Claimant's exhibit 20 is a record of claimant's mileage expenses.  
 
         Claimant's exhibit 21 is a copy of claimant's weekly earnings 
 
         from May 20, 1985 through September 15, 1985.  Attached thereto 
 
         is a copy of claimant's wage statement.  Claimant's exhibit 22 is 
 
         a bill from Dr. Walker in the amount of $306.  Claimant's exhibit 
 
         23 is a bill for $20 for a medical report.  Claimant's exhibit 24 
 
         is a copy of an attending physician's statement by Dr. Emerson to 
 
         the defendants.  Claimant's exhibit 25 is a copy of a physical 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  10
 
         
 
         
 
         activity assessment of claimant by Dr. Emerson.
 
         
 
              Defendants' exhibit A contains copies of the return to work 
 
         slips which have been previously discussed in claimant's 
 
         exhibits.  Defendants' exhibit B is a copy of a voluntary 
 
         termination by claimant dated May 29, 1986 which indicates that 
 
         claimant's sole and exclusive reason for leaving is that she had 
 
         her own business to run on a full-time basis.  Defendants' 
 
         exhibit C is a computer printout of medical treatment received by 
 
         claimant on December 10, 1985 at St. Joseph Hospital.  
 
         Defendants' exhibit D is a copy of claimant's attendance record.  
 
         Defendants' exhibit E is a copy of a towing charge dated January 
 
         7, 1986 to claimant for trying to start a Ford Escort.
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              The first matter for determination is whether claimant 
 
         suffered permanent partial disability and, if so, whether it was 
 
         causally related to her work injury.  Numerous medical reports in 
 
         the record including reports from Doctors Emerson, Walker, and 
 
         Gislason indicate that claimant does indeed suffer from permanent 
 
         partial disability.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of September 16, 1985 is causally 
 
         related to the disability on which he now bases his claim.  
 
         Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  
 
         Lindahl v. L. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The question of: causal connection is essentially within 
 
         the domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d l67 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.   Id. at 907.   Further, the weight 
 
         to be given to such an opinion is for the finder of fact, and 
 
         that may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.   Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              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 760-761 (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).
 
         
 
              Not only do the medical reports indicate that claimant 
 
         suffers permanent disability, there seems to be little debate 
 
         among the medical experts that claimant suffered a preexisting 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  11
 
         
 
         
 
         condition.  At the same time, however, those experts clearly 
 
         indicate that claimant's condition was materially aggravated at 
 
         work due to the fact that she did not have prior disability in 
 
         her low back.  The records do reflect that claimant suffered a 
 
         problem in 1983, however, it is clear that this was a temporary 
 
         aggravation and that claimant did not suffer continuing a 
 
         long-term disability as a result.  Accordingly, the record herein 
 
         establishes that there is a causal relationship between the 
 
         injury suffered by claimant on September 16, 1985 and her 
 
         subsequent disability.   It should be noted that not only do the 
 
         doctors agree as to the causal relationship, there appears to be 
 
         very little disagreement among the doctors as to the extent of 
 
         the permanent functional impairment suffered by claimant.  Dr. 
 
         Gislason assigned an impairment rating of 10 percent although he 
 
         later said that probably 25 percent of that rating is 
 
         attributable to the preexisting condition.   This would mean then 
 
         that Dr. Gislason has assigned claimant a 7 1/2 percent permanent 
 
         partial impairment as a result of the injury.  Likewise, Dr. 
 
         Walker assesses a 20 percent body as a whole impairment, but 
 
         reduces this impairment rating by 10 percent as a result of 
 
         preexisting conditions.  Dr. Emerson does not engage in dividing 
 
         up the disability between preexisting problems and subsequent 
 
         problems but did assign an impairment rating of 10 percent of the 
 
         body as a whole.  The record, thus, establishes rather 
 
         convincingly that claimant suffers a 10 percent body as a whole 
 
         impair-anent as a result of the work-related condition.
 
         
 
              Functional disability is an element to be considered in 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  12
 
         
 
         
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 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 later to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         These are matters which the finder of fact considers collectively 
 
         in arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 
         motivation - five percent; work experience - thirty percent, etc.  
 
         Neither does a rating of functional impairment directly correlate 
 
         to a degree of industrial disability to the body as a whole.  In 
 
         other words, there are no formulae which can be applied and then 
 
         added up to determine the degree of industrial disability. it 
 
         therefore becomes necessary for the deputy or commissioner to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, 
 
         February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, 
 
         March 26, 1985).
 
         
 
              This is not a case where the defendants refuse to return the 
 
         employee to work.  Defendants did return claimant to work and did 
 
         make every effort to accommodate her physical limitations.  It is 
 
         clear that it was claimant's decision to leave her employment to 
 
         engage in her business enterprise.  Certainly, the work injury 
 
         was a factor in this consideration since claimant as a 
 
         self-employed would have greater control over her activities.  
 
         Defendants, however, cannot be considered under such 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  13
 
         
 
         
 
         circumstances to have refused claimant employment, nor is the 
 
         record sufficient to make a finding that claimant could not 
 
         physically return to her previous employment.  It is clear on 
 
         this record that the defendants did have jobs available to 
 
         claimant that she could do within her restrictions and were 
 
         willing to make those jobs available to her.
 
         
 
              There are, however, other factors which indicate that 
 
         claimant has suffered industrial disability.  She has a limited 
 
         educational background and her prior work experience is in 
 
         physical menial labor.  It is noted, however, that claimant is 
 
         not inexperienced in the operation of her own business and did so 
 
         for five years with her husband.  The type of injury suffered by 
 
         claimant is the type most disabling to an individual who has her 
 
         type of prior work experience.  Claimant was impressive as to her 
 
         desire to return to work and become gainfully employed.  She 
 
         would appear to be intellectually, emotionally, and physically 
 
         capable of some types of employment.  She has not established 
 
         that she is an odd-lot employee in that the only type of work 
 
         available to her is of such limited quantity and quality as to 
 
         render her permanently and totally disabled.  Based upon all of 
 
         the factors of industrial disability, claimant has established a 
 
         permanent partial disability for industrial purposes equal to 35 
 
         percent of the body as a whole.
 
         
 
              Since this is an injury producing permanent disability, 
 
         defendants are obligated to pay claimant healing period benefits 
 
         as defined in section 85.34(l).  The record discloses that 
 
         claimant was off work from September 17, 1985 to February 17, 
 
         1986.  She did, however, return to work briefly on October 1, 
 
         1985 and defendants are not required to pay compensation for that 
 
         day.  Claimant contends that she is entitled to additional healing 
 
         period commencing July 1, 1986 and continuing to the present.  
 
         She has not established that she is so entitled.  She has not 
 
         established whether her lack of ability to work from September or 
 
         from July 1, 1986 to the present was a result of her condition or 
 
         the result of the failure of her business enterprise.  In any 
 
         event, claimant has submitted at least three different medical 
 
         reports that indicate she did achieve maximum medical recovery 
 
         prior to the present time.  The records indicate that claimant 
 
         did achieve maximum medical recovery on April 18, 1986 which was 
 
         subsequent to her return to work.  Claimant should, however, be 
 
         permitted to recover temporary total disability benefits for the 
 
         period from August 29, 1986 to and including September 4, 1986 
 
         for the period in which she was admitted to St. Joseph Mercy 
 
         Hospital.  Thus, the record establishes that claimant is entitled 
 
         to healing period benefits for the period from September 17, 1985 
 
         to October 1, 1985, and from October 2, 1985 to February 16, 
 
         1986.  Permanent partial disability benefits shall commence as of 
 
         February 17, 1986 and continue to August 29, 1986.  Additional 
 
         healing period or temporary total disability payments should 
 
         commence August 29, 1986 and continue to September 5, 1986 at 
 
         which time permanent partial disability payments shall 
 
         recommence.
 
         
 
              Claimant has established that she is entitled to 
 
         reimbursement for the examination by Dr. Walker under provisions 
 
         of section 85.39 in the amount of $306.  Pursuant to claimant's 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  14
 
         
 
         
 
         exhibit 19, defendants are directed to pay the following medical 
 
         expenses:
 
         
 
              North Iowa Medical Center                  $   87.00
 
              Radiologists of Mason City                     21.00
 
              Surgical Associates, P.C.                     243.00
 
              Mercy Hospital                              2,088.72
 
              Reimburse claimant for prescriptions costs     14.49
 
         
 
              Claimant also requests reimbursement for 328 miles travel to 
 
         secure medical treatment and payment should accordingly be 
 
         ordered.  Claimant should be reimbursed at the rate of $.24 per 
 
         mile.
 
         
 
              Claimant also seeks an adjustment in her rate of 
 
         compensation.  The basis of this adjustment is claimant's desire 
 
         to exclude certain incomplete work weeks which were included in 
 
         the calculation of her rate.  Claimant's request is consistent 
 
         with prior holdings of the agency which have interpreted section 
 
         85.36 to require a determination of weekly earnings based on full 
 
         or completed weeks.  See Lewis v. Alfs Manufacturing Co., I 
 
         Industrial Commissioner Report 206, Appeal Decision 1980, and 
 
         Schotanus v. Command Hydraulics, Inc., I Industrial Commissioner 
 
         Report 294 (1981).  Accordingly, claimant's rate of compensation 
 
         is adjusted to $133.77.
 
         
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, the following facts are found:
 
         
 
              1.  On September 16, 1985 claimant suffered an injury to her 
 
         low back while at work.
 
         
 
              2.  As a result of the low back injury, claimant was off 
 
         work from September 17, 1985 through September 30, 1985 and from 
 
         October 2, 1985 through February 16, 1986.
 
         
 
              3.  As a result of her injury, claimant suffered permanent 
 
         disability.
 
         
 
              4.  Claimant's low back injury resulted in a protruded 
 
         intervertebral disc at L4-L5.
 
         
 
              5.  Claimant's injury produced impairment to the body as a 
 
         whole equal to 10 percent.
 
         
 
              6.  Claimant has an eighth grade education and work 
 
         experience primarily limited to manual labor.
 
         
 
              7.  Defendants returned claimant to work following his 
 
         injury.
 
         
 
              8.  Claimant quit her employment voluntarily in May 1986 for 
 
         a variety of reasons.
 
         
 
              9.  Claimant is capable of doing light duty work.
 
         
 
             10.  Claimant has incurred the following medical expenses for 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  15
 
         
 
         
 
         which she is entitled to reimbursement:
 
         
 
                  a.  Mileage            $78.72 
 
                  b.  Prescriptions       14.99
 
         
 
             11.  Claimant is entitled to reimbursement for an independent 
 
         medical examination pursuant to section 86.39 in the amount of 
 
         $306.00.
 
         
 
             12.  Claimant has incurred the following medical expenses 
 
         which remain unpaid:
 
         
 
              a. North Iowa Medical Center          $    87.00
 
              b. Radiologists of Mason City              21.00
 
              c. Surgical Associates, P.C.              243.00
 
              d. Mercy Hospital                       2,088.72
 
         
 
             13.  Defendants have previously paid claimant weekly 
 
         compensation for the period from September 16, 1985 through 
 
         February 16, 1986, except for three weeks.
 
         
 
             14.  Claimant was temporarily totally disabled from August 
 
         29, 1986 through September 4, 1986.
 
         
 
             15.  Claimant's industrial disability resulting from the work 
 
         injury is 35 percent of the body as a whole.
 
         
 
             16.  Claimant's average weekly wage at the time of her injury 
 
         was $211.47 and she was single with one exemption.
 
         
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              IT IS THEREFORE CONCLUDED:
 
         
 
              Claimant has proven by a preponderance of the evidence that 
 
         she received an injury arising out of and in the course of her 
 
         employment on September 16, 1985.
 
         
 
              Claimant has proven by a preponderance of the evidence that 
 
         there is a causal relationship between her injury and the 
 
         disability and medical expenses upon which this claim is based.
 
         
 
              Claimant has proven by a,preponderance of the evidence that 
 
         she suffered permanent partial disability as a result of her 
 
         injury equal to thirty-five percent (35%) of the body as a 
 
         whole.
 
         
 
              Claimant has proven by a preponderance of the evidence that 
 
         she is entitled to reimbursement for an independent medical 
 
         examination.
 
         
 
              Claimant has proven by a preponderance of the evidence that 
 
         her rate of compensation is one hundred thirty-three and 77/100 
 
         dollars ($133.77).
 
         
 
                                      ORDER
 
         
 
              IT IS THEREFORE ORDERED that defendants pay unto claimant 
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  16
 
         
 
         
 
         healing period benefits from September 17, 1985 through September 
 
         30, 1985 and from October 2, 1985 through February 16, 1986 for a 
 
         total of twenty-one and five-sevenths (21 5/7) weeks; permanent 
 
         partial disability benefits from February 17, 1986 through August 
 
         28, 1986 and from September 5, 1986 and continuing until a total 
 
         of one hundred seventy-five (175) weeks shall have been paid; and 
 
         temporary total disability benefits from August 29, 1986 through 
 
         September 4, 1986 for a total of one (1) week.  All weekly 
 
         compensation shall be paid at the rate of one hundred 
 
         thirty-three and 77/100 dollars ($133.77).  All accrued payments 
 
         shall be paid in a lump sum together with statutory interest 
 
         thereon.
 
         
 
         
 
              IT IS FURTHER ORDERED that defendants be given credit for 
 
         eighteen and five-sevenths (18 5/7) weeks of compensation 
 
         previously paid at the rate of one hundred twenty-five and 79/100 
 
         dollars ($125.79).
 
         
 
              IT IS FURTHER ORDERED that defendants pay unto claimant for 
 
         reimbursement of expenses the following:
 
         
 
              a.  Dr. Walker                   $  306.00
 
              b.  Prescriptions                    14.49
 
              c.  Mileage                          78.72
 
         
 
              IT IS FURTHER ORDERED that defendants pay the following 
 
         medical expenses:
 

 
         
 
         
 
         
 
         BETTS V. ALEXANDER MANUFACTURING COMPANY
 
         Page  17
 
         
 
         
 
         
 
              a.  North Iowa Medical Center    $   87.00
 
              b.  Radiologists of Mason City       21.00
 
              c.  Surgical Associates, P.C.       243.00
 
              d.  Mercy Hospital                2,088.72
 
          
 
              All accrued payments shall be made in a lump sum with 
 
         interest.
 
         
 
              The costs of this action are taxed to the defendants.
 
         
 
              Defendants are to file an activity report upon completion of 
 
         this award.
 
         
 
              Signed and filed this 9th day of April, 1987.
 
         
 
         
 
         
 
         
 
                                          STEVEN E. ORT
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Robert S. Kinsey III
 
         Attorney at Law
 
         P.O. Box 679
 
         214 N. Adams
 
         Mason City, Iowa 50401
 
         
 
         Mr. Michael A. McEnroe
 
         Attorney at Law
 
         P.O. Box 810
 
         3151 Brockway Road
 
         Waterloo, Iowa 50704
 
         
 
         
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                     1402.40; 1802; 1801
 
                                                     1803; 3000
 
                                                     Filed 4-9-87
 
                                                     Steven E. Ort
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         PEGGY L. BETTS,
 
         
 
              Claimant,
 
                                                  File. No. 804631
 
         VS.
 
         
 
         ALEXANDER MANUFACTURING               A R B I T R A T I 0 N
 
         COMPANY,
 
                                                  D E C I S I 0 N
 
              Employer,
 
         and
 
         
 
         KEMPER GROUP,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         1402.40; 1802; 1801; 1803; 3000
 
         
 
              This was essentially an extent of disability issue.  
 
         Claimant suffered a back injury resulting in 7-10% functional 
 
         impairment without surgery.  Defendants had returned claimant to 
 
         work and put her on very light duty.  Claimant quit work for 
 
         personal reasons and perhaps in part because of her injury.  
 
         Claimant was awarded 35% permanent partial disability, additional 
 
         three weeks of healing period and 6/7 weeks of temporary total 
 
         disability.  Rate was calculated on 13 week average, excluding 
 
         two incomplete weeks.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     
 
         
 
                 BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         PAMELA PULJU,
 
         
 
              Claimant,                               File Nos. 804656
 
                                                                814502
 
         vs.
 
                                                        A P P E A L
 
         IBP, INC.,
 
                                                      D E C I S I O N
 
              Employer,
 
              Self-Insured,
 
                                                         F I L E D
 
         and
 
                                                        JUL 24 1989
 
         SECOND INJURY FUND OF IOWA
 
                                                     INDUSTRIAL SERVICES
 
              Defendants.
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Defendant Second Injury Fund of Iowa appeals from an 
 
         arbitration decision awarding permanent partial disability 
 
         benefits as the result of alleged injuries on September 1, 1984 
 
         and August 1, 1985.  Appeals by the claimant and the employer 
 
         have been resolved by an agreement of settlement approved March 
 
         31, 1989.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration hearing; claimant's exhibits 1 through 19; employer's 
 
         exhibits A through D; and second injury fund exhibits 1 through 
 
         8. All parties filed briefs on appeal.
 
         
 
                                       ISSUES
 
         
 
              Defendant second injury fund states the following issues on 
 
         appeal:
 
         
 
                I.  The deputy erred in failing to find that claimant was 
 
         not a credible witness.
 
         
 
               II.  The deputy erred in finding that claimant sustained a 
 
         left hand injury as alleged on September 1, 1984, or right hand 
 
         injury on August 1, 1985.
 
         
 
              III.  The deputy erred in finding that claimant has 
 
         permanent disability as a result of her right hand, left hand and 
 
         right knee conditions.
 
         
 
               IV.  The deputy erred in finding that claimant is entitled 
 
         to second injury fund benefits.
 
                                                
 
                                                         
 
         
 
                V.  The deputy erred in awarding interest against the 
 
         fund.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be set forth herein.
 
         
 
                                 APPLICABLE LAW
 
         
 
              The citations of law in the arbitration decision are 
 
         appropriate to the issues and the evidence.
 
         
 
                                  ANALYSIS
 
         
 
              The Second Injury Fund of Iowa (hereinafter the Fund) 
 
         alleges the deputy failed to pass on the claimant's credibility.  
 
         The Fund asserts that claimant made allegedly inconsistent 
 
         statements, failed to report part of her work history subsequent 
 
         to the injury, and asserts that claimant "has a mendacious 
 
         character" and is a "faker".
 
         
 
              A witness is presumed to be truthful unless and until the 
 
         witness' credibility is brought into question.  Even assuming 
 
         that the Fund raised the issue of claimant's credibility by its 
 
         cross-examination of claimant, the record does not disclose any 
 
         indication of a lack of credibility on the part of claimant. 
 
         Claimant worked at two positions of short duration subsequent to 
 
         her injury that the Fund alleges were not adequately disclosed. 
 
         Claimant was cross-examined on these omissions and offered an 
 
         explanation.  Taken as a whole, the record does not disclose a 
 
         lack of credibility on the part of the claimant
 
         
 
              The Fund also asserts that claimant has failed to show that 
 
         her present left and right hand conditions are causally related 
 
         to her employment.  However, the record contains the testimony of 
 
         Ronald A. Dierwechter, M.D., which does establish a causal 
 
         connection between claimant's hand conditions and her employment. 
 
         Although Dr. Dierwechter indicated this connection by checking a 
 
         box on a form without further elaboration, Dr. Dierwechter's 
 
         causal connection opinion is uncontroverted in the record. 
 
         Claimant has established by the greater weight of the evidence 
 
         that her present hand conditions were causally connected to her 
 
         employment.
 
         
 
              The Fund urges that claimant has not shown that her leg and 
 
         right and left hand conditions are permanent.  In regards to 
 
         claimant's right and left hands, several doctors offered ratings 
 
         of permanent impairment.  Oscar M. Jardon, M.D., rated both hands 
 
         as being five percent impaired.  Keith O. Garner, M.D., rated each 
 
         hand at 10 percent.  A. J. Wolbrink, M.D., rated claimant's left 
 
         hand as 11 percent impaired, and the right hand "as 7 percent.  
 
         The Fund stresses the fact that Dr. Dierwechter and Peter D. 
 
         Wirtz, M.D., rated claimant's hands at zero percent impairment.  
 
                                                
 
                                                         
 
         The Fund also notes that Mark Schultz, M.D., indicated that 
 
         claimant had "full use" of her limbs in 1986.
 
         
 
              Claimant has been given permanent ratings of impairment by 
 
         some of her.doctors, and ratings of no impairment by other 
 
         doctors.  Dr. Schultz' examination of claimant appears to have 
 
         been a general evaluation only, and did not result in a rating of 
 
         "zero" impairment, but only a general statement as to "full use" 
 
         of her limbs.  Dr. Schultz is apparently a general practitioner. 
 
         The opinions of Dr. Wirtz and Dr. Dierwechter did rate claimant's 
 
         hand impairments as zero.  Dr. Dierwechter's statements were made 
 
         shortly after claimant's carpal tunnel surgeries.  Dr. Wirtz's 
 
         opinion of zero impairment of claimant's hands was based at least 
 
         in part on an EMG study, and was the most recent evaluation of 
 
         claimant's condition.  Claimant expressed dissatisfaction with 
 
         the manner in which the EMG was performed.  Although Dr. Wirtz' 
 
         report is admitted into the record and appears on his letterhead 
 
         stationery, it is not signed by him.
 
         
 
              Claimant's testimony and that of her mother indicate that 
 
         claimant does continue to suffer impairment of her hands.  The 
 
         record is unclear whether claimant passed a manual dexterity test 
 
         before working for Aalf's.  Claimant has no permanent 
 
         restrictions.
 
         
 
              Based on the greater weight of the medical evidence, it is 
 
         concluded that claimant has a five percent permanent partial 
 
         impairment of each hand.
 
         
 
              The Fund also alleges that claimant has not shown permanent 
 
         impairment of the right leg.  However, the record shows that Dr. 
 
         Keane anticipated that claimant would have a 20 percent 
 
         impairment of the right leg following the recovery from the 
 
         motorcycle accident.  Claimant was later seen by Dr. Garner, who 
 
         rated claimant's right leg as 25 percent impaired.  The other 
 
         medical evidence indicates claimant cannot stand for prolonged 
 
         periods of time because of her leg condition, and that her foot 
 
         irregularities as a result of that accident result in back pain. 
 
         Claimant has shown that her right leg condition has resulted in 
 
         permanent impairment.
 
         
 
              The Fund next urges that claimant is not entitled to 
 
         benefits from the second injury fund.  The Fund requests an 
 
         interpretation of Irish v. McCreary Saw Mill, 175 N.W.2d 364 
 
         (Iowa 1970) requiring that a "first" injury for purposes of the 
 
         second injury fund result in at least a 90 percent impairment 
 
         before the Fund is liable for compensation.  Such a reading of 
 
         Irish is unreasonable.
 
         
 
              The Fund's final issue on appeal concerns the obligation of 
 
         the Fund to pay interest on unpaid compensation.  The case of 
 
         Braden v. Big W Welding Service, Appeal Decision, October .28, 
 
         1988, established that the Fund is not liable for interest 
 
         payments.
 
         
 
                                                
 
                                                         
 
                             FINDINGS OF FACT
 
         
 
              1.  Claimant sustained a carpal tunnel injury to her left 
 
         hand on September 1, 1984 which arose out of and in the course of 
 
         her employment with employer.
 
         
 
              2.  Claimant sustained a carpal tunnel injury to her right 
 
         hand on August 1, 1985 which arose out of and in the course of 
 
         her employment with employer.
 
         
 
              3.  Dr. Dierwechter, the surgeon for both of the carpal 
 
         tunnel surgeries, stated that the carpal tunnel injuries were 
 
         caused by claimant's employment.
 
         
 
              4.  Claimant performed several repetitive jobs with her 
 
         hands while working for employer.
 
         
 
              5.  The carpal tunnel injuries were the cause of a permanent 
 
         partial impairment of five percent to each hand.
 
         
 
              6.  Claimant sustained a severe injury to her right leg on 
 
         June 10, 1973 in a motorcycle accident.
 
         
 
              7.  Claimant sustained permanent partial impairment of 25 
 
         percent of her right leg due to this injury of June 10, 1973.
 
 
 
                             
 
                                                         
 
         
 
              8.  Claimant has no medical restrictions due to any of these 
 
         injuries.
 
         
 
              9.  Claimant is 35 years old, has a high school education, 
 
         and has experience as a secretary, bookkeeper, accountant, cook, 
 
         nurse's aide, bartender, production line worker and driving a 
 
         truck and a school bus.
 
         
 
              10.  Claimant had an industrial disability of 20 percent as 
 
         a result of the non-compensable right leg injury of June 10, 1973 
 
         and the left hand injury of September 1, 1984.
 
         
 
              11.  Claimant has an industrial disability of 25 percent as 
 
         a result of the non-compensable right leg injury on June 10, 
 
         1973, the left hand injury on September 11, 1984, and the right 
 
         hand injury of August 1, 1985.
 
         
 
                           CONCLUSIONS OF LAW
 
         
 
              Claimant sustained an injury on September 1, 1984 and 
 
         another injury on August 1, 1985 which arose out of and in the 
 
         course of employment with employer.
 
         
 
              Both injuries were the cause of permanent disability.
 
         
 
              Claimant is entitled to 9.5 weeks of permanent partial 
 
         disability as a result of the injury to the left hand on 
 
         September 1, 1984 and 9.5 weeks of permanent partial disability 
 
         as a result of the injury to the right hand on August 1, 1985.
 
         
 
              The disability attributable.to the non-compensable injury to 
 
         the right leg on June 10, 1973 is equivalent to 55 weeks.
 
         
 
              The overall industrial disability as a result of the 
 
         injuries of June 10, 1973, September 1, 1984 and August 1, 1985 
 
         is 75 percent.  Prior to the August 1, 1985 injury claimant had 
 
         an industrial disability of 20 percent.
 
         
 
              The obligation of the Fund is 51 weeks of permanent partial 
 
         disability benefits, 35.5 at the rate of $180.19 and 15.5 weeks 
 
         at the rate of $188.67.
 
         
 
              Claimant's entitlement to healing period compensation has 
 
         been fully paid.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed and 
 
         modified.
 
         
 
                                   ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendant employer pay to claimant nine point five 
 
         (9.5) weeks of permanent partial disability benefits at the rate 
 
                                                
 
                                                         
 
         of one hundred eighty and 19/100 dollars ($180.19) per week for 
 
         the injury of September 1, 1984 in the total amount of one 
 
         thousand seven hundred eleven and 81/100 dollars ($1,711.81) 
 
         commencing on October 6, 1984, at the end of the healing period.
 
         
 
              That defendant employer.pay to claimant nine point five 
 
         (9.5) weeks of permanent partial disability benefits at the rate 
 
         of one hundred eighty-eight and 67/100 dollars ($188.67) per week 
 
         for the injury of August 1, 1985 in the total amount of one 
 
         thousand seven hundred ninety-two.and 37/100 ($1,792.37) 
 
         commencing March 4, 1986, as stipulated.
 
         
 
              That defendant Second Injury Fund of Iowa pay to.claimant 
 
         thirty-five point five (35.5) weeks of permanent partial 
 
         disability benefits at the rate of one hundred eighty and 19/100 
 
         dollars ($180.19) per week in the total amount of six thousand 
 
         three hundred ninety-six and 75/100 dollars ($6,396.75) 
 
         commencing December 10, 1985 and an additional fifteen point five 
 
         (15.5) weeks of permanent partial disability benefits at the rate 
 
         of one hundred eight-eight and 67/100 dollars ($188.67) per week 
 
         commencing May 8, 1986 in the total amount of two thousand nine 
 
         hundred twenty-four and 38/100 dollars ($2,924.38).
 
         
 
              That all accrued benefits are to be paid in a lump sum.
 
         
 
              That interest on the employee's portion of this award will 
 
         accrue pursuant to Iowa Code section 85.30.
 
         
 
              That the costs of this action are to be paid by employer and 
 
         Second Injury Fund of Iowa equally.  The costs of appeal, 
 
         including the costs of preparing the transcript, shall be paid by 
 
         the second injury fund.
 
         
 
              That defendants file claim activity reports as requested by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
         
 
              Signed and filed this 24th day of July, 1989.
 
         
 
         
 
         
 
         
 
         
 
                                                    DAVID E. LINQUIST
 
                                                 INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Steven Hamilton
 
         Attorney at Law
 
         606 Ontario St.
 
         Storm Lake, Iowa  50588
 
         
 
         Mr. Harry Dahl
 
                                                
 
                                                         
 
         Attorney at Law
 
         974 73rd St. Ste. 16
 
         Des Moines, Iowa  50312
 
         
 
         Mr. Robert D. Wilson
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Bldg.
 
         Des Moines, Iowa  50319
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                   
 
                                            1401, 2906, 1108.50
 
                                            1803, 2602, 3203, 3800
 
                                            Filed July 24, 1989
 
                                            DAVID E. LINQUIST
 
         
 
                 BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         PAMELA PULJU,
 
         
 
              Claimant,
 
                                                     File  Nos. 804656
 
         vs.                                                    814502
 
         
 
         IBP, INC.,
 
                                                        A P P E A L
 
              Employer,
 
              Self-Insured,
 
                                                     D E C I S I 0 N
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA
 
         
 
              Defendants.
 
         
 
         
 
         1401, 2906
 
         
 
              Held that a deputy is not required to rule on a witness' 
 
         credibility unless credibility is attacked and placed in issue at 
 
         the hearing.
 
         
 
         1108.50
 
         
 
              A doctor's medical report, which merely checked a box 
 
         indicating the injury was work related, held sufficient to 
 
         establish causal connection between claimant's condition and her 
 
         work where such evidence is uncontroverted.
 
         
 
         1803, 2602, 2906
 
         
 
              Some of claimant's physicians rated her hand impairment as 
 
         zero, others assigned varying percentages of impairment. 
 
         Claimant's testimony and that of her mother as to claimant's loss 
 
         of function in daily activities following her injury noted to 
 
         corroborate medical testimony assigning a rating of medical 
 
         impairment.  Held that the greater weight of the evidence 
 
         established permanency.
 
         
 
         3203
 
         
 
              The Second Injury Fund's argument that Irish v. McCreary Saw 
 
         Mill, 175 N.W.2d 364 (Iowa 1970) requires that a "first" injury 
 
         for purposes of the Second Injury Compensation Act must result in 
 
         at least a 90 percent impairment to trigger Fund liability was 
 
                                                
 
                                                         
 
         rejected as contrary to both that case.and the statute.
 
         
 
         3203, 3800
 
         
 
              The Fund's argument that it was not liable for interest 
 
         affirmed pursuant to Braden v. Big W Welding Service, (appeal 
 
         decision, October 28, 1988).
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         PAMELA PULJU,
 
         
 
              Claimant,
 
                                                   File Nos.  804656
 
         vs                                                   814502
 
         
 
         IBP, INC.,                              A R B I T R A T I 0 N
 
         
 
              Employer,                             D E C I S I 0 N
 
              Self-Insured,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Pamela Pulju, 
 
         claimant, against IBP, Inc., employer, and Second Injury Fund of 
 
         Iowa for benefits as the result of an alleged injury to the left 
 
         hand which occurred on September 1, 1984 and an alleged injury to 
 
         the right hand which occurred on August 1, 1985.  A hearing was 
 
         held on April 17, 1987 at Storm Lake, Iowa and the case was fully 
 
         submitted at the close of the hearing.  The record consists of 
 
         claimant's exhibits 1 through 19; employer's exhibits A through 
 
         D; Second Injury Fund exhibits 1 through 8; and the testimony of 
 
         Pamela Pulju (claimant), Ilene Hogancamp (claimant's mother) and 
 
         Clare Petersen (hiring representative).  Defendant employer and 
 
         defendant Second Injury Fund of Iowa supplied a transcript of the 
 
         hearing to the industrial commissioner's file.  All three 
 
         attorneys filed outstanding briefs.
 
         
 
                                      BRIEFS
 
         
 
              All attorneys were directed to file briefs by June 17, 1987. 
 
          The time could be extended by mutual agreement by all three 
 
         attorneys.  Claimant's brief was filed late on July 30, 1987.  
 
         Counsel for employer agreed to an extension of time, but counsel 
 
         for the second injury fund did not.  Counsel for the second 
 
         injury fund objected to the late filing of claimant's brief.  
 
         Therefore, claimant's brief is excluded and will not be 
 
         considered in the determination of this case.
 
         
 
                             PRELIMINARY MATTER
 
         
 
              The prehearing report stated that claimant requests payment 
 
         for an independent medical examination.  Employer claims that an 
 
         independent medical examination was not authorized.  The hearing 
 
         assignment order did not designate that an Iowa Code section 
 
         85.39 examination was one of the hearing issues as the result of 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   2
 
         
 
         the prehearing conference.  Issues not raised at the time of the 
 
         prehearing conference and designated as hearing issues on the 
 
         hearing assignment order are waived.  Deputies determine only 
 
         issues designated on the hearing assignment order.  Therefore, 
 
         the issue of the independent medical examination will not be 
 
         determined in this decision.  Joseph Presswood v. Iowa Beef 
 
         Processors, Inc., File No.7324742 (Appeal Decision November 12, 
 
         1986); Rahn v. Sioux Land Towing and Auto Body, File No. 797004 
 
         (filed October 20, 1987 .
 
                                   STIPULATIONS
 
         
 
              The parties stipulated to the following matters.
 
         
 
              That an employer-employee relationship existed between 
 
         claimant and employer at the time of the alleged injuries.
 
         
 
              That claimant has been paid in full for all temporary 
 
         disability benefits and makes no claim for additional temporary 
 
         disability benefits.
 
         
 
              That the type of permanent disability, if the injury is 
 
         found to be the cause of permanent disability is scheduled member 
 
         disability to the left hand and to the right hand.
 
         
 
              That the commencement date for permanent partial disability 
 
         benefits, if such benefits are awarded, is March 4, 1986.
 
         
 
              That the rate of compensation in the event of an award of 
 
         weekly benefits is $180.19 per week for the left hand and $188.67 
 
         per week for the right hand.
 
         
 
              That no medical benefits are requested and that claimant's 
 
         entitlement to medical benefits is not an issue in this case at 
 
         this time.
 
         
 
              That defendant employer makes no claim for benefits paid 
 
         under an employee nonoccupational group plan or any workers' 
 
         compensation permanent partial disability benefits prior to 
 
         hearing.
 
         
 
              That there are no bifurcated claims.
 
         
 
                                      ISSUES
 
         
 
              The parties presented the following issues for determination 
 
         at the time of the hearing.
 
              Whether claimant sustained an injury to the left hand on 
 
         September 1, 1984 and to the right hand on August 1, 1985 which 
 
         arose out of and in the course of employment with employer.
 
         
 
              Whether the alleged injuries are the cause of permanent 
 
         disability.
 
         
 
              Whether claimant is entitled to permanent disability 
 
         benefits, if so, the nature and extent of entitlement.
 
         
 
              Whether the Second Injury Fund of Iowa is liable for any 
 
         permanent disability benefits and, if liable, the amount due.
 
         
 
         
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   3
 
         
 
                             SUMMARY OF THE EVIDENCE
 
         
 
              All of the evidence was examined and considered.  The 
 
         following is a summary of the pertinent evidence.
 
         
 
              Claimant is 35 years old, married and is the mother of three 
 
         dependant children.  She has lived in Storm Lake most of her life 
 
         and graduated from high school there in 1969.  She received B's 
 
         and C's in high school, had approximately a 2.75 grade point 
 
         average and did particularly well in mathematics and bookkeeping. 
 
          She started to work for an automobile dealership as a secretary 
 
         and bookkeeper in 1968 while still a student in high school.  She 
 
         continued employment with this employer as a warranty clerk after 
 
         graduation until 1972.  In 1972, claimant started to work for 
 
         Hygrade, a pork kill plant, which was the predecessor of IBP in 
 
         Storm Lake.  Claimant testified that she was the first female to 
 
         work in the plant on the kill floor where she did practically all 
 
         of the jobs, including pushing hogs and lugging hogs, until 
 
         November of 1978 shortly after her first baby was born 
 
         (Transcript pages 19 through 26).
 
         
 
              On June 10, 1973 claimant was involved in a car-motorcycle 
 
         accident.  The motor vehicle struck her right leg.  She was 
 
         initially treated in Storm Lake by R. R. Hanson, M.D. and K. H. 
 
         Prescott, M.D., general practitioners, who immediately referred 
 
         her to K. M. Keane, M.D., an orthopedic surgeon, in Sioux City.  
 
         Claimant was hospitalized for approximately one month until late 
 
         July of 1973 for a very severe right knee injury.  Claimant 
 
         rolled up her pant leg and exhibited that her right knee had 
 
         three scars. one was approximately eight inches long, one was 
 
         approximately four inches long and one was approximately three 
 
         inches long.  Claimant testified that she also injured her right 
 
         ankle in the accident and she exhibited a two inch scar on the 
 
         top of her ankle.  Claimant continued to see Dr. Keane regularly 
 
         for about a year; then she saw him approximately once a year 
 
         after that (Tran., pp 27-33).  She last saw Dr. Keane in August 
 
         of 1986.  Claimant testified that Dr. Keane has suggested an 
 
         ankle replacement for quite some time (Trans., pp. 36 & 37).
 
         
 
              Claimant stated that she is unable to walk flat footed with 
 
         her right ankle due to a piece of bone that is sticking out.  
 
         Arthritis bothers her in certain weather conditions.  She stated 
 
         that she could only walk about 50 feet without pain.
 
         
 
              Claimant testified that she returned to work at Hygrade in 
 
         November or December of 1973 as a clerk.  She went back on the 
 
         line on the kill floor in approximately June of 1974 (Trans., pp. 
 
         37-41).
 
         
 
              Claimant said that she complained to her personal physician 
 
         Gary Olson, M.D., about her ankle on June 21, 1977, August 5, 
 
         1977, August 25, 1977, and November of 1977.  She testified that 
 
         it made her leg and back hurt because one leg was shorter than 
 
         the other which would tilt her hip off (Trans., pp. 43-47).  
 
         Claimant testified that she left Hygrade in November of 1978 to 
 
         raise her children.  Her next employment was four years later 
 
         when she went to work for Methodist Manor in 1982 as a cook 
 
         (Trans., pp. 43-48).  She attended Buena Vista College from 
 
         January of 1983 to May of 1983 with an accounting major and a 
 
         computer minor (Trans., p. 48).  She applied for work at IBP, the 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   4
 
         
 
         successor of Hygrade, in September of 1983 (Trans., p. 49).  
 
         While waiting to be employed by IBP she tended bar at the Corner 
 
         Pocket for two weeks in January of 1984.  Her knee gave her 
 
         trouble tending bar (Trans., pp. 49 and 50).  Claimant said that 
 
         she then worked as a nurse's aide at Methodist Manor in July and 
 
         August of 1984 for approximately four weeks.  She said that she 
 
         was on her feet a lot and her knee gave her trouble in this 
 
         employment (Trans., pp. 51 & 52).
 
         
 
              Claimant then started to work at IBP on August 16, 1984.  
 
         She took a preemployment physical examination and the grip 
 
         strength in her hands was normal (Trans., pp. 52 & 53).  Claimant 
 
         described her jobs as hooking sides, separating viscera and 
 
         rounding heads (Trans., pp. 57 & 58).  On or about September 1, 
 
         1984 while rounding heads claimant had an unusual sensation on 
 
         her left hand which was reported to her supervisor and the nurse 
 
         (Tran., pp. 61-64).  Claimant then worked with chitterlings from 
 
         September of 1984 until she terminated on January 10, 1986.  The 
 
         plant processed 780 hogs per hour (Trans., pp. 63-67).  Claimant 
 
         testified that all of her jobs required repetitive use of her 
 
         hands.  She stated that she wore gloves.  Hog parts were often 
 
         hard to hang on to and you had to regrab them several times to 
 
         cut them off or to work with them (Trans., pp. 53-67).  Later, 
 
         her right hand became troublesome also (Trans., p. 70).
 
         
 
              She was sent to see W. E. Erps, M.D., for both hands 
 
         (Trans., pp. 70 and 71).  Dr. Erps sent her to see Dr. Isgreen 
 
         (full name unknown) a neurologist in Sioux City (Trans., pp. 
 
         71-74).  Ronald A. Dierwechter, M.D., performed outpatient carpal 
 
         tunnel surgery on her left hand on September 4, 1985 (Trans., pp. 
 
         74 & 75) which left a "Z" shaped scar on her left hand (Trans., 
 
         p. 76).
 
         
 
              Claimant had carpal tunnel surgery on her right hand on 
 
         January 15, 1986 which also left a similar "Z" shaped scar on 
 
         that hand (Trans., 77).  Claimant testified that she still has 
 
         pain and difficulties in both hands with numbness and weakness 
 
         (Trans., p. 80).
 
         
 
              Dr. Keane's records show claimant was hospitalized from June 
 
         10, 1973 to June 27, 1973 for fracture of the right knee, femur, 
 
         and right ankle injury.  She was hospitalized again for the 
 
         removal of five pins from September 13, 1973 to September 16, 
 
         1973.  On October 26, 1973 it was noted that x-rays of the right 
 
         ankle were suggestive of post-traumatic cartilage necrosis which 
 
         might get progressively worse and eventually require surgery.  On 
 
         February 12, 1974, a form of ankle arthritis was confirmed.  On 
 
         April 30, 1974 Dr. Keane said that prolonged standing all day on 
 
         the kill floor bothered her ankle but there was no trouble with 
 
         her knee.  On August 12, 1974 the doctor reported that claimant 
 
         complained of back pain aggravated by standing all day at her 
 
         job.  Claimant testified that Dr. Prescott at Storm Lake repaired 
 
         the wounds to her right foot and ankle before she was sent to 
 
         Sioux City to see Dr. Keane.  X-rays of the right knee and lumbar 
 
         spine were normal, but x-rays of the right ankle showed joint 
 
         narrowing.  On October 22, 1982 Dr. Keane recorded that x-rays 
 
         demonstrate a serious degree of cartilage necorsis with mild 
 
         anterior tilt and some post-traumatic arthritis (Exhibit 8).
 
         
 
              On August 1, 1984 Dr. Keane stated that claimant will have 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   5
 
         
 
         permanent disability to the right knee.  Motion was limited and 
 
         crepitus was present.  He summarized claimant's condition as 
 
         follows:
 
         
 
              She has now degenerative arthritis which I think will 
 
              get worse over the years.  It is difficult to project 
 
              accurately the disability which will result from this 
 
              injury but I would anticipate about twenty percent 
 
              (20%) permanent disability to the leg.
 
         
 
              In addition to this she has had symptoms referable to 
 
              the ankle over the past many months and x-rays have 
 
              shown narrowing of the joint space indicative of 
 
              cartilage necrosis.  She had no known fracture or 
 
              significant injury at the time of her accident but this 
 
              is apparently a complication of a bruising of the 
 
              cartilage.  I think it is very likely that as a result 
 
              of this she will have continuing symptoms and will 
 
              likely develop degenerative arthritis which could cause 
 
              symptoms severe enough over a long period of time that 
 
              an arthrodesis would be indicated but I cannot say with 
 
              reasonable medical certainty that such will occur.
 
         
 
         (Ex. 6)
 
              On September 19, 1974, Dr. Hansen, her personal family 
 
         physician, reported as follows:
 
         
 
              This girl was seen in June of 1973 after a rather 
 
              severe accident with multiple lacerations about the 
 
              legs and knee.  The lacerations were over the right 
 
              knee and there was also a laceration in the midleg.  
 
              Then there was also a laceration of the plantar surface 
 
              of the foot exposing the tendons.
 
         
 
              ...
 
         
 
              This patient has been working at Hygrade Company and 
 
              has had to stand a great deal.  Because of the weakness 
 
              of the right leg and also some weakness of the right 
 
              ankle, she has been putting more weight on the left 
 
              extremity and this has put a definite strain on her 
 
              back.  We saw the patient on July 16, 1974 and at that 
 
              time diagnosed muscle strain of the back.  Exam 
 
              revealed no acute tenderness of the muscle but there 
 
              was some definite muscle spasm.  We feel this is due to 
 
              strain because she does not stand with equal 
 
              distribution of her weight on both legs.
 
         
 
              In all probability she will always have some difficulty 
 
              with her right knee and there is a possibility of 
 
              developing arthritis in the ankle which was injured at 
 
              the same time.  This will also cause her to, have some 
 
              back strain if she is standing and working all the 
 
              time.  She will probably do better if she can do most 
 
              of her work when she is sitting and not put the 
 
              constant strain on her back.
 
         
 
         (Ex. 7)
 
         
 
              The records of her personal physician, Gary Olson, M.D., 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   6
 
         
 
         show that claimant frequently complained of her ankle in the fall 
 
         of 1977 and in early 1978 which claimant attributed to standing 
 
         at work.  Dr. Olson appeared to have believed claimant's 
 
         complaints; however, he did remark on May 30, 1978 that it was 
 
         extremely difficult to evaluate these complaints and that he had 
 
         no way to prove or disprove them (Ex. 9).  The clinic records 
 
         show that claimant also complained about the ankle on September 
 
         14, 1982 and November 11, 1982.  The same clinic records show 
 
         many office visits during the period of employment for employer 
 
         (IBP) from August 16, 1984 to January 10, 1986, but there are no 
 
         complaints recorded about her right knee or ankle during this 
 
         period of time (Ex. 9).
 
         
 
              The records of Ronald A. Dierwechter, M.D., and other 
 
         records in evidence, show that claimant received a left carpal 
 
         tunnel release on September 4, 1985 and a right carpal tunnel 
 
         release on January 15, 1986 (Ex. 14-17).  Dr. Dierwechter 
 
         completed a workers' compensation medical form dated September 
 
         23, 1985 on which he diagnosed bilateral carpal tunnel syndrome 
 
         At item number six on the form appears this question:  "Was the 
 
         injury or disease caused, aggravated or accelerated by the 
 
         patient's alleged employment activity?".  Dr. Dierwechter checked 
 
         the box marked "yes".  At item number nine on the form he stated 
 
         that he did not expect any permanent disability, assuming proper 
 
         healing (Ex. 15, p. 2).
 
         
 
              Dr. Dierwechter also completed a surgeon report on February 
 
         6, 1986 which stated claimant had bilateral carpal tunnel.  Item 
 
         number eight on the form asks this question: "Was the injury or 
 
         disease caused, aggravated or accelerated by patient's alleged 
 
         employment activity?"  Dr. Dierwechter checked the block marked 
 
         OyesO.  At item number 11 on the form appears this question: OIs 
 
         permanent disability likely?".  Dr. Dierwechter checked the block 
 
         marked "no". (Fund Ex. 4)
 
         
 
              On February 21, 1986 claimant saw Oscar M. Jardon, M.D., at 
 
         the University of Nebraska Medical Center in Omaha for a 
 
         impairment rating for her carpal tunnel surgeries.  Dr. Jardon 
 
         reported as follows:
 
         
 
              Pamela was seen in our clinic on February 20, 1986 for 
 
              a disability rating.  This patient is status post 
 
              carpal tunnel release of both the right and left wrists 
 
              performed on September 4, 1986.  She does complain of 
 
              minimal stiffness and there is a rather predominant 
 
              scar.  Grip test does show a slight decrease in grip 
 
              strength bilaterally with the presence of scar 
 
              bilaterally [sic].
 
         
 
              It is felt that the patient has a 5% partial permanent 
 
              disability to each upper extremity.  However, I believe 
 
              that the situation is static and that she has gone 
 
              through the normal healing period.  I do not expect the 
 
              situation to change.
 
         
 
         (Ex. 10)
 
         
 
              Claimant saw A. J. Wolbrink, M.D., in Mason City on June 12, 
 
         1986 for an impairment rating.  Dr. Wolbrink commented that 
 
         claimant told him that her carpal tunnel became progressively 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   7
 
         
 
         worse with activities, such as the rigor of her work.  Otherwise, 
 
         Dr. Wolbrink did not say the carpal tunnel syndrome was caused by 
 
         claimant's work as a matter of his own independent professional 
 
         medical judgment.  Dr. Wolbrink concluded as follows:
 
         
 
              It is my opinion that Mrs. Pulju has a permanent 
 
              impairment of 7% of the right hand.  This is equivalent 
 
              to 6% of the right upper extremity.  In my opinion she 
 
              has a permanent impairment of 11% of the left hand.  
 
              This is equivalent to 10% of the left upper extremity. 
 
               These values can be extrapolated to whole person 
 
              impairment to give the combined total permanent 
 
              impairment of 10% of the whole person.
 
         
 
         (Ex. 11)
 
         
 
              Claimant saw Keith 0. Garner, M.D., at Cherokee for a social 
 
         security disability examination on November 25, 1986.  With 
 
         respect to her right ankle he found an obvious deformity with 
 
         three-fourths of an inch of lateral deviation of the foot on the 
 
         ankle joint and 80 percent reduction in the range of motion of 
 
         the ankle.  He said that her right heel does not touch the ground 
 
         when she stands on both feet due to the permanent plantar flexion 
 
         of the right foot.  He stated that she had an altered gait 
 
         secondary to fixation of the right ankle and plantar flexion of 
 
         the foot.  He recorded that she had approximately a 50 percent 
 
         reduction in the grip strength in both hands (Ex. 13).  Dr. 
 
         Garner made the following conclusions:
 
         
 
              Diagnosis:  1. Deformity of the right ankle secondary 
 
     
 
         
 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   8
 
         
 
              to fracture.  2. Bilateral carpal tunnel surgery with 
 
              some reduction in function.
 
         
 
              Evaluation:  Patient states that she was able to work 
 
              until she had bilateral carpal tunnel surgery.  I have 
 
              never known a carpal tunnel surgery to be totally 
 
              disabling.  She does have some reduction in strength.  
 
              She certainly has deformity of the right ankle which 
 
              prevents her from standing flat on her foot.  This 
 
              would disable her from doing standing manual labor such 
 
              as her previous job a IBP; however she certainly could 
 
              work at a job sitting down.  She should be easily 
 
              rehabilitated for some type of sedentary employment.  
 
              Any further questions I would be glad to answer.  Thank 
 
              you.
 
         
 
         (Ex. 13)
 
         
 
              On December 15, 1986 Dr. Garner wrote to claimant's counsel 
 
         and awarded a 10 percent partial impairment of the hand on each 
 
         side due. to her carpal tunnel surgeries.  He also awarded a 25 
 
         percent permanent partial impairment of the right lower extremity 
 
         for the right foot and ankle (Ex. 12).
 
         
 
              Claimant was examined for defendant, employer, by Peter D. 
 
         Wirtz, M.D., on August 14, 1986.  He ordered an EMG of the upper 
 
         extremity which was performed by Alfredo Socarras, M.D., on 
 
         September 4, 1986.  Dr. Socarras found that conduction velocity 
 
         studies were normal and that the EMG was normal (Ex. B).  Dr. 
 
         Wirtz wrote as follows:
 
         
 
              This patient's examination 8/14/86 and 
 
              electromyographic study on 9/4/86 reveal that her 
 
              condition is one of postoperative bilateral carpal 
 
              tunnel release without permanent nerve injury.  This 
 
              patient has full range of motion and no neurological 
 
              and will not have any impairment based on the surgical 
 
              procedures to either wrist.
 
         
 
         (Ex. A)
 
         
 
              For some unexplained reason Dr. Wirtz' report is unsigned, 
 
         but it does appear on his letterhead stationary and appears to be 
 
         dictated by him in his practice as a physician.
 
         
 
              Claimant was terminated from employer on January 10, 1986 
 
         for excessive absenteeism which she felt was unjustified because 
 
         she missed work while being treated for gall bladder problems.  
 
         Claimant acknowledged that she also filed a civil suit against 
 
         employer for damages for lost wages and that the longer she is 
 
         only able to work part time the more this increases her claim for 
 
         damages in that law suit (Trans., p. 98).  She conceded that she 
 
         had not looked one day for full-time work (Trans., p. 100).  She 
 
         granted that she was not and had never been under any doctors 
 
         restrictions of any kind (Trans., pp. 100, 103 & 104).  Claimant 
 
         indicated that she had been checking the want ads in the paper 
 
         every week.  Counsel for the Second Injury Fund demonstrated that 
 
         she was not aware of several jobs that were in the local 
 
         newspapers in the last two weeks that he contended she could do 
 
         (Trans., p. 101; Fund Ex. 8).  Claimant admitted that she was not 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page   9
 
         
 
         terminated on January 10, 1986 due to her right knee injury 
 
         (Trans., p. 104).  She was able to return to Hygrade and did her 
 
         old job after the motorcycle accident until she voluntarily quit 
 
         to raise her children.  The motorcycle injury did not keep her 
 
         from looking for any other work (Trans., pp. 104 & 105).  
 
         Claimant granted that she was a cook at Methodist Manor, she 
 
         stood all of the time, from July 12, 1982 until May 14, 1983, 
 
         several hours a day, but she could sit down for a few minutes if 
 
         she needed to.  Claimant also agreed that she did not see a 
 
         doctor for her right leg during this period of time (Trans., pp. 
 
         105-109).
 
         
 
              Claimant admitted that when she applied for the job at 
 
         Methodist Manor as a cook she signed a statement that she did not 
 
         know of any disabilities, previous injury or illness which would 
 
         restrict her from performing the normal tasks of the position for 
 
         which she was employed (Trans., pp. 108 & 109; Fund Ex. 1, p. 
 
         11).  Also, Dr. Prescott, her personal physician, signed a 
 
         statement that he found no indication of any condition which 
 
         might represent a possible hazard to the health of patients, the 
 
         applicant or employee or other employees in the institution (Ex. 
 
         1, p. 11).  Claimant agreed that she did not give up this job due 
 
         to her right leg or knee (Trans., p. 110).
 
         
 
              Claimant also admitted that when she worked at the tavern 
 
         for a couple of weeks that she lost no work and did not leave the 
 
         job due to her right leg or knee (Trans., p. 111).  Claimant 
 
         acknowledged that when she worked at Methodist Manor again in 
 
         July and August of 1984 as a nurse's aide, for four weeks, that 
 
         she and Dr. Prescott again verified that there were no conditions 
 
         that would restrict her from doing this job (Tran., p. 114; Ex. 
 
         1, p. 10).  Claimant testified that before she started with 
 
         employer, IBP, on August 16, 1984 she took a physical examination 
 
         and went right to work on the production line eight or ten hours 
 
         a day, six days a week.  She acknowledged that she never missed 
 
         one day of work and did not see her treating physician at anytime 
 
         due to her right leg or knee while working at IBP (Trans., p. 116 
 
         & 117).  Claimant agreed that when she left IBP on January 10, 
 
         1986 it was not due to her right leg or knee.  She conceded that 
 
         she had not lost any job opportunity due to her right leg or knee 
 
         (Trans., p. 118).
 
         
 
              Claimant testified that she had not tried to find full-time 
 
         work because she knew that there was none to be found due to the 
 
         depressed economy, but that she did not decline to look for 
 
         employment due to her right knee or leg (Trans., p. 119).  
 
         Claimant said that she mentioned her right leg complaints at work 
 
         to her supervisor and the nurse, but, she did not know if they 
 
         made a record of it after she talked to them (Trans., p. 121).  
 
         Claimant testified that she looked for a number of jobs after 
 
         termination by IBP (Ex. 19).
 
         
 
              Claimant testified that she did not get a job at Aalfs 
 
         making blue jeans because she did not pass a dexterity test 
 
         (Trans., pp. 123-127; Fund Ex. 7, question 14).  Clare Petersen, 
 
         secretary at Aalfs, testified that she interviewed claimant 
 
         twice.  In the first part of 1984 claimant took a dexterity test 
 
         and passed it satisfactorily.  Petersen testified that she saw 
 
         claimant again in early 1986, possibly January or February, and 
 
         that she assumed that claimant passed the dexterity test because 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  10
 
         
 
         claimant went to the next step of being interviewed by the 
 
         supervisor.  If they fail the dexterity test they do not go on to 
 
         the next interview (Trans., pp. 156-159, 164, 167 & 168).  The 
 
         witness conceded that she did not know for a fact whether 
 
         claimant actually took a dexterity test or not in early 1986 
 
         (Trans., p. 162).
 
         
 
              Claimant took a preemployment physical examination before 
 
         starting her current job as a part-time school bus driver.  Mark 
 
         Schultz, M.D., her personal physician at that time, completed a 
 
         report on August 15, 1986.  Under the heading of limbs/members 
 
         appears this question:  ODoes this person possess full use of all 
 
         limbs?".  The handwritten answer to this question is "yes O(Fund 
 
         Ex. 3, p. 3, reverse side).  Claimant conceded that her personal 
 
         physician made no mention of any impairment to her right leg or 
 
         knee, left wrist or right wrist (Trans., pp. 130 & 131).  
 
         Claimant conceded again that she had not lost any work due to her 
 
         right leg or knee and that she had not attempted to find any 
 
         full-time employment since her termination on January 10, 1986 
 
         (Trans., pp. 131 & 132).
 
              Counsel for employer brought out that claimant filed a claim 
 
         and was paid lost wages for a trip to Des Moines on August 14, 
 
         1986 to see Dr. Wirtz.  Claimant admitted that she was not 
 
         actually working yet on that date (Trans., pp. 135 & 136).  
 
         Claimant also filed a claim for eight hours of lost wages for the 
 
         trip to see Dr. Socarras on September 4, 1986 for the EMG.  She 
 
         admitted that she did not actually lose eight hours or work but 
 
         only possibly six hours at the most on that date (Trans., pp. 137 
 
         & 138).  Claimant also answered that when she protested her 
 
         termination by employer for excessive absenteeism, which she felt 
 
         was justified by her gall bladder disease, that she did not make 
 
         any mention of any problems with her right knee or either wrist 
 
         (Trans., pp. 140-143).  Claimant testified that she did not 
 
         complain of her physical problems at work because (1) she was not 
 
         a complainer, (2) she would be ignored if she did complain, and 
 
         (3) she believed that she might be punished somehow if she 
 
         complained (Trans., pp. 149-151).
 
         
 
              Ilene Hogancamp testified that she is claimant's mother.  
 
         She felt claimant's leg was getting worse.  She testified that 
 
         her daughter uses a cane when it is raining.  She averred that 
 
         her daughter takes aspirin and tylenol for pain.  She stated that 
 
         claimant could not put the heel of her right foot on the floor.  
 
         Claimant walks on her toes.  Two years ago claimant could walk 
 
         two miles with her.  Now claimant can only walk approximately 
 
         five blocks.  The witness testified that claimant rubs her hands 
 
         most of the time (Trans., pp. 168-172).
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that she received an injury on September 1, 1984 and 
 
         August 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).
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  11
 
         
 
         
 
              The injury must both arise out of and be in the course of 
 
         the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 
 
         402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 of the 
 
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
 
         255 Iowa 847, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injuries of September 1, 1984 and August 1, 
 
         1985 is causally related to the disability on which she now bases 
 
         her claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 
 
         (1965).  Lindahl v. L. 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 connections   
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language. 
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is-for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              If claimant has an impairment to the body as a whole, an 
 
         industrial disability has been sustained.  Industrial disability 
 
         was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 
 
         593, 258 N.W. 899, 902 (1935) as follows:  "It is therefore plain 
 
         that the legislature intended the term 'disability' to mean 
 
         'industrial disability' or loss of earning capacity and not a 
 
         mere 'functional disability' to be computed in the terms of 
 
         percentages of the total physical and mental ability of a normal 
 
         man.O
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 1121, 125 N.W.2d 251, 
 
         257 (1963).
 
         
 
              Claimant has sustained the burden of proof by a 
 
         preponderance of the evidence that her right and left carpal 
 
         tunnel conditions are injuries arising out of and in the course 
 
         of her employment with employer.  Claimant testified, and it is 
 
         reasonable to believe, that all of her jobs on the production 
 
         line involved highly repetitive use of both hands most of the 
 
         time.  The surgeon who performed both carpal tunnel surgeries, 
 
         Dr. Dierwechter, stated that both carpal tunnel conditions were 
 
         caused by claimant's employment (Ex. 15, p. 2; Fund Ex. 4).  None 
 
         of the other doctors who examined and rated claimant specifically 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  12
 
         
 
         made a finding that these two carpal tunnel conditions were 
 
         directly caused by claimant's employment.  At the same time, all 
 
         of these doctors knew that they were rating claimant for an 
 
         alleged work-related injury.  None of the doctors offered any 
 
         evidence or suggestions that the condition was not caused by her 
 
         employment.  None of the doctors indicated that the carpal tunnel 
 
         conditions were caused by something other than her employment.  
 
         The only evidence on the point of causal connection is from Dr. 
 
         Dierwechter, and the sole evidence of causal connection is that 
 
         the work caused the carpal tunnel conditions (Ex. 9-15, & Ex.  
 
         A).  Consequently, it is determined that claimant did sustain the 
 
         burden of proof by a preponderance of the evidence that she did 
 
         sustain a carpal tunnel injury on September 1, 1984 to her left 
 
         wrist and a carpal tunnel injury on August 1, 1985 to her right 
 
         wrist, both of which arose out of and in the course of her 
 
         employment with employer.
 
         
 
              In awarding impairment ratings for alleged work injuries, 
 
         doctors of necessity imply that the injury was the cause of the 
 
         impairment which they find present (Ex. 10-15).  Therefore, it is 
 
         determined that both carpal tunnel injuries are found to be the 
 
         cause of some disability.
 
         
 
              Entitlement is determined as follows:
 
         
 
              With respect to the left hand Dr. Dierwechter, the 
 
         performing surgeon, found no impairment.  Dr. Jardon, the 
 
         university professor, found five percent impairment of the right 
 
         upper extremity which converts to five percent of the hand (Ex. 
 
         10) Guides to the Evaluation of Permanent Impairment, second 
 
         edition, table nine, page 10.  Dr. Wolbrink, an evaluating 
 
         physician for claimant, awarded 11 percent of the left hand (Ex. 
 
         11).  Dr. Garner, another evaluating physician for claimant, 
 
         awarded 10 percent of the left hand (Ex. 12).  Dr. Wirtz, an 
 
         evaluating physician for the employer, stated that claimant did 
 
         not have any impairment in the left hand (Ex.  A).  No doctor 
 
         issued any restrictions on claimant's activities with her left 
 
         hand.  Claimant, however, complained of numbness and weakness in 
 
         her hand.  Claimant's mother testified that she rubs her hands 
 
         much of the time.  Claimant may have passed the second dexterity 
 
         test at Aalfs since she went on to the interview for the job.  
 
         Claimant has been able to drive the school bus.  Dr. Schultz, a 
 
         personal physician, stated that claimant had full use of all 
 
         limbs and members on August 15, 1986 (Fund Ex. 3, p. 3, reverse 
 
         side).
 
         
 
              Based upon the foregoing evidence and agency expertise [Iowa 
 
         Administrative Procedure Act 17A.14(5)] it is determined that 
 
         claimant has sustained a five percent permanent partial 
 
         impairment to the left hand with deference going to the award of 
 
         Dr. Jardon, whose opinion appears to be the most reasonable, 
 
         detached, disinterested and objective (Ex. 10).
 
         
 
              The injury to the left hand in this case is the second 
 
         injury.  The first injury occurred on June 10, 1973, when 
 
         claimant was severely physically injured when she was struck by a 
 
         car in the right leg while riding a motorcycle.  On August 1, 
 
         1984 Dr. Keane said that it was difficult to project a rating at 
 
         that time.  He anticipated a 20 percent permanent partial 
 
         impairment of the leg (right lower extremity).  He predicted 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  13
 
         
 
         degenerative arthritis and a possible arthrodesis.  The 
 
         arthrodesis has never been performed, but claimant has developed 
 
         degenerative arthritis.  Dr. Keane did not place any restrictions 
 
         on claimant's working activities.  The only other impairment 
 
         rating for the right leg was made by Dr. Garner on December 15, 
 
         1986 when he awarded a 25 percent permanent partial impairment 
 
         rating of the right lower extremity (Ex. 12).  Dr. Garner's 
 
         rating is accepted as the most accurate rating because it is the 
 
         most current rating.  The Second Injury Fund saw fit not to 
 
         request it's own independent medical evaluation but chose instead 
 
         to rely on the ones summarized above which were obtained and 
 
         introduced by claimant.
 
         
 
              It is also well established that claimant has a 
 
         three-fourths inch lateral deviation of the right foot on the 
 
         ankle joint and permanent plantar flexion of the right foot so 
 
         that her right heel does not touch the ground when she is 
 
         standing on both feet (Ex. 13).  Claimant testified that standing 
 
         long periods of time hurts her leg and her back.  This would 
 
         appear to be very credible in view of the objective physical 
 
         condition of her right foot and ankle and the degenerative 
 
         arthritis.  Although the evidence varied as to how far claimant 
 
         is able to walk without pain, it is established that her walking 
 
         ability is impaired in some substantial degree.
 
         
 
              Claimant sustained a third scheduled member injury on August 
 
         1, 1985 to the right hand.  Claimant's entitlement to benefits 
 
         and the liability of the employer is determined as follows.
 
         
 
              With respect to the employer's liability for the right hand 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  14
 
         
 
         the various physicians awarded the following ratings: Dr. 
 
         Dierwechter O%: Dr. Jardon 5%: Dr. Wolbrink 7%: Dr. Garner 10%: 
 
         and Dr. Wirtz 0%.  Again, Dr. Jardon is selected as the best 
 
         rating for the reasons set forth with respect to the left hand 
 
         above.
 
         
 
              Employer, then is liable for 9.5 weeks of permanent partial 
 
         disability benefits based upon a five percent impairment of the 
 
         right hand due to the injury of August 1, 1985 (190 x .05) Iowa 
 
         Code section 85.34(2)1.
 
         
 
              Even though claimant has established a rather severe 
 
         physical injury it cannot be said that her disability is great 
 
         because she has performed as if she had practically no disability 
 
         at all due to her right foot and ankle.  After the motorcycle 
 
         injury she returned to work at Hygrade and performed production 
 
         line work full time from approximately June of 1974 until she 
 
         resigned to raise her children in November of 1978.  She then 
 
         worked at Methodist Manor on her feet most of the time as a cook 
 
         in 1982 and again in July and August of 1984 as a nurse's aide.  
 
         She then worked at IBP from August 16, 1984 to January 10, 1986 
 
         full time, eight to ten hours a day, six days a week on the 
 
         production line.  When she applied for all of these jobs she 
 
         indicated that she had no physical limitations that would 
 
         prohibit her from doing them.  Her personal physicians also 
 
         stated that she was fully capable of doing these jobs.
 
         
 
              Claimant testified that she did the work with difficulty and 
 
         with pain.  Nevertheless, except for 1977 and 1978, she was not 
 
         making any complaints to her personal physicians or to her 
 
         employers that she was having any difficulty doing these jobs.  
 
         She never quit a job and she was never terminated from a job due 
 
         to her leg or wrist injuries.  She never lost any time from work 
 
         at IBP due to her right leg injury.  She was never turned down by 
 
         an employer for any job that she ever wanted due to her leg 
 
         injury.  Since her termination by employer on January 10, 1986 
 
         she has not wanted or sought full-time work.  While claimant was 
 
         working for employer, from August 16, 1984 to January 10, 1986, 
 
         she was fully able to do all of the work that was assigned to her 
 
         or that she was requested to do.
 
         
 
              In summary, we have what claimant's counsel described as a 
 
         courageous person with a rather severe physical impairment which 
 
         has not appreciably reduced her earning capacity.  Nevertheless, 
 
         certain job opportunities are foreclosed to claimant.  Michael 
 
         v. Harrison County, 34 Biennial Report of the Industrial 
 
         Commissioner, 218, 219 (1979).  Claimant cannot do work which 
 
         requires substantial walking or walking long distances.  She is 
 
         more impaired than a normal person to perform work that requires 
 
         standing for long periods of time because of the arthritis in her 
 
         ankle which causes pain in her right leg and the shortened right 
 
         leg which causes pain in her back.  She has residual limitations 
 
         from carpal tunnel syndrome.
 
         
 
              Claimant's relatively young age, her reasonably good 
 
         education, her good school record, adaptability, background as a 
 
         secretary, bookkeeper, accountant, cook, nurse's aide, production 
 
         worker and her experience as a truck driver and school bus driver 
 
         leave many employment opportunities that claimant can perform.  
 
         Accordingly, based on all of the foregoing evidence it is 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  15
 
         
 
         determined that as a result of the first injury to her right leg 
 
         on July 10, 1973 and the second injury to her left wrist on 
 
         September 1, 1984, and the third injury to the right wrist on 
 
         August 1, 1985, that claimant has sustained an industrial 
 
         disability of 25 percent of the body as a whole.  Industrial 
 
         disability need not exceed functional impairment.  Birmingham v. 
 
         Firestone Tire & Rubber Co., II Iowa Industrial Commissioner 
 
         Report 39 (1981).  Industrial disability can be equal to, less 
 
         than or greater than functional impairment.  Lawyer & Higgs, 
 
         Iowa Workers' Compensation -- Law & Practice, section 13-5, p. 
 
         116 and 1987 supplement p. 20.  This provides an entitlement of 
 
         125 weeks of benefits.
 
         
 
              Claimant's entitlement and the employer's liability for the 
 
         injury to each hand is 9.5 weeks (190 x .05) based on Iowa Code 
 
         section 85.34(2)1 for a total of 19 weeks.  The 25% left leg 
 
         impairment provides a compensable value of 55 weeks.  The total 
 
         is 74 weeks.
 
         
 
              Claimant's entitlement to Second Injury Fund benefits and 
 
         the liability of the Second Injury Fund is determined as follows 
 
         when the second injury is a scheduled member injury:  from the 
 
         industrial disability resulting from the combined effects of both 
 
         the first and second injury is subtracted the impairment value of 
 
         the first injury and the impairment value of the second injury.  
 
         Iowa Code section 85.64, Fulton v. Jimmy Dean Meat Co., (file No. 
 
         755039, Appeal Decision July 23, 1986).  Second Injury Fund v. 
 
         Mich Coal Co., 274 N.W.2d 300 (Iowa 1979).
 
         
 
              The Second Injury Fund is liable for the industrial 
 
         disability caused by the combined effects of both the first and 
 
         second injury minus the impairment value of the first injury and 
 
         minus the impairment value of the second injury.
 
         
 
              The industrial disability of the combined effects of all 
 
         these injuries in this particular case is determined to be 125 
 
         weeks (500 x 25%) Iowa Code section 85.34(2)u.
 
         
 
              The impairment value of the first injury is 55 weeks (220 x 
 
         25%) Iowa Code section 85.34(2)o.
 
         
 
              The impairment value of the left hand is 9.5 weeks (190 x 
 
         .05, [Iowa Code section 85.34(2)], and a like impairment exists 
 
         for the right hand for a total of 19 weeks.
 
         
 
              Claimant's entitlement, to Second Injury Fund benefits and 
 
         the liability of the Second Injury Fund to claimant is 125 weeks, 
 
         minus 74 weeks which equals 51 weeks.
 
         
 
              The parties stipulated that the proper rate of compensation. 
 
          At the time of the left hand injury on September 1, 1984 is 
 
         $180.19 per week, for the right hand it is $188.67.
 
         
 
              The industrial disability following the left hand injury is 
 
         determined to have been 20 percent of the body as a whole.  
 
         Claimant's entitlement at that point, prior to the right hand 
 
         injury, would have been 100 weeks.  Deducting 64.5 weeks for the 
 
         compensable value of the right leg and left hand results in 35.5 
 
         weeks payable by the Second Injury Fund at the rate of $180.19 
 
         commencing 9.5 weeks after October 5, 1985, namely, December 10, 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  16
 
         
 
         1985.  It was stipulated that the healing period ended October 5, 
 
         1985.  The remaining 15.5 weeks of the entire 51 weeks awarded 
 
         are to be paid at the rate of $188.67 payable commencing 9.5 
 
         weeks after the employer's permanent partial disability payments 
 
         commenced on March 4, 1986, as stipulated, namely May 8, 1986.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, based upon the evidence presented the following 
 
         findings of fact are made.
 
         
 
              That claimant sustained a carpal tunnel injury to her left 
 
         hand on September 1, 1984 which arose out of and in the course of 
 
         her employment with employer.
 
         
 
              That claimant sustained a carpal tunnel injury to her right 
 
         hand on August 1, 1985 which arose out of and in the course of 
 
         her employment with employer.
 
         
 
              That Dr. Dierwechter, the surgeon for both of the carpal 
 
         tunnel surgeries, stated that the carpal tunnel injuries were 
 
         caused by claimant's employment.
 
         
 
              That claimant performed several repetitive jobs with her 
 
         hands while working for employer.
 
         
 
              That the carpal tunnel injuries were the cause of a 
 
         permanent partial impairment of five percent to each hand based 
 
         upon the evaluation of Dr. Jardon.
 
         
 
              That claimant sustained a severe injury to her right leg on 
 
         June 10, 1973 in a motorcycle accident.
 
         
 
              That claimant sustained permanent partial impairment of 25 
 
         percent of her right leg due to this injury of June 10, 1973 
 
         based on the most current evaluation made by Dr. Garner.
 
         
 
              That claimant has no medical restrictions due to any of 
 
         these injuries.
 
         
 
              That claimant is 35 years old, has a high school education, 
 
         is bright, and has experience as a secretary, bookkeeper, 
 
         accountant, cook, nurse's aide, bartender, production line worker 
 
         and has experience driving a truck over the road and a school 
 
         bus.
 
         
 
              That claimant has performed many jobs after the June 10, 
 
         1973 motorcycle accident; has never missed work or lost a job as 
 
         a result of this injury; and has never been turned down for 
 
         employment as a result of this injury.
 
         
 
              That claimant is limited on how far she can walk and that 
 
         she suffers pain in her back and in her right leg after prolonged 
 
         standing.
 
         
 
              That claimant has sustained an industrial disability of 25 
 
         percent of the body as a whole as a result of the right leg 
 
         injury on June 10, 1973 and the left hand injury on September 1, 
 
         1984 and the right hand injury of August 1, 1985.
 
         
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  17
 
         
 
              That claimant's industrial disability following the left 
 
         hand injury of September 1, 1984 was 20 percent.
 
                                
 
                                CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based upon the evidence presented and the 
 
         foregoing principles of law the following conclusions of law are 
 
         made.
 
         
 
              That claimant sustained an injury on September 1, 1984 and 
 
         another injury on August 1, 1985 which arose out of and in the 
 
         course of employment with employer.
 
         
 
              That both injuries were the cause of permanent disability.
 
         
 
              That claimant is entitled to 9.5 weeks of permanent partial 
 
         disability caused by the injury to the left hand on September 1, 
 
         1984 and 9.5 weeks of permanent partial disability caused by the 
 
         injury to the right hand on August 1, 1985.
 
         
 
              That the overall industrial disability caused by the 
 
         injuries of June 10, 1973, September 1, 1984 and August 1, 1985 
 
         is equal to 125 weeks.  Prior to the August 1, 1985 injury it was 
 
         100 weeks.
 
         
 
              That the compensable value of the permanent injury of June 
 
         10, 1973 is 55 weeks.
 
         
 
              That the compensable value of the second permanent injury on 
 
         September 1, 1984 is 9.5 weeks.
 
         
 
              That the compensable value of the injury to the right hand 
 
         on August 1, 1985 is 9.5 weeks.
 
         
 
              That the obligation of the Second Injury Fund is 51 weeks of 
 
         permanent partial disability benefits, 35.5 at the rate of 
 
         $180.19 and 15.5 weeks at the rate of $188.67.
 
         
 
              That claimant's entitlement to healing period compensation 
 
         has been fully paid.
 
         
 
                                      ORDER
 
         
 
              WHEREFORE, IT IS ORDERED:
 
         
 
              That defendant employer pay to claimant nine point five 
 
         (9.5) weeks of permanent partial disability benefits at the rate 
 
         of one hundred eighty and 19/100 dollars ($180.19) per week for 
 
         the injury of September 1, 1984 in the total amount of one 
 
         thousand seven hundred eleven and 81/100 dollars ($1,711.81) 
 
         commencing on October 6, 1984, at the end of the healing period.
 
              That defendant employer pay to claimant nine point five 
 
         (9.5) weeks of permanent partial disability benefits at the rate 
 
         of one hundred eighty-eight and 67/100 dollars ($188.67) per week 
 
         for the injury of August 1, 1985 in the total amount of one 
 
         thousand seven hundred ninety-two and 37/100 dollars ($1,792.37) 
 
         commencing March 4, 1986, as stipulated.
 
              
 
              That defendant Second Injury Fund pay to claimant 
 
         thirty-five point five (35.5) weeks of permanent partial 
 
         disability benefits at the rate of one hundred eighty and 19/100 
 
         dollars ($180.19) per week in the total amount of six thousand 
 

 
         
 
         
 
         
 
         PULJU V. IBP, INC.
 
         Page  18
 
         
 
         three hundred ninety-six and 75/100 dollars ($6,396.75) 
 
         commencing December 10, 1985 and an additional fifteen point five 
 
         (15.5 ) weeks of permanent partial disability benefits at the 
 
         rate of one hundred eighty-eight and 67/100 dollars ($188.67) per 
 
         week commencing May 8, 1986 in the total amount of two thousand 
 
         nine hundred twenty-four and 38/100 dollars ($2,924.38).
 
         
 
              That all accrued benefits are to be paid in a lump sum.
 
         
 
              That interest will accrue pursuant to Iowa Code section 
 
         85.30
 
         
 
              That the costs of this action are to be paid by both 
 
         defendants with employer and Second Injury Fund equally sharing 
 
         these costs pursuant to Division of Industrial Services Rule 
 
         343-4.33.
 
         
 
              That both defendants file claim activity reports as 
 
         requested by this agency pursuant to Division of Industrial 
 
         Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 9th day of February, 1988.
 
         
 
         
 
         
 
         
 
         
 
                                        WALTER R. McMANUS, JR.
 
                                        DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Steven Hamilton
 
         Attorney at Law
 
         606 Ontario St.
 
         Storm Lake, Iowa 50588
 
         
 
         Mr. Harry Dahl
 
         Attorney at Law
 
         974 - 73rd St. STE 16
 
         Des Moines, Iowa 50312
 
         
 
         Mr. Robert D. Wilson
 
         Assistant Attorney General
 
         Hoover State Office Bldg
 
         Des Moines, Iowa 50319
 
         
 
         
 
 
            
 
 
 
 
 
           
 
 
 
                                                  1106; 1108.50; 1402.20;
 
                                                  1402.30; 1402.40; 1803;
 
                                                  3201; 3202; 3203
 
                                                  Filed February 9, 1988
 
                                                  WALTER R. McMANUS, JR.
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         PAMELA PULJU,
 
         
 
              Claimant,
 
         
 
                                                     File Nos. 804656
 
         vs                                                    814502
 
         
 
         IBP, INC.                                 A R B I T R A T I 0 N
 
         
 
              Employer,                               D E C I S I 0 N
 
              Self-Insured,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         
 
         1106; 1108.50; 1402.20; 1402.30; 1402.40; 1803
 
         
 
              Held that repetitive work in the packing house caused two 
 
         separate carpal tunnels, one to each hand on separate dates.  
 
         Claimant awarded five percent for each hand (9.5 weeks each 
 
         hand).  Impairment ratings ranged from zero to ten percent.
 
         
 
         3201; 3202; 3203
 
         
 
              Claimant had suffered an earlier injury to her right lower 
 
         extremity from a motorcycle accident which was determined to be 
 
         the first injury in this case.  The left carpal tunnel was the 
 
         second injury.  The right carpal tunnel was the third injury.  
 
         Right lower extremity injury was determined to have a compensable 
 
         value of 25 percent or 55 weeks.  Overall industrial disability 
 
         from the first and second injury was 20 percent and from the 
 
         first, second and third injury was 25 percent.  The formula from 
 
         Mich Coal and Alphie Fulton vs Jimmy Dean was applied to 
 
         determine Second Injury liability of 35.5 weeks and 15.5 weeks.
 
         
 
         
 
                                                         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         PAMELA PULJU,
 
                                               File Nos. 804656/814502
 
              Claimant,
 
                                                      O R D E R
 
         vs.
 
                                                       N U N C
 
         IBP, INC,
 
                                                        P R O
 
              Employer,
 
              Self-Insured,                            T U N C
 
         
 
         and                                          F I L E D
 
         
 
         SECOND INJURY FUND OF IOWA,                 SEP 08 1989
 
         
 
              Defendants.                    IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
              The appeal decision filed July 24, 1989 stated in the Order 
 
         that interest on the employee's portion of the award would accrue 
 
         pursuant to Iowa Code section 85.30.
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That said paragraph is amended to require defendant employer 
 
         to pay interest on weekly benefits the employer is ordered to pay 
 
         in the appeal decision as set forth in Iowa Code section 85.30.
 
         
 
         
 
              Signed and filed this 8th day of September, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                                    DAVID E. LINQUIST
 
                                                 INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Steven Hamilton
 
         Attorney at Law
 
         606 Ontario St.
 
         Storm Lake, Iowa  50588
 
         
 
         Mr. Harry W. Dahl
 
         Attorney at Law
 
         974 73rd St., Suite 16
 
         Des Moines, Iowa  50312
 
         
 
                                                
 
                                                         
 
         Mr. Robert D. Wilson
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Bldg.
 
         Des Moines, Iowa  50319
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
 
 
 
 
          MARLA DAVIS,                                 File No. 804730
 
 
 
               Claimant,                            A R B I T R A T I O N
 
 
 
          vs.                                          D E C I S I O N
 
 
 
          K MART DISCOUNT STORE,                          F I L E D
 
 
 
               Employer,                                 APR 22 1988
 
               Self-Insured,
 
               Defendant.                       IOWA INDUSTRIAL COMMISSIONER
 
 
 
 
 
                                   INTRODUCTION
 
 
 
               This is a proceeding in arbitration brought by the claimant, 
 
          Marla Davis, against her self-insured employer, K-Mart Discount 
 
          Store, to recover benefits under the Iowa Workers' Compensation 
 
          Act as a result of an injury sustained September 10, 1985.  This 
 
          matter came on for hearing before the undersigned deputy 
 
          industrial commissioner at Burlington, Iowa on December 23, 1987. 
 
          A first report of injury was filed September 23, 1985.  Claimant 
 
          has been paid two weeks and five days of temporary total 
 
          disability or healing period benefits.
 
 
 
               The record in this case consists of the testimony of 
 
          claimant, of Murray Brooks, Jr., and of Linda Watson as well as 
 
          of joint exhibits 1 through 39.
 
 
 
                                     ISSUES
 
 
 
               Pursuant to the pre-hearing report, the parties stipulated 
 
          that claimant's rate of weekly compensation is $68.78; that 
 
          medical costs are fair and reasonable; that claimant did receive 
 
          an injury which arose out of and in the course of her employment 
 
          on the injury date; and, that the injury is causally related to 
 
          temporary total disability.  The issues remaining for resolution 
 
          are:
 
 
 
               Whether claimant's injury is a cause of permanent partial 
 
          disability;
 
 
 
               Whether claimant is entitled to benefits and the nature and 
 
          extent of any benefit entitlement, including whether claimant is 
 
          entitled to any additional temporary total or healing period 
 
          compensation;
 
 
 
               Whether claimant is entitled to payment of certain medical 
 
          costs as reasonable and necessary medical care causally related 
 
          to her work injury and authorized by the defendant; and,
 
 
 
                                                               
 
                                                               
 
               Whether claimant is entitled to additional benefits for 
 
          unreasonable delay or denial of payment pursuant to Iowa Code. 
 
          section 86.13.
 
 
 
                            REVIEW OF THE EVIDENCE
 
 
 
               Claimant is 28 years old, separated and has one child. 
 
          Claimant had been employed at K-Mart Discount Store for 
 
          approximately one and one-half years on September 10, 1985.  She 
 
          had worked at the cash registers and on the floor in housewares. 
 
          Claimant testified that she was working in the stock room when a 
 
          Sani-Flush display fell down and hit her on the head.  Claimant 
 
          reported she was bleeding, lost consciousness and was transported 
 
          to the hospital by ambulance.  Claimant stated she initially had 
 
          sharp pain at the injury site on the top of her head as well as 
 
          dizziness, double vision and pain and numbness in the neck. 
 
          Claimant was released for home care.  Charles F. Eddingfield, 
 
          M.D., treated claimant in the emergency room as well as on the 
 
          following day.  Claimant subsequently underwent physical therapy 
 
          with James P. Smith, L.P.T., on September 24, 25 and 26, 1985. 
 
          Claimant testified that, on September 25, 1985, she saw Robert R. 
 
          Kemp, M.D., the company physician, per K-Mart's instructions and 
 
          that she was instructed that she was no longer to see Dr. 
 
          Eddingfield, but was to see either Dr. Kemp or a Dr. Schulte.  
 
          Dr. Kemp released claimant for a work return after September 26, 
 
          1985. Claimant testified that, following her work return, she 
 
          received less work hours and was placed on a cash register more 
 
          often than on floor duty.  Claimant was terminated on April 11, 
 
          1986.
 
 
 
               Claimant apparently saw no physician from her work return 
 
          until her termination.  Subsequent to her termination, she saw 
 
          Dr. Eddingfield again.  Claimant testified that she called Linda 
 
          Watson, K-Mart personnel director at the Keokuk store, and asked 
 
          for medical care.  She reported Ms. Watson told her that, since 
 
          she was no longer employed, K-Mart was not responsible for her 
 
          medical care.  Claimant then saw Dr. Eddingfield on her own. 
 
          Claimant testified that Dr. Eddingfield advised her to see Walid 
 
          Hafez, M.D., a neurologist, hospitalized her for a CT scan and 
 
          prescribed one and one-half months of physical therapy.  She 
 
          reported that he subsequently referred her to William Vance, 
 
          D.C., who treated her complaints.  Claimant testified that she 
 
          continues to have numbness and pain in her head, neck and 
 
          shoulders which was not present prior to her injury.  She 
 
          identified medical statements in evidence as involving treatment 
 
          incurred for her condition as described.  At hearing, the parties 
 
          stipulated that K-Mart would send claimant to see Dr. Kemp.  They 
 
          further stipulated that, if necessary and recommended by Dr. 
 
          Kemp, a neurologist or orthopaedic surgeon of Dr. Kemp's choice 
 
          would examine claimant and issue further treatment, if necessary. 
 
          Claimant received unemployment benefits after contesting her 
 
          initial denial of those benefits subsequent to her employment at 
 
          K-Mart.  Claimant agreed that, at the time of her October, 1986 
 
          deposition, she was still receiving unemployment benefits.  She 
 
          did not contest that she had said in her deposition she was not 
 
                                                               
 
                                                               
 
                    sure she wanted to work as she wished to stay home and take care 
 
          of her daughter.  Claimant is now employed at the Ten Pin Bowl, 
 
          earning $3.75 per hour.  She works approximately 12 hours per 
 
          week and receives tips.  Claimant received $3.80 per hour at 
 
          K-Mart and worked 25-30 hours per week.  Claimant agreed that her 
 
          actual take-home net at the Ten Pin Bowl, with tips, is 
 
          approximately the same as it was at K-Mart.  Claimant is a high 
 
          school graduate. Prior to her K-Mart employment, claimant had 
 
          held a number of waitressing and bartending jobs, each paying 
 
          between $3-$4 per hour.  Claimant agreed that, after her work 
 
          return in September, 1985, she did not miss work at K-Mart on 
 
          account of neck or shoulder pain.  Claimant stated that such was 
 
          reoccurring, but that she did not "bring it up."
 
 
 
               Claimant agreed that outstanding bills with a doctor and 
 
          with the Four Seasons on her credit report were not related to 
 
          her K-Mart incident.
 
 
 
               Murray Brooks, Jr., general store manager of K-Mart at 
 
          Keokuk, reported that, to the best of his knowledge, claimant's 
 
          medical bills to her work return in September, 1985, were paid.  
 
          He indicated that, upon her work return, claimant did not inform 
 
          him of any physical limitations.  He denied that claimant was 
 
          demoted, but was unable to state whether claimant received less 
 
          hours.  He reported that different employees are given more or 
 
          less hours, but that claimant was not subjectively given less 
 
          hours than other employees.  Mr. Brooks denied that claimant had 
 
          ever told him of problems with her neck, shoulder or back.  He 
 
          stated that, had she done so, he would have advised her to see a 
 
          physician.  He reported that claimant exhibited no signs of 
 
          impairment in work performance from her work return until her 
 
          termination.  Mr. Brooks characterized claimant's termination as 
 
          resulting from cash register shortages and tardiness.  He reported 
 
          that the shortages arose from not properly supervising to prevent 
 
          shortages.  Brooks reported that claimant did not ask for medical 
 
          treatment until after she was denied unemployment benefits at the 
 
          first level. Brooks reported that claimant was not returned to the 
 
          company doctor after her termination because she was no longer 
 
          covered by company insurance at that point.
 
 
 
               Linda Watson, personnel director at K-Mart in Keokuk, 
 
          reported that she observed no limitations on claimant's ability 
 
          to perform her duties from her work return until April 11, 1986. 
 
          Watson reported that claimant called her following her 
 
          termination and that Watson initially told claimant she could see 
 
          either Dr. Kemp or Dr. Schulte, but that, after a conversation 
 
          with Mr. Brooks, Watson told claimant she would not be able to 
 
          see either physician since she was no longer employed by K-Mart.  
 
          Watson recalled a Spring, 1986 phone conversation with Dr. Kemp's 
 
          office in which she advised the office that claimant's medical 
 
          treatment would not be covered since claimant had been released 
 
          from work and terminated.  Watson reported she has never received 
 
          communication from a medical practitioner that claimant continues 
 
          to have problems related to her 1985 injury.  Watson reported 
 
          that claimant exhibited no symptoms on her work return and never 
 
                                                               
 
                                                               
 
                    requested to again see Dr. Eddingfield until April, 1986.
 
 
 
               A Keokuk area hospital outpatient record of September 10, 
 
          1985 reports that claimant has a superficial laceration to the 
 
          right side of the head of approximately one inch.  The report 
 
          indicates that claimant had no loss of consciousness, but had 
 
          kept wanting to go to sleep.  An x-ray was reported as negative. 
 
          Tylenol #3 was prescribed.  The diagnosis was of an abrasion on 
 
          the scalp and concussion.  Claimant was released to return home, 
 
          apparently in good condition and ambulatory.  On September 11, 
 
          1985, Charles Eddingfield, M.D., reported that claimant had had 
 
          vertigo while sitting in the waiting room and had lain down.  She 
 
          was advised to not go to work and to rest.  On September 16, 
 
          1985, claimant was, by Dr. Eddingfield's report, able to be up 
 
          and about for an hour and then would develop more pain.  She 
 
          continued to have some dizziness, but was considerably improved 
 
          and stated she felt much better.  She did not feel nauseated, had 
 
          not been vomiting and had had no vision changes.
 
 
 
               On September 24, 1985, James P. Smith, L.P.T., reported that 
 
          claimant had normal range of motion throughout the cervical area, 
 
          but slight associated soft tissue tightness of the bilateral 
 
          cervical spine.  On September 26, 1985, Mr. Smith noted that 
 
          claimant had shown good progress with a reduction in soft tissue 
 
          tightness about the posterior cervical area.  Increased cervical 
 
          
 
                            
 
                                                               
 
          motion was noted and claimant stated she had less acute pain 
 
          about the involved area, although some residual soreness 
 
          remained.
 
 
 
               A note, apparently of Dr. Kemp, of September 25, 1985, 
 
          reports that claimant is ready to return to work as of September 
 
          26, 1985.  A further note of Dr. Kemp indicates that claimant 
 
          missed a follow-up appointment on October 2, 1985.  A note, also 
 
          apparently of Dr. Kemp, of May 2, 1986 states that Linda Watson 
 
          from K-Mart had phoned and stated that patient had returned to 
 
          work and was later terminated.. The note indicates that claimant, 
 
          at that time, stated she had head, neck and back pain which she 
 
          believed related back to her September 10, 1985 injury.  Ms. 
 
          Watson apparently reported that K-Mart would refuse charges for 
 
          further office calls.
 
 
 
               On May 30, 1986, Walid Hafez, M.D., a neurologist, reported 
 
          that claimant's neurological examination was entirely within 
 
          normal limits for mental state, cranial nerves, motor system, 
 
          sensory system, coordination, reflexes, station and gait, and 
 
          Romberg test.  Percussion of the calvarium did elicit very 
 
          minimal tenderness over the right posterior parietal area.  
 
          Manipulation of the neck revealed excellent range of motion 
 
          without muscle spasm and without pain.  The doctor related that 
 
          claimant gave a history of post-traumatic headaches and possibly 
 
          mild depressive symptomology which could relate to her 
 
          unfortunate dealings with her employer.  Claimant's prognosis was 
 
          good and the doctor did not expect her to have chronic headaches, 
 
          migraines or neck pain. Claimant's examination was characterized 
 
          as extremely satisfactory and the doctor saw no need to proceed 
 
          with more testing, more specifically, any need for a CT brain 
 
          scan.  Claimant was advised to continue with Motrin.  The doctor 
 
          prescribed 25 mg of Amitriptyline for claimant at bedtime to 
 
          improve her sleep and to possibly alleviate some of her mild 
 
          depressive symptoms.
 
 
 
               On July 29, 1986, claimant described her complaints on a 
 
          patient admission form from Vance Chiropractic Clinic as "grating 
 
          sound on movement" of the neck, frontal head pain and aching 
 
          shoulders.  She also reported pain at the base of the neck, 
 
          headache, inability to sleep, some vertigo and some tingling, 
 
          apparently of the hand.  Handwritten notes, apparently of the 
 
          Vance Chiropractic Clinic, indicate headache improved as of 
 
          August 18, 1986; one headache during the week of August 22, 1986; 
 
          apparently a bad head [ache], neck and back [pain] on Wednesday 
 
          of the week of September 5, 1986; headache during the week of 
 
          September 18, 1986; nerves and headache during the week of 
 
          October 17, 1986; and, headache during the week of November 25, 
 
          1986.
 
 
 
               Charges with the Vance Chiropractic Clinic in evidence 
 
          include a $35.00 fee for full spine x-ray of July 29, 1986; 
 
          $35.00 fee for a lateral full spine x-ray of July 29, 1986; 
 
          $195.00 charge for office calls of July 31, August 11, August 13, 
 
          August 18, August 22, August 29, September 5, September 12, 
 
                                                               
 
                                                               
 
                    September 30, October 17, November 4, and November 25, 1986 and 
 
          February 6, 1987.  Claimant is reported as having already paid 
 
          prescription costs for Tylenol with codeine at $6.20; for Talwin 
 
          at $10.55; and for Tylenol with codeine at $6.20, prescribed from 
 
          September 10, 1985 through September 20, 1985.  Claimant has 
 
          $140.00 of outstanding charges with James Smith for services 
 
          rendered on May 19, 1986, May 20, 1986, May 21, 1986, May 22, 
 
          1986, May 27, 1986, May 28, 1986 and May 29, 1986.
 
 
 
               Claimant has $60.00 of charges for office visits for herself 
 
          with Dr. Eddingfield on July 23, 1986, October 11, 1986 and 
 
          January 28, 1987.  A balance forward with Dr. Eddingfield of 
 
          $180.00 also remains.  It cannot be discerned whether such 
 
          relates to treatment for claimant, for her daughter or for her 
 
          then spouse.  K-Mart Corporation paid Dr. Eddingfield a balance 
 
          of $140.00 by check dated February 14, 1986.
 
 
 
               Claimant has a $75.00 balance due for treatment with Dr. 
 
          Hafez.
 
 
 
               A Keokuk Area Hospital statement of September 13, 1985 
 
          reports $227.50 in charges for treatment rendered on September 
 
          10, [1985].  A notation of November 12, 1985 reports a payment of 
 
          $227.50 from K-Mart.
 
 
 
               A statement identified on the exhibit list as from the 
 
          Credit Bureau of Keokuk indicates a balance due of $1,177.15 with 
 
          $192.50 due to a Dr. Fortson, $140.00 due to Jim Smith, $92.76 
 
          due to a Dr. Strope, $717.05 due to the Keokuk Area Hospital and 
 
          $34.76 due to the Four Seasons.
 
 
 
               In his deposition taken December 7, 1987, Robert R. Kemp, 
 
          M.D., identified himself as a family practitioner.  He reported 
 
          that, when he released claimant to return to work on September 
 
          26, 1985, he recorded no limitations of bending, stooping or 
 
          lifting. He reported that his impression was that claimant then 
 
          should have been able to satisfactorily do any type of work that 
 
          would ordinarily be done at a K-Mart store.  In response to a 
 
          hypothetical question generally outlining claimant's medical 
 
          course subsequent to September 10, 1985, he opined that the 
 
          course would substantiate that she was not "disabled."  The 
 
          doctor stated, however, that claimant may have had subjective 
 
          complaints, even if those were not limiting the type of work that 
 
          she would have.  He reported that, if claimant continued to have 
 
          symptoms, then further evaluation would be appropriate.  The 
 
          doctor stated that mild concussions ordinarily might produce 
 
          symptoms such as dizziness for from one to three days.  He 
 
          reported that a blow to the head may indirectly injure the neck, 
 
          but that the length of time such would bother was moderate, 
 
          depending upon the severity of the injury.  The doctor reported 
 
          that, for her symptomatology to continue in the neck area for a 
 
          year and a half, would be a rather long time.  He reported that, 
 
          while patients may complain and have symptoms, those symptoms do 
 
          not necessarily mean permanent injury.  The doctor reported that 
 
          symptomatology and complaints in the neck area should resolve 
 
                                                               
 
                                                               
 
                    within six months to a year or less.
 
 
 
                        APPLICABLE LAW AND ANALYSIS
 
 
 
               Initially, we note that claimant, in her brief, conceded 
 
          that she has no further entitlement to additional temporary total 
 
          disability.  We agree with claimant as it is apparent from the 
 
          evidence presented that claimant could have continued working, 
 
          but for her termination on April 11, 1986 for noninjury-related 
 
          reasons.  We consider then the issue of whether claimant has 
 
          established a causal relationship between her work injury and 
 
          claimed permanent partial disability.
 
 
 
               The claimant has the burden of proving by a preponderance of 
 
          the evidence that the injury of September 10, 1985 is causally 
 
          related to the disability on which she now bases her claim.  
 
          Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  
 
          Lindahl v. L. O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
          possibility is insufficient; a probability is necessary.  Burt v. 
 
          John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
          (1955).  The question of causal connection is essentially within 
 
          the domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
          Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).
 
 
 
               However, expert medical evidence must be considered with all 
 
          other evidence introduced bearing on the causal connection.  
 
          Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
          not be couched in definite, positive or unequivocal language.  
 
          Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
          the expert opinion may be accepted or rejected, in whole or in 
 
          part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
          be given to such an opinion is for the finder of fact, and that 
 
          may be affected by the completeness of the premise given the 
 
          expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
          516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
          Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
 
 
               Claimant has presented no direct medical evidence supporting 
 
          her contention of a causal connection between her work injury 
 
          consisting of a scalp laceration and possible concussion and 
 
          claimed permanency.  Claimant returned to work in late September, 
 
          1985 and worked until her termination on April 11, 1986.  Claimant 
 
          saw no physician from her work return until subsequent to her 
 
          termination.  Claimant did not request medical treatment or make 
 
          complaints to her employer during the period from her work return 
 
          until subsequent to her termination.  Physicians whom claimant saw 
 
          subsequent to her termination, while relating claimant's 
 
          subjective history as to the origin of her complaints, have not 
 
          rendered opinions causally connecting those complaints to the 
 
          earlier work-injury.  Dr. Hafez has stated that claimant's 
 
          prognosis was good and that he did not expect her to have chronic 
 
          headaches, migraines or neck pain.  He found her neurological 
 
          examination to be entirely within normal limits.  He did not feel 
 
          that CT scan or other further testing was appropriate for 
 
          claimant.  He agreed that claimant had mild depressive symptoms 
 
                                                               
 
                                                               
 
                    which could relate to her unfortunate dealings with her employer, 
 
          but did not connect those with the work injury per se.  Given 
 
          claimant's variety of problems with K-Mart, that statement even 
 
          coupled with lay evidence would not be sufficient to connect 
 
          claimant's depressive symptomatology to her work injury.  
 
          Likewise, Dr. Hafez's statement that claimant would not be 
 
          expected to have chronic headaches, migraines or neck pain would 
 
          mitigate any claim as to permanency on account of those 
 
          conditions.
 
 
 
               Further, the doctor did not relate them to the work injury, 
 
          but for claimant's subjective history.  Additionally, Dr. Kemp, 
 
          who, with Dr Eddingfield, treated claimant subsequent to her 
 
          injury in September, 1985, reported that, when released to work, 
 
          she had no limitations on bending, stooping or lifting.  He 
 
          stated his impression that mild concussions would ordinarily 
 
          produce symptoms such as dizziness for from one to three days and 
 
          that any blow to the head which indirectly injured the neck would 
 
          probably cause symptomatology and complaints in the neck area 
 
          which would resolve within six months to a year or less.  Such 
 
          would suggest that any continuing difficulties claimant now has 
 
          were too distant in time when initially made manifest after her 
 
          April, 1986 termination and are currently too distant in time to 
 
          be rationally related to her September, 1985 work incident.  
 
          Further, while claimant has treated with the Vance Chiropractic 
 
          Clinic since at least July, 1986, notes of the clinic in evidence 
 
          suggest that claimant's principal complaint is of headaches.  
 
          Nothing in the notes suggests that the headaches relate to the 
 
          September, 1985 work incident.  Clinic notes in their entirety 
 
          suggest that claimant's personal circumstances and personal 
 
          activities could have also contributed to her headaches and other 
 
          complaints. Claimant's claim of a causal relationship between her 
 
          work incident and permanent disability fails.
 
 
 
                        
 
                                                               
 
 
 
               As claimant has not shown a causal relationship between her 
 
          work incident and claimed permanent disability, we need not make 
 
          a determination as to the nature and extent of any claimed 
 
          permanent partial disability.  We note in passing, however, that, 
 
          had such been established, any permanency award would have been 
 
          de minimous.  Claimant was not precluded from returning to work 
 
          at K-Mart following her work incident.  Indeed, she worked for 
 
          her employer for at least seven months subsequent to the 
 
          incident. Claimant, at least in part, voluntarily removed herself 
 
          from the labor market subsequent to her K-Mart termination.  When 
 
          she did ultimately seek employment, such employment was well 
 
          within the skills she had possessed prior to and subsequent to 
 
          her injury and paid approximately the same as her K-Mart salary. 
 
           Claimant has had no physician-imposed limitations.  All of the 
 
          above would suggest that any permanency award would have been 
 
          minimal, at best.
 
 
 
               As regards the section 85.27 issue, the parties stipulated 
 
          at hearing that claimant would be permitted to schedule an 
 
          examination by Dr. Kemp and that, if Dr. Kemp thought such was 
 
          warranted, she would be referred to a neurologist or orthopaedic 
 
          surgeon of Dr. Kemp's choice.  Therefore, such is not an issue.
 
 
 
               Claimant seeks payment of medical costs with physicians seen 
 
          after her April, 1986 termination.  Section 85.27 requires the 
 
          defendant to pay claimant for reasonable and necessary medical 
 
          care, both authorized and related to a compensable injury.  For 
 
          reasons further elaborated above in the discussion of the 
 
          permanency causal connection issue, claimant has not shown that 
 
          care sought after her April 11, 1986 termination related to her 
 
          September, 1985 work injury.  As noted, such care was remote in 
 
          time from claimant's original injury.  Claimant had not made 
 
          complaints nor sought care for an extended period from her 
 
          post-injury work return to following her termination.  No 
 
          physician has causally connected such care with conditions 
 
          related to claimant's work injury.  Hence, on the record as 
 
          submitted, claimant has not established the requisite causal 
 
          connection between such care and her work injury.  Payment for 
 
          such is not required of the defendant.
 
 
 
               As the defendant has no requirement to pay claimant for any 
 
          care sought and as claimant has not shown any entitlement to 
 
          permanent partial disability benefits, the issue of whether a 
 
          penalty is appropriate for unreasonable delay or denial of 
 
          benefits is moot.
 
 
 
                                FINDINGS OF FACT
 
 
 
               WHEREFORE, IT IS FOUND:
 
 
 
               Claimant received an injury arising out of and in the course 
 
          of her employment on September 10, 1985 when she was hit on her 
 
          head by items from a Sani-Flush display while working at K-Mart.
 
 
 
                                                               
 
                                                               
 
               Claimant had a superficial laceration to the right side of 
 
          her head of approximately one inch.  Claimant had no loss of 
 
          consciousness, but had kept wanting to go to sleep.
 
 
 
               Claimant's diagnosis was of an abrasion on the scalp and 
 
          concussion.
 
 
 
               Claimant had dizziness when seen by Dr. Eddingfield on 
 
          September 11, 1985 and on September 16, 1985.
 
 
 
               On September 16, 1985, claimant felt that her dizziness was 
 
          considerably improved and she did not feel nauseated, had not 
 
          been vomiting and had had no vision changes.
 
 
 
               On September 25, 1985, claimant was released to work after 
 
          September 26, 1985 without restrictions.
 
 
 
               Claimant worked from after September 26, 1985 until her 
 
          termination at K-Mart on April 11, 1985 for cash register 
 
          shortages and tardiness.
 
 
 
               From her work return until her termination, claimant did not 
 
          complain of symptoms related to her work injury and was able to 
 
          work.
 
 
 
               Subsequent to her termination, claimant requested further 
 
          medical care.
 
 
 
               Subsequent to her termination, claimant sought further 
 
          medical care on her own accord when K-Mart refused to authorize 
 
          such care.
 
 
 
               Further care received after claimant's termination was not 
 
          causally related to claimant's work incident.
 
 
 
               Conditions complained of subsequent to claimant's 
 
          termination were not causally related to claimant's work 
 
          incident.
 
 
 
                             CONCLUSIONS OF LAW
 
 
 
               THEREFORE, IT IS CONCLUDED:
 
 
 
               Claimant has not established that her injury of September 
 
          10, 1985 is causally related to any additional temporary total 
 
          disability or causally related to any permanent partial 
 
          disability.
 
 
 
               Claimant has not established she is entitled to payment of 
 
          medical costs for treatment sought after her April 11, 1985 
 
          termination by K-Mart.
 
 
 
                                    ORDER
 
 
 
               THEREFORE, IT IS ORDERED:
 
                                                               
 
                                                               
 
 
 
               Claimant take nothing further from this proceeding.
 
 
 
               Claimant pay costs of this proceeding pursuant to Division 
 
          of Industrial Services Rule 343-4.33.
 
 
 
               Signed and filed this 22nd day of April, 1988.
 
 
 
 
 
                                               
 
 
 
 
 
                                             HELEN JEAN WALLESER
 
                                             DEPUTY INDUSTRIAL COMMISSIONER
 
 
 
          Copies To:
 
 
 
          Mr. James P. Hoffman
 
          Attorney at Law
 
          Middle Road
 
          P.O. Box 1066
 
          Keokuk, Iowa  52632
 
 
 
          Mr. John B. Grier
 
          Attorney at Law
 
          P.O. Box 496
 
          112 West Church Street
 
          Marshalltown, Iowa  50158
 
 
 
 
 
 
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 1108, 1803
 
                                                 Filed April 22, 1988
 
                                                 HELEN JEAN WALLESER
 
         
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         MARLA DAVIS,
 
         
 
              Claimant,
 
                                                      File No. 804730
 
         vs.
 
                                                   A R B I T R A T I 0 N
 
         K MART DISCOUNT STORE,
 
                                                      D E C I S I 0 N 
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         1108, 1803
 
         
 
              Claimant did not establish causal connection between work 
 
         incident and claimed permanent partial disability where claimant 
 
         did not seek further care after post-injury work return for seven 
 
         months and only after the employer terminated her for 
 
         noninjury-related reasons.
 
 
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            ROSALIE CAMPBELL,             :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  804937
 
            CASEY'S GENERAL STORE,        :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            U S F AND G,                  :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                 This is a proceeding in arbitration brought by Rosalie 
 
            Campbell as a result of injuries to her back which occurred 
 
            on August 19, 1985.  Defendants admitted compensability and 
 
            paid compensation and medical benefits.
 
            
 
                 The case was heard and fully submitted at Des Moines, 
 
            Iowa, on January 25, 1991.  The record in the proceeding 
 
            consists of joint exhibits 1 through 7, claimant's exhibit A 
 
            and the testimony of claimant.  Claimant's exhibit B was 
 
            received as an offer of proof.
 
            
 
                                      issue
 
            
 
                 The issue for determination is claimant's entitlement 
 
            to permanent partial disability under Iowa Code section 
 
            85.34(2)(u).  
 
            
 
                                 findings of fact
 
            
 
                 Having considered all the evidence received, the 
 
            following findings of fact are made:
 
            
 
                 Rosalie Campbell worked for Casey's General Store in 
 
            Des Moines, Iowa, as a manager in October 1985.  In that 
 
            capacity she was responsible for managing all aspects of the 
 
            store.  She hired and discharged employees.  She purchased 
 
            and stocked supplies.  She also unloaded supplies off 
 
            trucks, ran the cash register and did other manual labor 
 
            within the store.  Claimant was 25 years of age on August 
 
            19, 1985.  While unloading a truck on August 19, 1985, on 
 
            her employer's premises claimant was lifting boxes and felt 
 
            a pop in her back which got progressively worse throughout 
 
            the day.  The next morning claimant had pain down her legs.  
 
            She called her supervisor and then went to the Wilden Clinic 
 
            for treatment.  She was eventually referred to Thomas 
 
            Carlstrom, M.D., and finally went to William Boulden, M.D., 
 
            for another opinion.
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 A diagnosis of lumbosacral strain secondary to lifting 
 
            was initially made.  However, after considerable medical 
 
            treatment and further testing, a diagnosis of herniated disc 
 
            L4-5 was made by Dr. Boulden.  Claimant underwent an 
 
            anterior lumbar interbody fusion at L4-5 with lumbar fusion 
 
            on April 10, 1987.  Dr. Boulden provided her with the 
 
            follow-up care.  Dr. Boulden rated claimant's permanent 
 
            partial impairment at 15 percent of the body as a whole on 
 
            November 30, 1987 (exhibit 6, page 19).  On October 24, 
 
            1988, Dr. Boulden again confirmed that the impairment rating 
 
            was 15 percent and imposed physical limitations that would 
 
            prevent claimant from standing in one position for long 
 
            periods of time and also to avoid prolonged sitting, bending 
 
            and twisting with her back (ex. 6, p. 33).
 
            
 
                 Claimant had an evaluation by Jerome G. Bashara, M.D., 
 
            orthopedic surgeon, on May 5, 1989.  Dr. Bashara's 
 
            evaluation was made at the request of claimant's attorney.  
 
            Dr. Bashara agreed with Dr. Boulden with respect to 
 
            claimant's diagnosis of herniated lumbar disc L4-5 (ex. A, 
 
            p. 4).  He opined that claimant sustained 20 percent 
 
            permanent partial impairment to the body as a whole as a 
 
            result of the injury which was sustained on August 19, 1985.  
 
            He also placed permanent work restrictions upon claimant 
 
            comprised of 10 pounds lifting restrictions with no 
 
            excessive repetitive bending, stooping or bending of the 
 
            lower back.  
 
            
 
                 It is found that claimant sustained a 15 to 20 percent 
 
            permanent partial impairment of the body as a whole as a 
 
            result of the August 19, 1985, injury.  The impairment 
 
            rating is the compromise of the two examining phsycians' 
 
            ratings.  Both physicians' examinations resulted in almost 
 
            identical diagnoses and work restrictions.    
 
            
 
                 It is found that claimant's permanent work 
 
            restrictions, incurred as a result of the August 19, 1985, 
 
            injury, are no excessive or repetitive bending, stooping or 
 
            twisting of the lower back with no lifting over 10 pounds.  
 
            It is also found that as a result of the work restrictions, 
 
            claimant is prohibited from returning to her position as 
 
            manager with employer.  
 
            
 
                 Claimant was released to return to work in May 1988.  
 
            Employer offered claimant a position as donut maker at their 
 
            store on East Grand Avenue in Des Moines, Iowa.  Claimant 
 
            testified that the work was too demanding and that it 
 
            required her to stand on her feet for prolonged periods of 
 
            time thereby exacerbating her low back pain.  Claimant 
 
            testified that donut maker was a step down from her position 
 
            as manager.  Claimant earned $3.90 per hour as a donut 
 
            maker.  Claimant left that position because of her inability 
 
            to perform the physical requirements of the job.  
 
            
 
                 Claimant was then offered another position with 
 
            employer at its corporate office.  Her job title was 
 
            clerical assistant and she earned a wage of $3.90 per hour.  
 
            She started that position in January of 1989 and her 
 
            employment was terminated in May of the same year.  Her 
 
            duties consisted of stuffing envelopes, moving small boxes 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            and general clerical work.  Between the dates of January 31, 
 
            1989 and May 16, 1989, claimant was to have worked a total 
 
            of 375 hours.  She was absent a total of 155 hours with a 
 
            resulting absenteeism rate of 41 percent (ex. 2, p. 14).  
 
            Claimant was discharged from employment with Casey's General 
 
            Stores as a result of the excessive and chronic absenteeism.  
 
            Claimant alleged that her absenteeism was due to poor 
 
            working conditions and back pain.  
 
            
 
                 Claimant was next employed with P and P Small Engines 
 
            on East University in Des Moines, Iowa.  She worked that job 
 
            in November 1989.  She was a computer operator.  Claimant 
 
            testified that her back held up well during the work, but 
 
            she did experience some back pain.    
 
            
 
                 Claimant has been on ADC since January of 1990.  
 
            However, claimant testified that she has sought employment 
 
            after January 1990.  She testified that between the middle 
 
            of 1989 and the middle of 1990 she had made application for 
 
            jobs at companies such as ABC Milling, Manpower Temporary 
 
            Services, Meredith Publishing, Rose Bowl Tap and Commtron as 
 
            well as other companies.  Claimant stated that she had made 
 
            at least a dozen such applications as well as signing up 
 
            with Job Service and with the ADC Promise Jobs program.
 
            
 
                 Having considered the testimony of claimant and 
 
            exhibits offered, it is found that claimant was not 
 
            motivated to return to work with employer.  Throughout her 
 
            convalescence, claimant exhibited the inability to attend 
 
            scheduled appointments (ex. 6, p. 105).  Claimant also found 
 
            it impossible to appear on time for the work awareness 
 
            program (ex. 6, p. 5).  Claimant's chronic absenteeism with 
 
            employer upon her return to work in 1989 and early 1990, was 
 
            just another example of her lack of motivation to engage in 
 
            gainful employment.  
 
            
 
                 The sole issue presented for resolution is the extent 
 
            of claimant's entitlement to industrial disability.  Factors 
 
            to be considered when assessing industrial disability 
 
            include claimant's age, education, experience, work 
 
            restrictions, impairment and employer's offer of employment.  
 
            Claimant was age 25 at the time of injury.  She did not have 
 
            a high school diploma at that time, but with the assistance 
 
            of vocational rehabilitation, offered by employer, claimant 
 
            did acquire a GED in 1987.  
 
            
 
                 Claimant's experience prior to working for Casey's was 
 
            that of unskilled manual labor.  A good portion of 
 
            claimant's life was spent unemployed and on ADC during the 
 
            period 1981 through 1984 (ex. 1, p. 21).  The position as 
 
            manager for employer was clearly the highest paying and best 
 
            job that claimant had ever occupied during her entire work 
 
            life.  Claimant's current work restrictions prevent her from 
 
            returning to such employment.  The work restrictions placed 
 
            upon claimant as a result of the August 19, 1985, injury 
 
            weigh heavily in favor of finding of industrial disability.
 
            
 
                 Claimant's permanent partial impairment of 15 to 20 
 
            percent also weighs heavily in favor of finding of 
 
            significant industrial disability.
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            
 
                 In the case at hand, the employer made a good faith 
 
            effort to reemploy claimant.  Not only did employer offer 
 
            the assistance of vocational rehabilitation counselors, in 
 
            an effort to locate employment, but employer offered two 
 
            separate positions.  The first position as donut maker was 
 
            too physically demanding for claimant to perform.  The 
 
            second position as a clerical worker was well within 
 
            claimant's work restrictions.  However, claimant was not 
 
            motivated to return to work and lost that job due to 
 
            excessive absenteeism.  Employer's good faith offer of 
 
            employment and vocational rehabilitation weighs against 
 
            industrial disability.  
 
            
 
                 It should be noted that the work offered by employer 
 
            subsequent to claimant's discharge from medical care paid 
 
            between $3.90 and $4 per hour.  Claimant's work as a manger 
 
            paid $200 per week with a monthly bonus paid based upon 
 
            profitability of the local store.  Exhibit 4 page 10 
 
            indicates that claimant's commissions would continue to 
 
            increase as her seniority increased with employer.  
 
            Claimant's initial commission was 1 percent of inside sales 
 
            less sales tax.  If claimant had not been injured, she would 
 
            have received 1 1/2 percent of inside sales starting 
 
            February 18, 1986, and 2 percent of inside sales beginning 
 
            February 18, 1987.  Claimant's work week as a manager 
 
            consisted of approximately 50 hours per week.  Claimant's 
 
            average weekly wage at the time of injury was approximately 
 
            $274 per week.  Based upon a 50-hour work week she was 
 
            earning approximately $5.48 per hour.  It stands to reason 
 
            that reemployment at the rate of $3.90 to $4 per hour 
 
            resulted in a significant loss of earning capacity.  
 
            However, claimant also testified that her job at P and P 
 
            paid $4.50 per hour.  
 
            
 
                 Having considered all of the evidence received, it is 
 
            found that claimant sustained 35 percent industrial 
 
            disability as a result of the August 19, 1985, injury to her 
 
            low back.  The work restrictions imposed upon claimant as a 
 
            result of that injury significantly impair her ability to 
 
            compete in the open job market against better educated and 
 
            healthier individuals.  Had the employer failed to offer 
 
            employment and vocational rehabilitation, claimant's 
 
            industrial disability would have been significantly higher.
 
            
 
                                        
 
            
 
                                conclusions of law
 
            
 
                 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, expe
 
            rience and inability to engage in employment for which he is 
 
            fitted.  Olson v. Goodyear Service Stores, 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 disabil
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            ity.  This is so as impairment and disability are not syn
 
            onymous.  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 dis
 
            ability include the employee's medical condition prior to 
 
            the injury, immediately after the injury, and presently; the 
 
            situs of the injury, its severity and the length of healing 
 
            period; the work experience of the employee prior to the 
 
            injury, after the injury and potential for rehabilitation; 
 
            the employee's qualifications intellectually, emotionally 
 
            and physically; earnings prior and subsequent to the injury; 
 
            age; education; motivation; functional impairment as a 
 
            result of the injury; and inability because of the injury to 
 
            engage in employment for which the employee is fitted.  Loss 
 
            of earnings caused by a job transfer for reasons related to 
 
            the injury is also relevant.  These are matters which the 
 
            finder of fact considers collectively in arriving at the 
 
            determination of the degree of industrial disability.
 
            
 
                 There are no weighting guidelines that indicate how 
 
            each of the factors are to be considered.  There are no 
 
            guidelines which give, for example, age a weighted value of 
 
            ten percent of the total value, education a value of fifteen 
 
            percent of total, motivation - five percent; work experience 
 
            - thirty percent, etc.  Neither does a rating of functional 
 
            impairment directly correlate to a degree of industrial 
 
            disability to the body as a whole.  In other words, there 
 
            are no formulae which can be applied and then added up to 
 
            determine the degree of industrial disability.  It therefore 
 
            becomes necessary for the deputy or commissioner to draw 
 
            upon prior experience, general and specialized knowledge to 
 
            make the finding with regard to degree of industrial dis
 
            ability.   See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985); Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, l985).
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
         
 
              Upon considering all the material factors it is found that 
 
         the evidence in this case supports an award of 35 percent 
 
         permanent partial disability which entitles the claimant to 
 
         recover 175 weeks of benefits under Iowa Code section 85.34(2)(u) 
 
         as a result of the low back injuries incurred on August 19, 1985.
 
         
 
                                      order
 
         
 
              IT IS THEREFORE, ORDERED:
 
         
 
              Defendants are to pay claimant one hundred seventy-five 
 
         (175) weeks of permanent partial disability benefits at the rate 
 
         of one hundred seventy-two and 16/100 dollars ($172.16) per week 
 
         commencing July 21, 1988.
 
         
 
              It is further ordered that defendants shall receive credit 
 
         for benefits previously paid.
 
         
 
              It is further ordered that all accrued benefits are to be 
 
         paid in a lump sum.
 
         
 
              It is further ordered that interest will accrue pursuant to 
 
         Iowa Code section 85.30. 
 
         
 
              It is further ordered that the costs of this action are 
 
         assessed against defendants pursuant to rule 343 IAC 4.33.
 
         
 
              It is further ordered that defendants file claim activity 
 
         reports as requested by this agency pursuant to rule 343 IAC 3.1.
 
         
 
              Signed and filed this ____ day of March, 1991.
 
         
 
         
 
         
 
         
 
                                       ______________________________
 
                                       MARLON D. MORMANN
 
                                       DEPUTY INDUSTRIAL COMMISSIONER    
 
         
 
         Copies to:
 
         
 
         Mr. Larry D. Krpan
 
         Attorney at Law
 
         3100 Ingersoll Ave.
 
         Des Moines, Iowa  50312
 
         
 
         Mr. Joseph Bauer
 
         Attorney at Law
 
         Saddlery Bldg. STE 500
 
         309 Court Ave.
 
         Des Moines, Iowa  50309
 
         
 
         Ms. Iris J. Post
 
         Attorney at Law
 
         2222 Grand Ave.
 
         PO Box 10434
 
         Des Moines, Iowa  50306
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      5-1803
 
                      Filed March 13, 1991
 
                      MARLON D. MORMANN
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            ROSALIE CAMPBELL,   :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 804937
 
            CASEY'S GENERAL STORE,   :
 
                      :    A R B I T R A T I O N
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            U S F AND G,   :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            5-1803
 
            Claimant, a manual laborer at age 25, injured her low back 
 
            with a resulting fusion surgery and 15-20 percent 
 
            impairment.  Claimant given work restrictions of no lifting 
 
            over 10 pounds by treating physician.  Employer offered work 
 
            at lower rate of pay.  Employer offered vocational 
 
            rehabilitation which resulted in claimant obtaining a GED.  
 
            Claimant awarded 35 percent PPD.