Page 1 before the iowa industrial commissioner ____________________________________________________________ : COLEEN J. RHEA, : : Claimant, : File Nos. 820183 : 886121 vs. : 872759 : WILSON FOODS CORPORATION, : A R B I T R A T I O N : Employer, : D E C I S I O N Self-Insured, : Defendant. : ___________________________________________________________ Colleen Rhea (claimant) filed three petitions for arbitration as a result of injuries to claimant's hand and shoulder. The petitions were filed on the following dates: File Number 886121, April 27, 1989, File Number 820183, December 31, 1987 and File Number 872759 on April 27, 1989. The alleged injury dates are as follows: File Number 886121, November 11, 1987, File Number 820183, March 27, 1986, and File Number 872759, February 26, 1988. Wilson Foods, Inc. (Wilson) was identified as employer and is self-insured for the purposes of workers' compensation liability. On April 30, 1991, these matters came on for hearing in Storm Lake, Iowa. The parties appeared as follows: the claimant in person and by his counsel Harry Smith of Sioux City, Iowa and Wilson by its counsel David Sayre of Cherokee, Iowa. The record in this proceeding consisted of the following: 1. The live testimony of the claimant and Dr. Keith Garner. 2. Joint exhibits 1-6 and 8-25. 3. Defendants' exhibit A. preliminary matters At the conclusion of the hearing, the undersigned asked counsel for both parties for an assessment of the industrial value to be assigned for the injuries suffered by the claimant in this dispute. There was discussion of an award of a permanent total disability benefit for the claimant. At that juncture, an objection was noted for the record that a question of permanent total disability had not been identified as an issue prior to the time of the hearing. The objection was overruled. The undersigned is free to decide the extent of claimant's industrial disability from 0 to 100 percent depending on the evidence adduced at the time of the hearing. As long as claimant identified industrial disability as an issue, the range of the award is not limited. Consequently, the ruling on the objection is reaffirmed and overruled. Page 2 In claimant's brief there was a reference to medical records from Dr. Mike O'Neil, identified as Exhibit 3. No such exhibit was offered at the time of the hearing. Exhibit 3 in this record is a document from Dr. Dennis Nitz regarding an EMG study. Additionally, there was mention made in the brief of two agreements for settlement that were made in connection with the injuries identified herein. A review of the file indicates that no such agreements have been made part of these files. stipulations In connection with all three injuries the parties stipulated to the following matters at the time of the hearing: a. An employer-employee relationship existed between claimant and employer at the time of the alleged injury. b. The type of permanent disability, if the injury is found to be a cause of permanent disability, is industrial disability to the body as a whole. c. The rate of compensation, in the event of an award, is as follows: File Number Rate Gross Wage 872759 $246.12 $375.00 886121 $246.12 $375.00 820183 $236.90 $369.00 At the time of all of these injuries, claimant was married and had two children. She is entitled to four exemptions. d. The entitlement to medical benefits is not in dispute. e. Wilson makes no claim for employee nonoccupational group health plan benefits paid prior to hearing. f. On File Number 820183, Wilson has paid 28.5 weeks of compensation at the rate of $236.90 per week prior to the hearing and is entitled to a credit for that amount. Additionally, Wilson has 25 weeks of compensation for File Numbers 886121 or 872759 at the rate of $246.12 per week prior to the hearing and is entitled to a credit for that amount. g. The parties have agreed on the amount of the costs to be taxed in this matter. In connection with the injury suffered on March 27, 1986 the parties stipulated to the following matters at the time of the hearing: a. The claimant sustained an injury on March 27, 1986, which arose out of and in the course of employment. Page 3 b. The injury caused a permanent disability. c. The type of permanent disability, if the injury is found to be a cause of permanent disability, is a scheduled member disability to the hand. d. The commencement date for permanent partial disability, is July 27, 1986. In connection with the injury suffered on November 11, 1987 the parties stipulated to the following matters at the time of the hearing: a. The claimant sustained an injury on November 11, 1987, which arose out of and in the course of employment. b. The injury caused a permanent disability. c. The type of permanent disability, if the injury is found to be a cause of permanent disability, is industrial disability to the body as a whole. In connection with the injury suffered on February 26, 1988, the parties stipulated to the following matters at the time of the hearing: a. An employer-employee relationship existed between claimant and employer at the time of the alleged injury. b. The type of permanent disability, if the injury is found to be a cause of permanent disability, is industrial disability to the body as a whole. Issues The issues for resolution for all three injury dates are as follows: 1. Whether claimant sustained an injury on February 26, 1988 which arose out of and in the course of her employment with Wilson. 2. Whether a causal relationship exists between claimant's claimed injuries and the claimed disability and the nature and extent of any entitlement to benefits, if any. findings of facts 1. At the time of the hearing, claimant was 33. At the time of claimant's first injury to her hand, she had just turned 28 years old. At the time of the second injury, on November 11, 1987, claimant was 29 years old. At the time of the alleged third injury, claimant was a day short of being 30 years old. 2. Claimant is a high school graduate and has attended Iowa Lakes Community College. She attended that institution for three quarters focusing in the areas of clerical, accounting, and office machines. This is the only post high Page 4 school education claimant has had. Claimant left school and entered the work force, initially at Hilltop Nursing Home as kitchen help. Claimant was paid minimum wage. Thereafter, claimant worked at a series of jobs for minimum wage. Claimant performed retail sales work, restaurant help work and office work. Claimant began working for Wilson in 1983. Claimant worked on the kill floor and in the packaging department. Claimant has also worked in the wiener room, the pump and press room, and the conversion room. Claimant's most recent positions included boning hams, and using a stylexer to shave fat off of hams. 3. Prior to the time that claimant was employed by Wilson, she was in good health and had no complaints of difficulties with her hand or shoulder. 4. Beginning in 1985, claimant developed work related injuries. She was diagnosed as having trigger finger in her right hand. She had a trigger finger release and was assigned a four percent functional impairment rating to the right hand due to the trigger finger surgery. This rating was given in September of 1985 by the orthopedic surgeon who performed the surgery, Oscar M. Jardon, M.D. 5. Beginning in 1986, claimant began to experience carpal tunnel syndrome symptoms in her right hand. In March of 1986, her hand became too numb to work. Claimant was taken off work on March 27, 1986. On April 23, 1986, Dr. Jardon performed a carpal tunnel release for claimant. During the course of the surgery, Dr. Jardon discovered that claimant had a rupture of the flexor digitorum profundus to the fifth finger. As a result of that discovery, Dr. Jardon increased claimant's functional impairment rating. On June 30, 1986, claimant was awarded a rating of fifteen percent (15%) of the hand. Dr. Jardon reaffirmed his fifteen percent (15%) rating on July 31, 1986. Claimant was returned to work shortly after the rating was given. Thereafter, claimant continued to complain of right wrist pain beginning in September of 1986 and intermittently thereafter. EMG studies were performed on September 22, 1987. These studies Page 5 showed that there was no evidence of carpal tunnel in the right hand at that time. Claimant was not off work during this time period. 6. On November 11, 1987, claimant slipped on some fat and fell off a stand, landing on her right shoulder and left forearm. After the fall, there was an onset of pain in the right shoulder area. Claimant returned to work the next day and had no further pain complaints in her right shoulder until January 1988. 7. After claimant complained of pain in her shoulder in January, Dr. Garner, Wilson's company physician, referred claimant to Dr. Jardon. Dr. Jardon saw claimant on January 13, 1988 and noted that claimant's carpal tunnel syndrome had not reappeared but that claimant's shoulder showed evidence of mild inflammation. Dr. Garner ordered x-ray studies of claimant's right shoulder on February 26, 1988 The x-ray study revealed a soft tissue swelling over the acromioclavicular joint. Additionally, the acromioclavicular joint appeared to be slightly widened, suggestive of a first degree tear in the rotator cuff. However, no follow-up studies were performed to confirm a possible tear of the rotator cuff. The x-ray did not show a soft tissue injury. Claimant was not taken off work at the time the x-ray was performed. Claimant was receiving physical therapy three times a week. 8. Claimant continued to complain of right shoulder pain. On March 30, 1988, claimant was taken off work for three weeks and a diagnosis of tendinitis was made by the company nurse. 9. On April 20, 1988, claimant was referred to Mark Wheeler, M.D., an orthopedist for further examination of her shoulder. Upon examination, Dr. Wheeler determined that there had been an insidious onset of pain with no precipitating trauma or event. Dr. Wheeler in his history indicated that claimant regularly uses a Whizard knife in her work. Dr. Wheeler found that claimant had tendinitis in her right shoulder. As a result of the tendinitis, Dr. Wheeler took claimant off work for three weeks. Claimant did not advise Dr. Wheeler that she had fallen on November 11, 1987. 10. When Dr. Wheeler saw claimant again on July 7, 1988, he indicated that claimant's work had aggravated the symptoms of tendinitis in her right shoulder, but that she was working. Claimant was released to return to work after this examination. Claimant was returned to work without restriction on July 21, 1988. 11. On October 20, 1988, claimant continued to complain of shoulder pain and that she was ready to quit work. She returned to see Dr. Wheeler for a rating of her shoulder. Dr. Wheeler found that claimant had a ten percent functional impairment of her shoulder. However, Dr. Wheeler did not impose any restrictions at the time he gave this rating to claimant. The rating was based on her limitations of external and internal rotation and her limitation of ten Page 6 degrees of full abduction and flexion. Claimant's ten percent functional impairment rating was attributed to the loss of motion that she had in the joint. Dr. Wheeler gave claimant a release for full duty on October 20, 1988. 12. On January 20, 1989, claimant voluntarily quit her employment with Wilson to accept a new position. Claimant was under the impression from conversations that she had with her medical providers that she should leave the packing industry as a worker. However, there is no documentary evidence that would support this conclusion. Further, there was no recommendation by any of claimant's doctors in any written form that indicates they advised her to stop working at Wilson as a result of her injuries at the time she left Wilson. 13. On May 11, 1989, Pat Luse, D.C., evaluated claimant for the purposes of assigning an industrial disability rating. Dr. Luse identified two injuries that claimant had suffered, one on February 26, 1988 and another on November 11, 1987. Apparently, Dr. Luse was unaware that claimant had suffered an injury with carpal tunnel syndrome claimed to have occurred on March 27, 1986. Dr. Luse did note that claimant had a carpal tunnel release on the right hand however. It is unclear from Dr. Luse's report the total loss he assigned to claimant's hand for the carpal tunnel release. He did not separately identify this condition as an injury.(1) The balance of the report discussed claimant's shoulder. Dr. Luse did not separately rate claimant's shoulder. Dr. Luse rated separate parts of claimant's loss and then combined the values. Dr. Luse indicated that he used the AMA Guides to the Evaluation of Permanent Impairment, third edition, but he did not indicate that he used the combined value table for assessing the loss. He summarily concluded that claimant had a functional impairment rating of 20%. The worksheet referenced in his report was not part of the exhibit that was submitted at the time of trial. 14. In November of 1989, claimant began to work at Countryside Nursing Home. After she had been working at the nursing home, claimant's shoulder flared up again. Claimant testified that her pain was worse at Countryside and that she was having more problems. Claimant quit her work at Countryside Nursing Home in March of 1990. She indicated to (1). From Dr. Luse's report, it is unclear exactly what disability of functional impairment rating he assigned to claimant's hand. There were three parts to the rating, a nine percent rating to the upper extremity for a motor impairment loss, a ten percent rating for loss of function due to sensory deficit and a ten percent loss assigned to the ruptured flexor digitorum profundus tendon. However, Dr. Luse did not combine these values to reach an impairment rating for claimant's hand. Since Dr. Jardon performed the surgery and had an opportunity to see the claimant before and after the surgery, Dr. Jardon's rating of 15 percent to the hand will be adopted as the rating for the functional impairment loss for claimant's hand. Page 7 her medical providers that she was in too much pain to continue working. On April 3, 1990, Dr. Wheeler sent a report to the Iowa Disability Determination Service Bureau regarding claimant's shoulder condition. He indicated that claimant had chronic recurring tendinitis in her right shoulder. Dr. Wheeler gave her a lifting and carrying restriction of no greater than 20 pounds and a restriction of no work above shoulder level. He further indicated that her standing was unlimited as well as walking and sitting. Additionally, claimant was not limited in terms of stooping, climbing, kneeling or crawling. Claimant's manual dexterity was adequate and her hearing, speaking and traveling abilities were not restriction in a work environment. 15. On April 17, 1990, Dr. Garner, directed a letter to the Social Security Administration in support of claimant's application for Social Security disability income. Dr. Garner indicated that claimant had a history of trigger finger, right carpal tunnel syndrome, and a probable right rotator cuff tear.(2) Dr. Garner indicated that claimant had continuing complaints of pain in her right shoulder. He found on the date of his examination, no evidence of swelling, redness or instability. Additionally, he found no evidence of nerve root compression. He found that her range of motion was fairly normal and that she had some crepitation with rotation of the shoulder. In terms of claimant's restrictions, Dr. Garner concluded that claimant could not lift or carry more than 10 pounds. He felt that she could walk, stand, move about and sit without restrictions. Additionally, claimant was capable of stooping, climbing and crawling. Claimant can handle objects, see and hear, however, Dr. Garner did note that claimant would have great difficulty doing any type of manual labor with her right shoulder. Dr. Garner concluded that claimant has tried to do manual labor with her right arm and this has not worked out. He recommended that she not do this type of work in the future. 16. In June of 1990, claimant participated in a demolition derby at the Cherokee fairgrounds. During the course of a demolition derby, claimant attempts to run into other automobiles being driven in a large track infield type area. Additionally, claimant attempts to avoid being hit. In the demolition derby that claimant participated in, if a participant was struck three times then the car and driver were disqualified. Claimant participated in this activity though she was not in the competition very long. 17. As of the date of the hearing, claimant had had no further medical care for her shoulder. Additionally, at the time of the hearing, claimant indicated that she could not (2). Dr. Garner qualified this part of his letter at the time of hearing, when he indicated that there had been no firm diagnosis of a rotator cuff tear. He orally amended his letter to indicate that claimant had a possible rotator cuff tear. He did indicate that the muscle on top of claimant's shoulder was involved in claimant's ongoing pain complaints. Page 8 mow the lawn, she could not vacuum and she could not play recreational softball. Additionally, claimant could not ride a motorcycle or drive a car with a clutch. She indicated that her activities regarding grocery shopping and playing with her children had been limited. CONCLUSIONS OF LAW I. March 27, 1986 Injury The only issue for resolution regarding this injury is the extent of permanent partial disability claimant is entitled to as a result of the carpal tunnel injury to her hand. Claimant contends that she is entitled to a benefit in excess of 15%. Wilson asserts that claimant has been paid all that she is entitled to receive. Permanent partial disabilities are classified as either scheduled or unscheduled. A specific scheduled disability is evaluated by the functional method; the industrial method is used to evaluate an unscheduled disability. Martin v. Skelly Oil Co., 252 Iowa 128, 133, 106 N.W.2d 95, 98 (1960); Graves v. Eagle Iron Works, 331 N.W.2d 116 (Iowa 1983); Simbro v. DeLong's Sportswear, 332 N.W.2d 886, 887 (Iowa 1983). 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. Barton v. Nevada Poultry Co., 110 N.W.2d 660, 663 (Iowa 1961); Soukup v. Shores Co., 268 N.W. 598, 601 (Iowa 1936). Where there is an injury to a specific part of claimant's body, such loss shall be compensable only to the extent provided by the statute. Thus by legislative edict, where the result of an injury causes the loss of a foot, or eye etc, such loss, together with its ensuing natural results upon the body, is declared to be a permanent partial disability and entitled only to the prescribed compensation. Barton, 110 N.W.2d at 663. Expert medical evidence forms the basis for evaluating a claimant's functional impairment. This evidence must be considered with all other evidence introduced bearing on the causal connection. Burt v. John Deere Waterloo Tractor Works, 73 N.W.2d 732, 738 (Iowa 1955). Moreover, the expert opinion may be accepted or rejected, in whole or in part, by the trier of fact. Sondag v. Ferris Hardware, 220 N.W.2d 903, 907 (Iowa 1974). Finally, 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 material circumstances. Bodish v. Fischer, Inc., 133 N.W.2d 867, 870 (Iowa 1965); Musselman v. Central Telephone Co., 154 N.W.2d 128, 133 (Iowa 1967). The Supreme Court has also observed that greater deference is ordinarily accorded expert testimony where the opinion necessarily rests on medical expertise. Sondag, 220 N.W.2d at 907. In this instance, the only evidence of an increased impairment for claimant's hand is from the report of Dr. Luse. Dr. Luse did not correlate his findings to claimant's hand. He assigned his rating to claimant's upper extremity. Page 9 In connection with the rating, Dr. Luse did not combine the values to arrive at a functional impairment for claimant's hand. Dr. Luse did not recognize claimant's hand injury as a separate injury for the purpose of the evaluation he did in May of 1989. Finally, Dr. Luse did not have an opportunity to follow claimant's course of treatment and perform the surgery and post operative care. He only saw claimant once. Consequently, Dr. Luse's opinion can be accorded little weight in connection with the loss to claimant's hand. The functional impairment rating of 15% given by Dr. Jardon on July 30, 1986 and reaffirmed by him will be adopted as the rating for claimant's hand. Consequently, claimant will take nothing further on the claim for her hand as that claim was fully paid by Wilson prior to the hearing on this matter. II. November 11, 1987 injury The threshold issue to resolve with this injury and the injury of February 26, 1988 is to determine whether there were two separate injuries or one injury and an aggravation that led to a diagnosis of chronic tendinitis in March of 1988. Wilson does not dispute that claimant fell on November 11, 1987 while she was at work. However, Wilson does dispute that claimant suffered another injury on February 26, 1988. Claimant urges that she suffered two injuries that have contributed to her permanent partial disability that should be compensated industrially. The evidence supports claimant's contention that she was injured on November 11, 1987. However, it does not support a conclusion that claimant suffered any permanent disability from her fall. Claimant has the burden of proving by a preponderance of the evidence that the injury of November 11, 1987, is causally related to the disability on which she now bases her claim. Bodish, 133 N.W.2d at 868; Lindahl, 18 N.W.2d at 613-14. A possibility is insufficient; a probability is necessary. Burt, 73 N.W.2d at 738. The question of causal connection is essentially within the domain of expert testimony. Bradshaw, 101 N.W.2d at 171. Expert medical evidence must be considered with all other evidence introduced bearing on the causal connection. Burt, 73 N.W.2d at 738. The opinion of the experts need not be couched in definite, positive or unequivocal language. Sondag, 220 N.W.2d at 907. Moreover, the expert opinion may be accepted or rejected, in whole or in part, by the trier of fact. Sondag, 220 N.W.2d at 907. Finally, 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 material circumstances. Bodish, 133 N.W.2d at 870; Musselman, 154 N.W.2d at 133. The Supreme Court has also observed that greater deference is ordinarily accorded expert testimony where the opinion necessarily rests on medical expertise. Sondag, 220 N.W.2d at 907. Page 10 The evidence shows that claimant fell and was off work the night she fell. She returned to work the next day. Claimant had no further complaints relating to her shoulder until January 4 1988. The fall in November of 1987 did not have any affect on the claimant's ability to work. She went home the night of the fall and returned to work the next day. Claimant lost no time at work as a result of the fall on November 11, 1987. Claimant did not recount any traumatic event for Dr. Jardon on January 13, 1988 that would have led him to conclude that she suffered permanent damage to her shoulder at the time of her fall. Moreover, claimant did not think her fall was important enough to mention to Dr. Wheeler, when she was examined in April regarding pain in her shoulder. Even Dr. Luse did not differentiate between the injury on November 11, 1987 and the injury suffered in February. The greater weight of the evidence supports the conclusion that claimant did not suffer any disability as a result of her fall on November 11, 1987. Consequently, claimant will take nothing for this injury. III. February 26, 1988 Injury Regarding the February 26, 1988 injury, claimant has the burden of proving by a preponderance of the evidence that she received an injury on February 26, 1988 which arose out of and in the course of her employment. McDowell v. Town of Clarksville, 241 N.W.2d 904, 908 (Iowa 1976); Musselman, 154 N.W.2d at 130. The words "arising out of" have been interpreted to refer to the cause and origin of the injury. McClure v. Union County, 188 N.W.2d 283, 287 (Iowa 1971); Crowe v. DeSoto Consolidated School District, 68 N.W.2d 63, 65 (Iowa 1955). The words "in the course of" refer to the time, place and circumstances of the injury. McClure, 188 N.W.2d at 287; Crowe, 68 N.W.2d at 65. A determination that an injury "arises out of" the employment contemplates a causal connection between the conditions under which the work was performed and the resulting injury; i.e., the injury followed as a natural incident of the work. Musselman, 154 N.W.2d at 130; Reddick v. Grand Union Tea Co., 296 N.W. 800, 804 (Iowa 1941). The Supreme Court has defined a personal injury for the purposes of workers' compensation cases. Almquist v. Shenandoah Nurseries, 254 N.W. 35, 38 (Iowa 1934). In this case the Court found that a personal injury, is an injury to the body, the impairment of health, or a disease, not excluded by the Workers Compensation Act, which comes about, not through the natural building up and tearing down of the human body, but because of a traumatic or other hurt or damage to the health or body of an employee. The injury to the human body must be something, whether an accident or not, that acts extraneously to the natural processes of nature, and thereby impairs the health, overcomes, injures, interrupts, or destroys some function of the body, or otherwise damages or injures a part or all of the body. The Almquist Court further observed that while a Page 11 personal injury does not include an occupational disease under the Workmen's Compensation Act, yet an injury to the health may be a personal injury. A personal injury includes a disease resulting from an injury. However, the result of changes in the human body incident to the general processes of nature do not amount to a personal injury. This is true, even though natural change may come about because the life has been devoted to labor and hard work. Results of those natural changes do not constitute a personal injury even though the same brings about impairment of health or the total or partial incapacity of the functions of the human body. A cumulative injury may occur over a period of time. The injury in such cases occurs when, because of pain or physical disability, the claimant is compelled to leave work. McKeever Custom Cabinets v. Smith, 379 N.W.2d 368, 374 (Iowa 1985). Moreover, claimant's last employer becomes liable for the cumulative injury, even if the incidents that lead to the ultimate injury do not occur while a claimant is employed with the last employer. McKeever, 379 N.W.2d at 376; See also, Doerfer Division of CCA v. Nicol, 359 N.W.2d 428, 434-35 (Iowa 1984). After claimant complained of pain in her right shoulder she was seen on January 13, 1988 by Dr. Jardon. At the time she was examined by Dr. Jardon, he noted mild inflammation in her shoulder. When the pain did not resolve, claimant was referred to Dr. Wheeler who found that claimant had an insidious onset of pain in her right shoulder. Claimant was compelled to leave work on March 30, 1988 as a result of the tendinitis diagnosis. Dr. Wheeler's notes indicated that the source of claimant's tendinitis was unknown. However, he did conclude that claimant's tendinitis was aggravated by her work. 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, 76 N.W.2d 756, 760-61 (Iowa 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. Gosek v. Garmer and Stiles Co., 158 N.W.2d 731, 737 (Iowa 1968); Barz v. Oler, 133 N.W.2d 704, 707 (Iowa 1965); Olson v. Goodyear Service Stores, 125 N.W.2d 251, 256 (Iowa 1963); Nicks v. Davenport Produce Co., 115 N.W.2d 812, 815 (Iowa 1962); Yeager v. Firestone Tire & Rubber Co., 112 N.W.2d 299, 302 (Iowa 1961); Ziegler v. United States Gypsum Co., 106 N.W.2d 591, 595 (Iowa 1960); Almquist, 254 N.W. at 38. As a result of these conclusions by Dr. Wheeler, it is clear that claimant suffered an aggravation of a preexisting condition that caused her to leave work on March 30, 1988. Consequently, there is sufficient evidence in the record to conclude that claimant suffered an injury on March 30, 1988 to her shoulder.(3) Once claimant has demonstrated that she suffered an injury arising out of and in the course of her employment, claimant must also prove by a preponderance of the evidence that the injury of March 30, 1988 is causally related to the (3). This injury date is selected based on the holding in McKeever Custom Cabinets v. Smith, 379 N.W.2d at 368, 374 (Iowa 1985) which requires a claimant to select an injury date in a cumulative trauma case as the date that claimant was compelled to leave work. Page 12 disability on which she now bases her claim. The authority cited earlier in connection with the November 11, 1987 injury is equally applicable to this injury. See p. 10. The March 30, 1988 injury caused Dr. Wheeler to conclude that claimant was suffering from chronic recurring tendinitis. Claimant has suffered a 10% permanent functional impairment to her right upper extremity. It is clear that claimant's injury extends into the body as a whole and is not limited to her right arm. An injury to the muscle group surrounding claimant's shoulder and on top of her shoulder extends beyond her arm and into the body as a whole. Alm v. Morris Barrick Cattle Co., 38 N.W.2d 161, 163 (Iowa 1949). Once a permanent injury has been found, 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., 258 N.W.2d 899, 902 (Iowa 1935) as 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 person. The essence of an earning capacity inquiry then, is not how much has the claimant been functionally impaired, but whether that impairment, in combination with the claimant's age, education, work experience, pre and post injury wages, motivation and ability to get a job within her restrictions, if any restrictions have been imposed, have caused a loss of earning capacity. Olson v. Goodyear Service Stores, 125 N.W.2d 251, 257 (Iowa 1963); Diederich v. Tri-City Railway Co., 258 N.W. 899, 902 (Iowa 1935); Peterson v. Truck Haven Cafe, Inc., 1 Iowa Industrial Comm'r Dec. No. 3, 654, 658 (1985); Christensen v. Hagen, Inc., 1 Iowa Industrial Comm'r Dec. No. 3, 529, 534-535 (1985). There are no weighting guidelines that indicate how each of the factors are to be considered. There is no equation which can be applied and then calculated to determine the degree of industrial disability to the body as a whole. It therefore becomes necessary for the deputy or commissioner to draw upon prior experience and general and specialized knowledge to make a finding with regard to the degree of industrial disability. See, Peterson, 1 Iowa Industrial Commissioner Decisions No. 3, at 658; Christening, 1 Iowa Industrial Commissioner Decisions No. 3, at 535. In this instance, the only limitation claimant had when she was released to return to work at Wilson was a 10% functional impairment to her right upper extremity.(4) Claimant returned to work at her same job and at the same rate of pay she had prior to the date of her injury. Claimant's relative age also plays a role. Where the claimant is young, the industrial disability is not as serious as it would be for an older employee. Mccoy v. Donaldson Company, Inc., File nos. 752670, 805300, (Iowa Ind. Comm'r App. 1989); Walton v. B & H Tank Corp., II Iowa Industrial Commissioner Report 426, 429 (Arb. 1981); Becke v. Turner-Busch, Inc., 34 Biennial Report Iowa Industrial Commissioner 34, 36 (Appeal 1979). Claimant was almost 30 at the time of her injury. Claimant also has a high school diploma and has some post high school education. Claimant returned to work without any restrictions in July of 1988. (4). Dr. Luse found significant impairment five months after claimant left her employment with Wilson and that these findings suggest that claimant's employment at Wilson is the sole cause of her functional impairment. However, Dr. Luse's conclusions are not persuasive. The evidence from Dr. Wheeler, an orthopedic physician is more compelling. Dr. Wheeler had a better opportunity to observe the claimant as her treating physician. He saw her on a number of occasions and was in a better position to judge her limitations after she had been at work and off work. Dr. Luse saw claimant only once, nearly 18 months after the diagnosis was made. Consequently, Dr. Luse's rating will be given little weight and Dr. Wheeler's rating will be adopted as the correct functional impairment for claimant's shoulder. Page 13 Claimant's post injury employment and recreational activities are also factored into this consideration. When considering the effects of multiple injuries on the earning capacity of an injured worker, the case of Bearce v. FMC Corporation, 465 N.W.2d 531 (Iowa 1991) is instructive. The court found that an employer should not be responsible for an industrial disability the employer did not cause. Where claimant has suffered a prior injury but has returned to work full time, earning full time wages without any physical restrictions, does all the assigned work, seeks no medical attention, loses no time from work due to the injury and suffers no drop in pay, the claimant has not suffered an industrial loss. Bearce, 465 N.W.2d at 536-37. Claimant voluntarily left her Wilson job in January 1989 to accept new employment. The job claimant was supposed to take did not materialize. However, claimant eventually went to work for Countryside Nursing Home between November 1988 and March 1990. Claimant testified that she had more pain after this employment experience than when she was working at Wilson. Dr. Wheeler imposed lifting restrictions on her after this employment experience as did Dr. Garner. There is no evidence that claimant had further problems with her shoulder after she returned to work at Wilson in July and after she was rated in October of 1988. Claimant did not seek any medical treatment for her shoulder during the time between January 1989 and March or April 1990 except for an evaluation for the purposes of worker's compensation benefits in May of 1989. These factors suggest that a substantial portion of claimant's disability resulted from Page 14 her sojourn at Countryside Nursing Home rather than with Wilson. Moreover, claimant's participation in the demolition derby suggests that claimant's injury to her shoulder is not as debilitating as she indicated. Based upon the foregoing factors, all of the factors used to determine industrial disability, and employing agency expertise, it is determined that claimant sustained a 15% industrial disability. The commencement date for the payment of benefits is the date that claimant is released to return to work or the treating physician makes a judgment that maximum recovery has been achieved. Peterson v. John Morrell & Co., File Nos. 906408, 933308, Slip op. (Iowa Ind. Comm'r Arb. May 21, 1991). When a permanent rating is given, it indicates that the physician does not expect the claimant to improve and this conclusion meets the criteria of Iowa Code section 85.34(1) and Thomas v. William Knudson & Sons, Inc., 349 N.W.2d 124, 126 (Iowa App. 1984) for ending a healing period. In this instance, claimant was released to return to full duty on approximately July 21, 1988. Dr. Wheeler concluded that he had little to offer claimant at the time of the July 7, 1988 examination. She was fully released from Dr. Wheeler's care on October 20. 1988. Dr. Wheeler rated claimant on October 20, 1988. It is clear from the medical evidence submitted that there was no change in claimant's condition after the July 7, 1988 examination. Consequently, claimant's healing period for her shoulder ended on July 7, 1988 and permanency payments should be paid from July 8, 1988. order THEREFORE, it is ordered that: 1. Claimant shall take no additional benefits for the injury suffered to her right hand. Wilson has paid claimant 28.5 weeks of compensation at the rate of $236.90 per week prior to the date of the hearing. No other amounts are owed for this injury. 2. Claimant shall take no benefits for the injury suffered on November 11, 1987. 3. Wilson shall pay to claimant permanent partial disability benefits in the amount of fifteen percent (15%) with payment commencing on July 8, 1988 at the rate of $246.12 per week. As these benefits have accrued, they shall be paid in a lump sum together with statutory interest thereon pursuant to Iowa Code section 85.30 (1991). 3. Wilson is entitled to a credit of 25 weeks of compensation for the injury to claimant's shoulder identified in File Number 872759 at the rate of $246.12 per week. 4. The costs of this action shall be assessed to Wilson pursuant to rule 343 IAC 4.33. 5. Wilson shall file claim activity reports as required by rule 343 IAC 3.1. Page 15 Page 16 Signed and filed this ____ day of October, 1991. ________________________________ ELIZABETH A. NELSON DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr Harry H Smith Attorney at Law PO Box 1194 Sioux City Iowa 51102 Mr David L Sayre Attorney at Law 223 Pine Street PO Box 535 Cherokee Iowa 51012 5-1108.50; 5-1402.40; 5-1803; 5-1803.1 Filed October 24, 1991 ELIZABETH A. NELSON before the iowa industrial commissioner ____________________________________________________________ : COLEEN J. RHEA, : : File Nos. 820183 Claimant, : 886121 : 872759 vs. : : A R B I T R A T I O N WILSON FOODS CORPORATION, : : D E C I S I O N Employer, : Self-Insured, : Defendant. : ___________________________________________________________ 5-1108.50 The medical evidence demonstrated that claimant suffered a cummulative trauma injury that caused her to leave work after her physician indicated she had chronic tendinitis in her shoulder. 5-1402.40 Claimant failed to show that she was entitled to a higher disability benefit for her hand after carpal tunnel release. The opinion of the evaluating chiropractor was rejected in favor of the opinion of the treating orthopedic surgeon who had a better opportunity to evaluate claimant's loss. In connection with the injury in file number 886121, claimant did not show that a fall five months before the diagnosis of chronic tendinitis resulted in any disability to her shoulder. 5-1803 - 5-1803.1 Claimant, a 30-year-old high school graduate with three quarters of post-high school education, who had worked at minimum wages all her life until she worked at Wilson, was awarded a 15 percent industrial disability for tendinitis in the shoulder. Claimant was released to return to work with a ten percent functional impirment rating and no restrictions in July of 1988. She worked until she voluntarily quit her employment in January of 1989. Claimant subsequently worked for a nursing home. This activity aggravated her shoulder. After this employment, claimant's primary treating physicians imposed lifting restrictions and work restrictions. This loss was not attributable to Wilson. Bearce v. FMC Corp., 465 N.W.2d 531 (Iowa 1991).