BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LOIS I. BURKHARDT,
 
         
 
              Claimant                          File No.  821646
 
         
 
         vs.                                 A R B I T R A T I 0 N
 
         
 
         WILSON FOODS CORPORATION,              D E C I S I 0 N
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Lois I. 
 
         Burkhardt, claimant, against Wilson Foods Corporation, employer, 
 
         and self-insured defendant, for benefits as the result of an 
 
         alleged injury that occurred on or about April 24, 1986.  A 
 
         hearing was held in Storm Lake, Iowa, on November 2, 1988, and 
 
         the case was fully submitted at the close of the hearing.  The 
 
         record consists of the testimony of Lois I. Burkhardt, claimant, 
 
         Donald E. Burkhardt, claimant's husband, Allan E. Fluke, manager 
 
         of sales accounting, and Joint Exhibits 1 through 4.  Exhibit 4 
 
         also has subparts 4A through 4G.  Both attorneys submitted 
 
         excellent briefs.
 
         
 
                                   STIPULATIONS
 
         
 
              The parties stipulated to the following matters.
 
         
 
              That an employer-employee relationship existed between 
 
         claimant and employer at the time of the alleged injury.
 
         
 
               That 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.
 
         
 
              That the rate of compensation, in the event of an award, is 
 
         $257.31 per week.
 
         
 
              That the medical bills are fair and reasonable and were 
 
         incurred for reasonable and necessary medical treatment.
 
         
 
              That defendant is entitled to a credit under Iowa Code 
 
         section 85.38(2) for the previous payment of $1600 of termination 
 
         benefits paid to claimant prior to hearing.
 
         
 
              That defendant has paid no workers' compensation benefits 
 
         to claimant prior to hearing.
 
         
 
              That there are no bifurcated claims.
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   2
 
         
 
         
 
                                     ISSUES
 
         
 
              The parties presented the following issues for determination 
 
         at the time of the hearing.
 
         
 
              Whether claimant sustained an injury on or about  April 24, 
 
         1986, which arose out of and in the course of her employment with 
 
         employer.
 
         
 
              Whether the alleged injury is the cause of either temporary 
 
         or permanent disability.
 
         
 
              Whether claimant is entitled to either temporary or 
 
         permanent disability benefits, and if so, the nature and extent 
 
         of benefits.
 
         
 
              Whether claimant is entitled to the payment of medical 
 
         expenses.
 
         
 
                             SUMMARY OF THE EVIDENCE
 
         
 
              The evidence was examined and considered.  The following is 
 
         a summary of the evidence most pertinent to this decision.
 
         
 
              Claimant was 53 years old at the time of the alleged injury 
 
         and 55 years old at the time of the hearing.  She graduated from 
 
         high school in 1951 and attended Buena Vista College for a period 
 
         of time.  She studied teaching, but was unable to complete the 
 
         course because of a lack of funds in order to do so.  Claimant 
 
         has not received any other educational or occupational training. 
 
          After high school and college, claimant was employed as a 
 
         bookkeeper for approximately one year before she was married.  
 
         After her marriage, she had five children and also raised a child 
 
         of her husband.  During this period of time she worked at home as 
 
         a homemaker, wife and mother.  She began working outside of her 
 
         home again in 1965.  She was employed for one year in a 
 
         supermarket.  She then worked one year in a greeting card and 
 
         gift shop as assistant manager doing bookwork, clerk work and 
 
         ordering merchandise.  She denied any prior accidents, illnesses 
 
         or injuries.
 
         
 
              Claimant testified that employer called her to come out to 
 
         the plant and apply for work.  She was interviewed on April 1, 
 
         1967.  She started to work on April 7, 1967, and gave up her 
 
         prior employment at that time.  Claimant said that she told them 
 
         when she started that she could not handle a job out in the 
 
         plant.  Claimant testified that she passed a preemployment 
 
         physical examination.
 
         
 
              Claimant's first job was as a cost clerk in the general 
 
         business office where she figured labor costs on products made at 
 
         the plant.  She performed this job for two years.
 
         
 
              She then became the secretary to the superintendent and 
 
         performed this job 40 hours a week for ten years.
 
         
 
              The company then adopted a point system.  At that time she 
 
         gave up her secretarial job and transferred to the industrial 
 
         engineering department because it paid more points than the 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   3
 
         
 
         secretarial job.  She performed labor cost work again with one 
 
         other employee in the industrial engineering department until 
 
         1983.  She testified that she was in good health at that time.
 
         
 
              Claimant testified that in 1983, she was told that her job 
 
         had been discontinued and that she would have to take a job at 
 
         lower pay out in the plant on the production line.  At first, she 
 
         was put on the ham line as the only job that she could do.  
 
         Claimant testified that she asked if she could do several other 
 
         jobs that came up from time to time, but she was told no on all 
 
         of them.
 
         
 
              Claimant testified that she checked the quality and 
 
         condition of hams for approximately one or two months on the ham 
 
         line.  This consisted of picking up each ham individually, 
 
         checking it and putting it back down again.  She was then 
 
         transferred to the loin line.  No reason was given for this 
 
         transfer.  They just said to do it.
 
         
 
              The loin line job consisted of pulling 80 pound boxes of cut 
 
         loins off of the line, inspecting the loins and putting the box 
 
         back on the line.  Claimant testified that two younger women who 
 
         were performing this job, refused to do it, and they were 
 
         transferred into the office.  She asserted that she tried to 
 
         refuse the job because the boxes were too heavy and she had 
 
         difficulty keeping up with the speed of the line.  Jams would 
 
         occur.  She alleged that she was denied the opportunity to return 
 
         to the office so she continued to do the loin line job for 
 
         approximately one year.  Claimant testified that it was at this 
 
         time that she began to develop a nervous condition.  The stress 
 
         of various facets of her employment began to get to her.  She 
 
         could not sleep at night.  She developed back problems and had to 
 
         see the plant physician for shots.  Sometimes she could not get 
 
         out of bed.  Her nerves could not handle the stress.  She cried 
 
         over everything and could not cope.
 
         
 
              After one year, a Mr. Jordahl (full name unknown) was 
 
         instrumental in getting claimant back into the office in the 
 
         credit department in 1985.  Claimant maintained that Mr. Jordahl 
 
         felt that claimant had been treated unjustly.  In the credit 
 
         department, claimant's job was to check the credit of purchasers 
 
         of outgoing loads of meat.  She handled shipping orders, bank 
 
         drafts and performed bookkeeping and accounting functions.  
 
         Claimant testified that she was able to perform this work, but 
 
         that her nervous condition did not improve because of certain job 
 
         pressures.  Claimant alleged that she was pushed and pressed to 
 
         perform more work than she was able to do.  Claimant maintained 
 
         that the attitude of Allan E. Fluke toward her created additional 
 
         pressure.  She asserted that he made her feel unwanted.  Claimant 
 
         alleged that at one time, Fluke told another employee, who had 
 
         induced another woman to quit, why don't you get Lois to quit 
 
         also.  Claimant alleged that she was harassed by her superiors.  
 
         Claimant testified that she thought that her job performance was 
 
         satisfactory.
 
         
 
              Claimant testified that one day, in the latter part of April 
 
         of 1986, her blood pressure became very high.  It affected her 
 
         vision and she could barely see to get home.  Claimant testified 
 
         that she had some blood pressure problems in the past, but that 
 
         it had never been critical before.  Her family physician, Thomas 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   4
 
         
 
         M. Gary, M.D., came to her house, and because of the severe 
 
         nature of her condition he stayed with her to observe her for 
 
         approximately two hours.  Claimant said that Dr. Gary suspected a 
 
         brain tumor because there was blood in her eyes.  Claimant 
 
         testified that she was off work for two weeks after this episode.  
 
         She then returned to work before the doctor released her to 
 
         return to work, because she was worried about her job.  After she 
 
         returned to work, she worked approximately one and one-half to 
 
         two weeks and was then called in and told that she was 
 
         terminated.  She was short less than one year from qualifying for 
 
         a retirement pension after 20 years of service.  Claimant 
 
         testified that she had performed 19 years and one month of 
 
         employment service when she was terminated by employer.
 
         
 
              Dr. Gary later determined through a CT scan that claimant 
 
         did not have a brain tumor.  He said that her condition was 
 
         stress related and that she was on the verge of a nervous 
 
         breakdown.  Dr. Gary placed her on two blood pressure 
 
         medications--Maxzide and Vasotec.  She has been required to take 
 
         these medications ever since this episode in the later part of 
 
         April of 1986.  Claimant testified that Dr. Gary also prescribed 
 
         Premarin, which is a hormone, for her nerves.  Claimant admitted 
 
         that Premarin is estrogen which is also taken after a 
 
         hysterectomy and that she might have been taking this medication 
 
         anyway.  Claimant testified that Dr. Gary has recommended 
 
         antidepressant medications, but that she cannot afford to pay for 
 
         them.  She added that Dr. Gary continues to be her treating 
 
         physician for this condition.
 
         
 
              Claimant related that she still has headaches constantly and 
 
         takes six or eight Tylenol tablets a day.  Claimant testified 
 
         that she also gets dizzy spells and that her equilibrium is off. 
 
          She said that she is very nervous and cries easy.  She has 
 
         difficulty working at home because she cannot concentrate.  She 
 
         doesn't get much accomplished because she is so depressed.
 
         
 
              Claimant admitted that in the spring of 1986, approximately 
 
         April or May, employer executed a drastic reorganization of the 
 
         plant at Cherokee.  The kill floor, cut floor and fresh meat 
 
         operations were completely eliminated.  Claimant denied that the 
 
         amount of shipments or credit checks were reduced as the result 
 
         of the reorganization.  Claimant denied that her job was 
 
         eliminated.  Claimant denied that she was discharged because her 
 
         previous job was transferred into the data processing department. 
 
          Claimant alleged on the contrary that her job still existed and 
 
         that someone else with less years of service than herself was 
 
         doing it.
 
         
 
               Claimant admitted that she had instituted a civil rights 
 
         action against employer shortly after she was terminated.  The 
 
         allegations made in the civil rights action include age 
 
         discrimination, physical disability discrimination and the 
 
         unfairness of her termination.  Claimant maintained that the 
 
         industrial engineering job and credit department job were still 
 
         there.  These jobs were not eliminated.  Claimant insisted that 
 
         this work or similar work was still being performed by other 
 
         employees in the office at the time of hearing.
 
         
 
              Claimant admitted that after her termination she operated an 
 
         antique shop part-time in a vacant building that she and her 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   5
 
         
 
         husband owned.  It was just something to help keep her mind 
 
         busy--a hobby.  It was not profitable.  Actually, it lost money 
 
         every year and the shop was closed in the summer of 1988.
 
         
 
              Claimant reasserted that her nervous condition and her high 
 
         blood pressure condition were caused by job pressures which 
 
         culminated in her eventual termination of employment just a few 
 
         months prior to her eligibility for retirement.
 
         
 
              Claimant testified that she thought her nervous problem 
 
         started in 1983 when she was told she would have to take a lower 
 
         paying job performing physical labor out in the plant working on 
 
         the production line.  The pressure started then and gradually got 
 
         worse from there.
 
         
 
              Donald H. Burkhardt, claimant's husband of 34 years, 
 
         corroborated the change of her condition from a happy person to a 
 
         very nervous person.  She cries a lot and breaks down easy.  She 
 
         had headaches and double vision.  She has lost her energy and 
 
         spark for life.  Previously she was happy with her job.  The 
 
         antique venture was just a hobby in some vacant property to help 
 
         keep her busy.  She did not really work at it.  It was not 
 
         profitable.  The venture has been discontinued.
 
         
 
              Allan E. Fluke testified that he is the manager of sales 
 
         accounting at the headquarters of employer in Oklahoma City.  He 
 
         has performed this job since July of 1986.  Before that, Fluke 
 
         was controller at the Cherokee plant for one to one and one-half 
 
         years.  Before that, he was the assistant controller at Cherokee.  
 
         He did not directly supervise claimant, but ultimately she 
 
         answered to him.  Claimant was in the industrial engineering 
 
         department when Fluke came to Cherokee.
 
         
 
              Fluke testified that a lot of work was put on the computer. 
 
          A person had to be eliminated.  Claimant was that person.  Fluke 
 
         added that a major restructuring occurred in the spring of 1986. 
 
          The kill floor and the cut floor were eliminated.  After that, 
 
         the plant had no fresh meat to sell.  Even before that, the 
 
         company began using distribution centers.  The Kansas City 
 
         distribution center greatly reduced the number of outside orders 
 
         and the need for credit checks by claimant.  Over time, outside 
 
         sales were reduced from 95 percent to 5 percent.  Fluke testified 
 
         that claimant's job was eliminated for this reason and what 
 
         remained of it was transferred to the data processing 
 
         department.
 
         
 
              Fluke denied that he ever stated that he wished claimant 
 
         would resign.
 
         
 
              Defendant marked defendant's exhibit A for identification, 
 
         which is a memo which eliminated the credit associate job as a 
 
         part of the major plant reorganization.  Claimant objected to the 
 
         introduction of this exhibit because it had not been served upon 
 
         her prior to hearing.  Claimant's objection was sustained because 
 
         the document was not served within 15 days prior to hearing as 
 
         required by paragraph six of the hearing assignment order.  
 
         Defendant stated that he did not want to put the exhibit in the 
 
         record as an offer of proof.
 
         
 
              Fluke testified that he was one of the persons involved in 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   6
 
         
 
         the decision to discharge claimant.  The other persons involved 
 
         in the decision were the plant manager and the controller.  The 
 
         ultimate decision to terminate claimant was made by the plant 
 
         manager.  Fluke denied that claimant was discharged because of 
 
         her physical condition.  Fluke said that it was discussed that 
 
         claimant was a long-term employee.  Fluke testified that the 
 
         nearness of claimant's eligibility to a pension was discussed.  
 
         Fluke said the fact that claimant had a nervous breakdown was not 
 
         discussed.  Fluke said that he did know if the plant manager knew 
 
         that claimant had suffered a nervous breakdown.  This matter was 
 
         not discussed.  Fluke indicated the plant manger should have 
 
         known this because they all worked in a small office with only 13 
 
         employees in it.  Fluke testified that he personally knew for a 
 
         long time that claimant was an emotional person and a nervous 
 
         person with emotional problems.  Fluke said that claimant was 
 
         happy to get back into the office a year earlier and that she did 
 
         not complain about her job.  Fluke said that he was not aware of 
 
         any harassment of claimant by any of her superiors.
 
         
 
              Fluke testified that claimant's nervous condition did not 
 
         enter into the decision to terminate lier.  He asserted that this 
 
         decision was simply part of a major plant restructuring.  This 
 
         reorganization affected the production line and the office staff.  
 
         Hundreds of jobs were eliminated and not replaced.  The credit 
 
         coordinator job was eliminated from the structure.
 
              Fluke testified that there was no written policy to consider 
 
         seniority when terminating employees.
 
         
 
              The medical evidence begins with Dr. Gary's office notes of 
 
         May 1, 1986, at 8 a.m. showing that claimant still had headaches, 
 
         her eyes were no better and she felt pressure on the top of her 
 
         head.  Her blood pressure was 164/100.
 
         
 
              Dr. Gary also saw claimant again on May 1, 1986, for 
 
         headache, conjunctivitis, vertigo, ringing of ears and shortness 
 
         of breath.  His diagnosis was hypertension.  He prescribed 
 
         Maxzide and Vasotec.  Her blood pressure was recorded at 156/92.
 
         
 
              Dr. Gary noted on May 5, 1986, that an EKG was within normal 
 
         limits.  The blood pressure reading was 130/92.
 
         
 
               On May 8, 1986, claimant continued to have severe frontal 
 
         and occipital headaches, nausea and bilateral vertigo and 
 
         bilateral conjunctivitis.  Dr. Gary commented that the blood 
 
         pressure was controlled, but that he suspected a brain tumor and 
 
         ordered a CAT scan.  Later on May 8, 1986, he noted that the CAT 
 
         scan was normal with respect to the brain.
 
         
 
              On May 13, 1986, claimant was much improved.  She  had no 
 
         further headaches and her eyes and conjunctivitis had cleared.  
 
         Blood pressure.readings were 146/90 and 130/82 in the right arm.
 
         
 
              On May 27, 1986, Dr. Gary noted that claimant had been 
 
         terminated from her employment and that many of her symptoms had 
 
         returned.  Her blood pressure was 152/92.  She had dizziness, 
 
         nausea, loss of balance and conjunctive redness again.  A portion 
 
         of his office note from May 27, 1986, reads as follows:
 
         
 
              Lois is seen follow-up.  She is under a lot of stress 
 
              recently.  Friday she was just informed that her job 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   7
 
         
 
              was terminated and she has really minimal benefits.  
 
              She is about seven months from reaching retirement and 
 
              length of service and I can appreciate her frustration 
 
              and anger.  Unfortunately it aggravates both her 
 
              headache situation and her hypertension.  It is 
 
              explained to her that she should try and cope in the 
 
              best manner satisfactory.  Several suggestions are 
 
              offered.  I would have her increase her Vasotec to 5 
 
              mg. b.i.d. continue her Maxzide one daily.  She should 
 
              have her blood pressure checked in a week and then will 
 
              see her in two weeks.
 
         
 
         (Exhibit 3, page 2)
 
         
 
              On June 3, 1986, claimant's blood pressure was 122/86.  She 
 
         complained of headache, mostly pressure.
 
         
 
              On June 13, 1986, claimant's blood pressure read 132/84.  
 
         Dr. Gary said that she still had a lot of stress from the loss of 
 
         her job.  She still had tension headache, but it was some 
 
         better.
 
         
 
              On July 14, 1986, claimant's blood pressure was 142/90.  
 
         Most of her symptoms were better except for her eyes.
 
         
 
              Dr. Gary summarized claimant's situation by a letter dated 
 
         November 13, 1986.  It reads as follows:
 
         
 
              Please see copy of my office notes from May 1, 1986 
 
     
 
         
 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   8
 
         
 
              through the present.  Lois has been under a lot (sic) 
 
              of stress with the job situation and I do think that it 
 
              is causally related to her hypertension problem and 
 
              associated symptoms, as this seemed to be well 
 
              controlled until the situation deteriorated at work.
 
         
 
         (Ex. 1)
 
         
 
              On August 11, 1987, Dr. Gary performed a yearly physical 
 
         assessment.  The blood pressure reading is slightly obliterated 
 
         but it appears to say 150/90.  Dr. Gary made these entries in his 
 
         notes:
 
         
 
              Lois is seen for yearly physical assessment.  She still 
 
              continues to have a lot anxiety, insomnia, 
 
              restlessness, and generalized feeling poor with some 
 
              cephalgia since her dismissal from Wilson's.  She has 
 
              put in multiple job applications but has not been 
 
              successful in obtaining any job.  There apparently have 
 
              been some openings at Wilson's but she was not called 
 
              back.  She continues to do her antique shows and run 
 
              her store on a parttime (sic) basis.  Lois does not 
 
              like to take any medications because of feeling that 
 
              they may have adverse effects on her body.  She is 
 
              trying to cope with her symptoms pretty much on her own 
 
              through self-help and through friends and family.  
 
              Other problems is that she does not feel like she could 
 
              afford to take medicines that are quite expensive.  She 
 
              does take about 2 to 6 Tylenol per day for her 
 
              headaches.  She has been taking her blood pressure 
 
              medicine which is Vasotec 5 mg. b.i.d. She does when 
 
              she gets under stress develop hives and she takes the 
 
              Benadryl for this.  Occasionally she does develop the 
 
              redness of her eyes, conjunctivitis when she is 
 
              emotionally labile and tearful.  She continues to take 
 
              her Premarin 625 25 days out of the month.  Review of 
 
              systems is otherwise essentially negative.  Physical 
 
              findings reveal a pleasant women (sic) who is in no 
 
              acute distress.
 
         
 
         (Ex. 3, P. 4)
 
         
 
              On August 14, 1987, Dr. Gary summarized claimant's condition 
 
         in a letter as follows:
 
         
 
              Enclosed find a copy of my recent office visit on Lois.  
 
              Mrs. Burkhardt continues to have a stress reaction 
 
              related to her termination at Wilson's.  She has tried 
 
              to accept it and cope as best she can, but she has been 
 
              frustrated in her attempts to achieve other employment 
 
              and also her self-confidence and self-esteem is at a 
 
              low point since this happened.  Mrs. Burkhardt should 
 
              be on medication because of the job related condition, 
 
              but because of financial reasons she has not been 
 
              taking may medication.
 
         
 
         (Ex. 2)
 
         
 
              Exhibit 4 reads as follows:
 
         
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE   9
 
         
 
                            LOIS BURKHARDT UNPAID BILLS
 
         
 
              Dr. Gary                               $330.75
 
         
 
              Valley Pharmacy                        $275.10
 
         
 
              Drug Town                              $549.26
 
         
 
              (copies sent later)
 
         
 
              Exhibit 4A is an adding machine tape with "Dr.  Gary" hand 
 
         written at the top of a column of numbers.       It reads as 
 
         follows:
 
         
 
                                      25.00
 
                                      14.00
 
                                      41.00
 
                                      14.00
 
                                      14.00
 
                                      14.00
 
                                      14.00
 
                                      24.00
 
                                      14.00
 
                                      50.00
 
                                       6.00
 
                                      15.50
 
                                      45.25
 
                                     290.75*
 
         
 
              Exhibit 4B is a detailed medication bill.  The  name  of the 
 
         pharmacy is not on the bill.  The prescription total $235.63 is 
 
         for Maxzide, Vasotec and opthalmic solution.  Claimant identified 
 
         that bill at the hearing as being from Valley Pharmacy.
 
         
 
              Exhibit 4C and 4D are detailed bills for medications from 
 
         Drug Town in the amounts of $101.64 and $378.76 respectively for 
 
         Premarin, Maxzide and Vasotec.
 
              
 
              Exhibit 4E is a detailed bill from Drug Town for Premarin in 
 
         the amount of $14.21 and Ativan in the amount of $7.25.  The 
 
         final total is $21.46.  Ativan is an antidepressant medication.
 
         
 
              Exhibit 4F shows two bills from Drug Town.  One is for 
 
         Maxzide in the amount of $14.75 and the other is for Vasotec in 
 
         the amount of $37.68.
 
         
 
              Exhibit 4G is three bills from Valley Pharmacy: (1) Premarin 
 
         $6.51, (2) Maxzide - $14.79, and (3) Prinivil - $18.17. Prinivil 
 
         is a hypertension medication.
 
         
 
         
 
                           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 April 24, 1986, 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. 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  10
 
         
 
         Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              The injury must both arise out of and be in the course of 
 
         the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 
 
         402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 of the 
 
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
 
         255 Iowa 847, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         
 
              The words "out of" refer to the cause or source of the 
 
         injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63.
 
         
 
              The words "in the course of" refer to the time and place and 
 
         circumstances of the injury.  McClure v. Union et al.  Counties, 
 
         188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 402, 68 N.W.2d 63.
 
         
 
              The supreme court of Iowa in Almquist v. Shenandoah 
 
         Nurseries, 218 Iowa 724, 254 N.W. 35 (1934) at 731-32, discussed 
 
         the definition of personal injury in workers' compensation cases 
 
         as follows:
 
         
 
              While a 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 [Citations omitted.] Likewise a personal injury 
 
              includes a disease resulting from an injury .... The 
 
              result of changes in the human body incident to the 
 
              general processes of nature do not amount to a personal 
 
              injury.  This must follow, even though such natural 
 
              change may come about because the life has been devoted 
 
              to labor and hard work.  Such result of those natural 
 
              changes does 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 personal injury, contemplated by the Workmen's 
 
              Compensation Law, obviously means an injury to the 
 
              body, the impairment of health, or a disease, not 
 
              excluded by the 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. [Citations omitted.] 
 
              The injury to the human body here contemplated 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.
 
         
 
              An employer takes an employee subject to any active or 
 
         dormant health impairments, and a work connected injury which 
 
         more than slightly aggravates the condition is considered to be a 
 
         personal injury.  Ziegler v. United States Gypsum Co., 252 Iowa 
 
         613, 620, 106 N.W.2d 591 (1960), and cases cited.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  11
 
         
 
         the evidence that the injury of April 24, 1986, 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, 261 Iowa 352, 154 
 
         N.W.2d 128.
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2nd 756, 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).
 
         
 
              When an aggravation occurs in the performance of an 
 
         employer's work and a causal connection is established, claimant 
 
         may recover to the extent of the impairment.  Ziegler, 252 Iowa 
 
         613, 620, 106 N.W.2d 591.
 
         
 
              Claimant did sustain the burden of proof by a preponderance 
 
         of the evidence that she sustained an injury on or about April 
 
         24, 1986, which arose out of and in the course of her employment 
 
         with employer.  There is no evidence to the contrary.
 
         
 
              Claimant testified that she began having nervous problems in 
 
         1983.  At that time, she had 15 years of service with employer.  
 
         She had always performed office or secretarial work.  At that 
 
         time, she was told she would have to take a job as a production 
 
         line employee out in the plant.  Claimant testified that when 
 
         employer called her in for the initial employment interview in 
 
         1978, and before she gave up the job that she was doing at the 
 
         gift shop in order to become a cost clerk with employer, she told 
 
         employer that she could not handle a job out in the plant.  Under 
 
         the foregoing facts, it is not unusual that claimant began to 
 
         experience problems with her nerves when she was put on the ham 
 
         line at approximately age 50 after 15 years of clerical work in 
 
         the office.  It would have been more unusual if claimant had not 
 
         experienced problems of some type under these facts.
 
         
 
              The ham line job was followed by the loin job which 
 
         consisted of pulling 80 pound boxes of loins off the line, 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  12
 
         
 
         inspecting the loins and putting the boxes back on the line.  The 
 
         loin line job appears to be more strenuous than the ham line.  
 
         Claimant testified that the loins were top heavy for her and that 
 
         she could not keep up with the pace of the line.  Jams occurred 
 
         which added to her stress.
 
         
 
              Claimant testified that she identified other job vacancies 
 
         in the plant that she could perform, but she was told no on all 
 
         of them.
 
         
 
              Claimant testified that two younger women working on the 
 
         loin line refused to do it and they were given jobs in the 
 
         office.  When she tried to refuse the job and obtain a more 
 
         suitable job, she was denied the opportunity to transfer.  This 
 
         evidence in uncontradicted.  Claimant was credible. it would be 
 
         more unusual if claimant's frustration and nerve problem was not 
 
         increased in light of these circumstances.
 
         
 
              Claimant eventually did get back into the office in 1985; 
 
         however, her problem with her nerves continued.  She said that 
 
         she was assigned more work then she could do.  The attitude of 
 
         Allan Fluke created pressure on her.  She alleged that Fluke and 
 
         other employees made hurtful comments about her.  Fluke denied 
 
         that he stated that he wished that she would resign.  Fluke 
 
         denied that he was aware of any harassment by other superiors.
 
         
 
              Claimant testified that she had some blood pressure symptoms 
 
         in the past but they had never been critical before.  Claimant 
 
         related that on or about April 24, 1986, her blood pressure 
 
         became so high that it affected her vision.  She was forced to 
 
         leave work for the first time and remain off work for two weeks.  
 
         About one to one and one-half weeks after she returned to work, 
 
         she was told that she was terminated.  She had accumulated 19 
 
         years and one month toward lifetime retirement benefits.  She 
 
         only needed 11 more months of employment with employer to qualify 
 
         for a lifetime retirement income after 20 years of employment 
 
         service.  Claimant had devoted over 19 years of her employment 
 
         service to this employer and the meat packing industry.  This was 
 
         a major portion of her entire adult working lifetime.  At her age 
 
         it was not feasible to start over in the employment market and 
 
         now acquire twenty years to qualify for a similar retirement 
 
         program with some other employer.  Less than one year short of 
 
         her retirement eligibility she was discharged.  Her job security 
 
         and financial security, at that time and in the future, were 
 
         summarily extinguished at a time when her physical health was 
 
         already precariously threatened due to insecurity and instability 
 
         in her employment situation during the previous three years.  It 
 
         is not unusual that claimant developed high blood pressure, 
 
         dizziness, ringing in the ears, shortness of breath, headaches, 
 
         nausea and conjunctivitis.  It would have been more unusual if 
 
         claimant had not manifested physical symptoms due to the trauma 
 
         of her employment situation and the peremptory unexpected loss of 
 
         lifetime retirement benefits.  It is fortunate for both parties 
 
         that claimant's physical response to this action on the part of 
 
         employer in the later years of her life was not worse than what 
 
         did happen to her.
 
         
 
              Claimant's medical history is well documented.  It is the 
 
         only medical evidence in this case.  Her blood pressure readings 
 
         from May 1, 1986 to May 27, 1986 showed that her blood pressure 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  13
 
         
 
         was being reduced and controlled.  Dr. Gary said in his letter of 
 
         November 13,.1986, that her hypertension and associated symptoms 
 
         seem to be well controlled until the situation deteriorated at 
 
         work when she was terminated (Ex. 1; Ex. 3, p. 4).
 
         
 
              In his letter of November 13, 1986, Dr. Gary said that 
 
         claimant's job situation was causally related to her hypertension 
 
         and associated problems (Ex. 1).  In his office note of May 27, 
 
         1986, Dr. Gary said that claimant's job termination with minimal 
 
         benefits just a few months before reaching retirement aggravated 
 
         her headache situation and her hypertension (Ex. 3, p. 2).
 
         
 
              On June 13, 1986, Dr. Gary said that claimant still had a 
 
         lot of stress from the loss of her job (Ex. 3, p. 2).  On August 
 
         11, 1987, Dr. Gary said she continued to have a lot of anxiety, 
 
         insomnia, restlessness and generalized feeling poor with some 
 
         cephalgia since her dismissal from Wilson's (Ex. 3, p. 4).
 
         
 
              On August 14, 1987, Dr. Gary flatly stated, "Mrs. Burkhardt 
 
         continued to have a stress reaction related to her termination at 
 
         Wilson's".  He added, "Mrs. Burkhardt should be on medication 
 
         because of the job related condition, but because of financial 
 
         reasons she has not been taking any medication". (Ex. 2).
 
         
 
              Claimant's blood pressure readings decreased and became 
 
         under control after she started treating with Dr. Gary up until 
 
         the time of her termination. These reading were as follows:
 
         
 
               May 1, 1986                 164/100
 
               May 1, 1986                 156/92
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  14
 
         
 
               May 5, 1986                 130/92
 
               May 8, 1986                 112/80
 
               May 13,1986                 130/82
 
         
 
              After her termination, her blood pressure reading shot up 
 
         and went out of control again.  The readings are as follows:
 
         
 
              May 27, 1986                 152/92
 
              June 3, 1986                 122/86
 
              June 13, 1986                132/84
 
              July 14, 1986                142/90
 
         
 
              Fluke testified that claimant was arbitrarily terminated 
 
         because the need for her job was eliminated in a massive 
 
         reorganization.  The portion of her job that was not eliminated 
 
         was transferred to the data processing department.  Claimant 
 
         insisted that there are employees at the plant that are still 
 
         doing essentially the same work that she used to do.
 
         
 
              Fluke testified that he knew, and that it was generally 
 
         known in their small office of only 13 employees, that claimant 
 
         was a nervous person and manifested emotional problems for a long 
 
         time.  He indicated that claimant's physical health and her 
 
         physical disability were not taken into consideration at the time 
 
         it was decided to terminate her.
 
         
 
              Fluke testified that it was known that claimant was a 
 
         long-term employee, but he testified that her proximity to 
 
         retirement and eligibility for a pension were not taken in to 
 
         consideration at the time she was terminated.
 
         
 
              Fluke testified that claimant's age was generally known, but 
 
         that her age was not taken in to consideration at the time it was 
 
         decided to terminate her.  Fluke stated that there was no written 
 
         policy to consider seniority when terminating employees.
 
              Claimant's testimony and the information from Dr. Gary 
 
         concerning claimant's physical health and its relationship to her 
 
         employment is not disputed, contradicted or controverted.
 
         
 
              Hypertension, cephalgia, tinnitus, vertigo, nausea and 
 
         conjunctivitis are all physical conditions.  The only evidence in 
 
         this case was that they were caused by claimant's employment.
 
         
 
              Dr. Gary said the hypertension and  associated  symptoms 
 
         were aggravated by her work situation and due to the work 
 
         situation she should be taking medications (Exs. 1 & 2).
 
         
 
              Therefore, claimant did sustain the burden of proof by a 
 
         preponderance of the evidence that she sustained an injury on or 
 
         about June 24, 1986, which arose out of and in the course of her 
 
         employment with employer.
 
         
 
              Claimant testified that she lost two weeks from work.  
 
         However, there is no medical evidence that Dr. Gary, her treating 
 
         physician and the only doctor in this case, either took her off 
 
         of work or returned her to work.  Therefore, claimant has not 
 
         sustained the burden of proof by a preponderance of the evidence 
 
         that she sustained any temporary disability.  Therefore, claimant 
 
         is not entitled to temporary disability benefits under chapter 85 
 
         of the Code of Iowa.
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  15
 
         
 
         
 
              Dr. Gary did not state that claimant was permanently 
 
         impaired; nor did he give her a permanent impairment rating.  
 
         Therefore, claimant has not sustained the burden of proof by a 
 
         preponderance of the evidence that she sustained a permanent 
 
         disability.  Therefore, claimant is not entitled to permanent 
 
         disability benefits under chapter 85 of the Code of Iowa.
 
         
 
              Claimant is entitled to the payment of so much of Dr. Gary's 
 
         bill that is causally connected to  this  injury.  Defendant 
 
         stipulated that the medical bills are fair and reasonable an that 
 
         they were incurred for reasonable and necessary medical 
 
         treatment.  Defendant asserted, however, that he did not concede 
 
         that any of the medical expenses were causally connected to this 
 
         injury.  Claimant did not submit any itemized medical bills from 
 
         Dr. Gary.  Therefore no determination can be made as to what 
 
         portion of Dr. Gary's medical bills are causally connected to 
 
         this injury.  It is not likely that claimant's yearly physical 
 
         assessment on August 11, 1987, which appears to be an annual 
 
         physical examination was caused by this injury.  Exhibit 4 states 
 
         that Dr. Gary's charges amount to $330.75.  A parenthetical 
 
         remark at the bottom of this itemization says that copies will be 
 
         sent in later.  If copies are sent in later they cannot be 
 
         considered in the determination of this case.  Division of 
 
         Industrial Services Rule 343-4.31 provides that, "No evidence 
 
         shall be taken after the hearing".  Furthermore, the $330.75 
 
         figure on Exhibit 4 conflicts with the adding machine tape 
 
         tabulation of Dr. Gary's charges which total $290.75 at exhibit 
 
         4B.  Consequently, it is not possible to make a determination on 
 
         how much of Dr. Gary's bills are causally connected to this 
 
         injury and how much medical expense was actually incurred with 
 
         Dr. Gary on account of this injury.
 
         
 
              Claimant has sustained the burden of proof by a 
 
         preponderance of the evidence that she is entitled to all of her 
 
         medication expenses shown on exhibits 4B through 4G.  All of 
 
         these bills are itemized.  Almost all of these prescriptions are 
 
         mentioned by Dr. Gary in his office notes (Ex. 3, pp. 1-4).  The 
 
         opthalmic solution was obviously for conjunctivitis.  Even though 
 
         the Premarin may or may not have been taken anyway as a 
 
         post-hysterectomy medication, claimant testified that Dr. Gary 
 
         prescribed it specifically for the nervous condition caused by 
 
         this injury.  This testimony is not controverted.  Ativan, as 
 
         shown on exhibit 4E is for nervousness and anxiety and Prinivyl 
 
         on exhibit 4G is for hypertension.  Therefore, these two 
 
         medications should also be allowed.
 
         
 
              The total medical expenses for which claimant is entitled 
 
         are as follows:
 
         
 
              Exhibit 4       Valley Pharmacy          $235.63
 
              Exhibit 4C      Drug Town                 101.61
 
              Exhibit 4D      Drug Town                 378.76
 
              Exhibit 4E      Drug Town                  21.16
 
              Exhibit 4F      Drug Town                  52.43
 
              Exhibit 4G      Valley Pharmacy            39.47
 
                                        
 
                                        TOTAL          $829.06
 
         
 
              In addition, claimant is entitled to future medical expense 
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  16
 
         
 
         and prescription drugs for the treatment of what Dr. Gary 
 
         described as hypertension and associated symptoms (Ex. 1).
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Wherefore, based upon the evidence presented the following 
 
         findings of fact are made.
 
         
 
              That claimant was employed by employer from April 7, 1978, 
 
         until she was terminated in approximately July of 1986.
 
         
 
              That on or about April 1, 1978, employer solicited claimant 
 
         to come to the plant and interview for employment with employer.
 
         
 
              That claimant gave up her previous employment and started to 
 
         work for employer with the understanding that she would be doing 
 
         office work for the reason that she would not be able to handle 
 
         work on the production line in the plant.
 
         
 
              That claimant worked in the office at clerical jobs for 
 
         approximately 15 years until 1983.
 
         
 
              That, in 1983, claimant was told that her job in the 
 
         industrial engineering department was eliminated and that it 
 
         would be necessary for her to work on the production line in the 
 
         plant.
 
         
 
              That in 1983, claimant was 50 years of age and had never 
 
         performed production line work.
 
         
 
              That on the production line claimant was required to lift 80 
 
         pound boxes of meat which she stated were too heavy for her and 
 
         that she could not keep up with the speed of the line and jams 
 
         occurred.
 
         
 
              That claimant developed problems with her nerves and her 
 
         blood pressure at this time.
 
         
 
              That in 1984, claimant was reassigned to the office, but 
 
         testified that she continued to be under a great deal of pressure 
 
         because more work was assigned then she was able to do, she was 
 
         made to feel unwanted and she was harassed by remarks of her 
 
         superiors.
 
         
 
              That in approximately the later part of April of 1986, 
 
         claimant suffered an episode of high blood pressure and 
 
         associated symptoms and contacted her family physician, Dr. 
 
         Gary.
 
         
 
              That claimant was terminated by her employer in 
 
         approximately July of 1986, less than one year before she 
 
         qualified for a lifetime retirement pension for 20 years of 
 
         employment service.
 
         
 
              That claimant was terminated without any consideration to 
 
         the effect of this action on her health.
 
         
 
              That subsequent to the termination, claimant's hypertension 
 
         and associated symptoms increased and became worse and it became 
 
         necessary for claimant to take several prescription drugs.
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  17
 
         
 
         
 
              That claimant did sustain an injury on or about  April 24, 
 
         1984, which arose out of and in the course other employment with 
 
         employer.
 
         
 
              That Dr. Gary, the treating physician and only physician in 
 
         this case, stated that claimant's hypertension and associated 
 
         symptoms were caused by her employment.
 
         
 
              That Dr. Gary stated that claimant's need for prescription 
 
         medications was caused by her employment situation.
 
         
 
              The appearance and demeanor of all individuals who testified 
 
         was observed.  Claimant's testimony is determined to be accurate 
 
         and more accurate than conflicting testimony from any other 
 
         witness.
 
         
 
         
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based upon the evidence presented and the 
 
         principles of law previously discussed, the following conclusions 
 
         of law are made.
 
         
 
              That claimant did sustain an injury on or about April 24, 
 
         1986, which arose out of and in the course of her employment with 
 
         employer.
 
         
 
              That the injury was not proven to be the cause of any 
 
         temporary or permanent disability.
 
         
 
              That claimant is not entitled to any temporary or permanent 
 
         disability benefits.
 
         
 
              That claimant is entitled to medical expenses in the amount 
 
         of $829.06 for prescription drugs; that the portion of Dr. Gary's 
 
         bill causally connected to this injury cannot be determined from 
 
         the evidence presented; and that claimant is entitled to 
 
         continued medical expenses for the hypertension and associated 
 
         symptoms.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That defendant pay to claimant eight hundred twenty-nine and 
 
         06/100 dollars ($829.06) in medical expenses.
 
         
 
              That this amount is to be paid in a lump sum.
 
         
 
              That interest does not accrue on medical expenses pursuant 
 
         to Iowa Code section 85.30.
 
         
 
              That the costs of this action are charged against defendant 
 
         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.
 

 
         
 
         
 
         
 
         BURKHARDT V. WILSON FOODS CORPORATION
 
         PAGE  18
 
         
 
         
 
         
 
              Signed and filed this 22nd day of December, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                         WALTER R. McMANUS, JR.
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         Copies to:
 
         
 
         Mr. Harry Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City, Iowa  51102
 
         
 
         Mr. David Sayre
 
         Attorney at Law
 
         233 Pine St.
 
         P.O. Box 535
 
         Cherokee, IA 51012
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                          1106; 1108.50; 1401; 1402.20;
 
                                          1402.30; 1402.40; 1402.60; 
 
                                          1801;
 
                                          1802; 1803; 2505; 2602
 
                                          Filed December 22, 1988
 
                                          WALTER R. McMANUS, JR.
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LOIS I. BURKHARDT,
 
         
 
              Claimant,                           File No.  821646
 
         
 
         vs.                                  A R B I T R A T I 0 N
 
         
 
         WILSON FOOD CORPORATION,                 D E C I S I 0 N
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
         1106; 1108.50; 1402; 1402.20; 1402.30; 1402.40; 1402.60
 
         
 
              Claimant did sustain the burden of proof by a preponderance 
 
         of the evidence that she sustained an injury arising out of and 
 
         in the course of employment.  Claimant was initially hired as an 
 
         office employee.  At age 50 and after 15 years of service 
 
         employer transferred claimant to the production line in the 
 
         plant.  Claimant developed hypertension, cephalgia, tinnitus, 
 
         vertigo, nausea, and conjunctivitis.  Claimant's treating 
 
         physician and the only physician in the case said the employment 
 
         caused these problems.  Claimant was then terminated with 19 
 
         years and one month of service and only 11 months short of 
 
         qualifying for a lifetime pension after 20 years of service and 
 
         continued to have these problems after her termination.  
 
         Claimant's symptoms were considered to be physical injuries and 
 
         not stress injuries.
 
         
 
         1801; 1802; 1803
 
         
 
              Claimant was not awarded temporary disability benefits 
 
         because there was no medical evidence taking her off work or 
 
         returning her to work for the period of time of about two or 
 
         three weeks that she was off work.  Claimant was not awarded any 
 
         permanent disability benefits because she did not prove an 
 
         impairment rating or any other objective evidence that she could 
 
         not work other than her own subjective testimony and economic 
 
         conditions.
 
         
 
         2505; 2602
 
         
 
              Claimant awarded $829.06 for medications which were proven.
 
                                                
 
                                                         
 
         No award could be made for the doctor because no itemized bills 
 
         were presented and claimant introduced two numbers as the amount 
 
         of doctor's bill and there was no way to determine which amount 
 
         was correct or how much of it was causally connected.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         WILLIAM E. SMITH,
 
         
 
              Claimant,
 
         
 
         vs.                                       File No. 821647
 
         
 
         BOYS & GIRLS HOME/FAMILY               A R B I T R A T I O N
 
         SERVICES,
 
                                                   D E C I S I O N
 
              Employer,
 
         
 
         and
 
         
 
         CONTINENTAL INSURANCE COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by William E. 
 
         Smith, claimant, against Boys & Girls Home/Family Services, 
 
         employer (hereinafter referred to as Family Services), and 
 
         Continental Insurance Company, insurance carrier, for workers' 
 
         compensation benefits as a result of an alleged injury on August 
 
         4, 1985.  On June 21, 1988, a hearing was held on claimant's 
 
         petition and the matter was considered fully submitted at the 
 
         close of this hearing.
 
         
 
              The parties have submitted a prehearing report of contested 
 
         issues and stipulations which was approved and accepted as a part 
 
         of the record of this case at the time of hearing.  Oral 
 
         testimony was received during the hearing from claimant and his 
 
         wife, Janice.  The exhibits received into the evidence at the 
 
         hearing are listed in the prehearing report.
 
         
 
              According to the prehearing report, the parties have 
 
         stipulated to the following matters:
 
         
 
              1.  On August 5, 1985, claimant received an injury which 
 
         arose out of and in the course of employment with Family 
 
         Services;
 
         
 
              2.  Claimant is entitled to temporary total disability or 
 
         healing period benefits from August 9, 1985 through August 11, 
 
         1985 and claimant is not seeking additional temporary total 
 
         disability or healing period benefits in this proceeding;
 
         
 
              3.  If permanent disability benefits are awarded herein, 
 
         they shall begin as of August 12, 1985; and,
 
         
 
            4.  Claimant's rate of weekly compensation in the event of an 
 
         award of weekly benefits from this proceeding shall be $75.50 per 
 
         week.
 

 
         
 
         
 
         
 
         SMITH V. BOYS & GIRLS HOME/FAMILY SERVICES
 
         PAGE   2
 
         
 
         
 
         
 
                                      ISSUES
 
         
 
              The parties submitted the following issues for determination 
 
         in this proceeding:
 
         
 
              I.  Whether there is a causal relationship between the work 
 
         injury and the claimed disability;
 
         
 
             II.  The extent of claimant's entitlement to weekly benefits 
 
         for permanent disability; and,
 
         
 
            III.  The extent of claimant's entitlement to medical 
 
         benefits.
 
         
 
                             SUMMARY OF THE EVIDENCE
 
         
 
              Pursuant to order of the undersigned, each party prepared 
 
         and filed a "Statement of Facts Relied Upon" to simplify the 
 
         writing of this decision.  These statements are attached and 
 
         incorporated into this summary as if fully set out herein.  
 
         Whether or not specifically referred to in these statements, or 
 
         in the following brief summary prepared by the undersigned, all 
 
         of the evidence received at the hearing was independently 
 
         reviewed and considered in arriving at this decision.  Any 
 
         conclusionary statements in the following summary should be 
 
         considered as preliminary findings of fact.
 
         
 
              Briefly, claimant testified that he fell from a retaining 
 
         wall while working at the Boys & Girls Home operated by Family 
 
         Services.  Claimant worked as a maintenance person and while 
 
         attempting to remove a marijuana plant at the direction of his 
 
         superiors, he fell and landed on a concrete driveway striking his 
 
         head and his left arm and hand.  Claimant said that he briefly 
 
         lost consciousness and was taken to a local hospital for medical 
 
         treatment.  Claimant's physicians at the hospital found that 
 
         claimant suffered from the following multiple injuries:  cerebral 
 
         contusion, laceration of the left forehead above the eye, 
 
         contusion of the left hand and contusion abrasion of the right 
 
         knee.  Claimant remained in the hospital for a brief time for 
 
         observation as they found blood in his urine.  Claimant was 
 
         released to return to work on the following Monday, August 12, 
 
         1985 and claimant did, in fact, return to work at that time.  
 
         Although not stated in the release, claimant said that he was 
 
         restricted, at least temporary, from climbing by his physician.
 
         
 
             A few days after the fall, claimant complained of facial 
 
         numbness and was referred for evaluation by a neurosurgeon, Keith 
 
         McLarnan, M.D.  According to his report in evidence, Dr. McLarnan 
 
         found a partial neuropathy of the facial nerves of the left side 
 
         about the nose and lip.  Claimant expressed concern to him about 
 
         weakness of the face but the doctor indicated that this 
 
         neuropathy would not result in palsy or weakness of the face.  
 
         Claimant said that his numbness has caused problems shaving in 
 
         that he cannot feel when he is cut by his shaving razor and also 
 
         was advised by his physician not to wear his upper false teeth 
 
         because he cannot detect sores due to a loss of feeling in his 
 
         gums.
 
         
 
              Claimant was treated by a chiropractor, R. Sprague, D.C., in 
 
         July, 1985, October, 1985 and again in August, 1987, primarily 
 
         for low back pain which claimant said, in his deposition, has 
 
         plagued him since an auto accident in 1972.  Dr. Sprague stated 
 

 
         
 
         
 
         
 
         SMITH V. BOYS & GIRLS HOME/FAMILY SERVICES
 
         PAGE   3
 
         
 
         
 
         in his report that claimant complained to him of left hand 
 
         tingling and numbness along with neck, arm and shoulder problems 
 
         since October, 1985.  However, he added that he did not treat 
 
         claimant for these complaints and had no prognoses or diagnosis 
 
         of these complaints.
 
         
 
              Claimant testified that he claims that his facial numbness, 
 
         left arm and hand numbness, a loss of hearing and his neck 
 
         problems are attributable to the 1985 fall at Family Services.  
 
         Claimant contends that his physicians have causally connected the 
 
         hearing loss to the fall.  However, there are no medical reports 
 
         to verify this claim.
 
         
 
              Claimant testified that his past employment primarily 
 
         consists of a multitude of manual labor jobs.  Claimant is 50 
 
         years of age and said that he completed only the fifth grade.  
 
         Claimant states that he has difficulty comprehending written 
 
         materials and is a very poor speller.
 
         
 
              According to claimant, he was terminated by Family Services 
 
         in April, 1986 because they were not satisfied with the quality 
 
         of his work and were worried about his bronchitis condition.
 
         
 
              Claimant denies having any prior problems with his left arm, 
 
         face, hearing or neck before the work injury herein.  Claimant 
 
         has had continuing difficulties with chronic bronchitis and 
 
         asthma.  Claimant said that he has unsuccessfully looked for work 
 
         since leaving Family Services.  Claimant said that he lists 
 
         bronchitis/asthma and low back problems as two possible 
 
         impairment problems in his employment applications.
 
         
 
              Claimant is currently working with his wife in a family 
 
         roofing and snow removal business.  Claimant contends that his 
 
         disability adversely affects his ability to earn income from 
 
         these businesses.  He states that he is slower now in applying 
 
         roofing shingles and must restrict his activities in cold weather 
 
         due to an inability to detect frost bite on his face.  Claimant's 
 
         vocational rehabilitation counselor reported that claimant may 
 
         have some difficulty dealing with customers due to the fact that 
 
         he is unable to wear his upper false teeth.
 
         
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              I.  The claimant has the burden of proving by a 
 
         preponderance of the evidence that the work injury is a cause of 
 
         the claimed disability.  A disability may be either temporary or 
 
         permanent.  In the case of a claim for temporary disability, the 
 
         claimant must establish that the work injury was a cause of 
 
         absence from work and lost earnings during a period of recovery 
 
         from the injury.  Generally, a claim of permanent disability 
 
         invokes an initial determination of whether the work injury was a 
 
         cause of permanent physical impairment or permanent limitation in 
 
         work activity.  However, in some instances, such as a job 
 
         transfer caused by a work injury, permanent disability benefits 
 
         can be awarded without a showing of a causal connection to a 
 
         physical change of condition.   Blacksmith v. All-American, Inc., 
 
         290 N.W.2d 348, 354 (Iowa 1980); McSpadden v. Big Ben Coal Co., 
 
         288 N.W.2d 181 (Iowa 1980).
 
         
 
              The question of causal connection is essentially within the 
 
         domain of expert medical opinion.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).  The opinion of 
 

 
         
 
         
 
         
 
         SMITH V. BOYS & GIRLS HOME/FAMILY SERVICES
 
         PAGE   4
 
         
 
         
 
         experts need not be couched in definite, positive or unequivocal 
 
         language and 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 (Iowa 1974).  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 v. Fischer, Inc., 257 
 
         Iowa 516, 133 N.W.2d 867 (1965).
 
         
 
              Furthermore, if the available expert testimony is 
 
         insufficient along to support a finding of causal connection, 
 
         such testimony may be coupled with nonexpert testimony to show 
 
         causation and be sufficient to sustain an award.  Giere v. Asse 
 
         Haugen Homes, Inc., 259 Iowa 1065, 146 N.W.2d 911, 915 (1966).  
 
         Such evidence does not, however, compel an award as a matter of 
 
         law.  Anderson v. Oscar Mayer & Co., 217 N.W.2d 531, 536 (Iowa 
 
         1974).  To establish compensability, the injury need only be a 
 
         significant factor, not be the only factor causing the claimed 
 
         disability.  Blacksmith, 290 N.W.2d 348, 354.  In the case of a 
 
         preexisting condition, an employee is not entitled to recover for 
 
         the results of a preexisting injury or disease but can recover 
 
         for an aggravation thereof which resulted in the disability found 
 
         to exist.  Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 
 
         N.W.2d 251 (1963).
 
         
 
              In the case sub judice, claimant has established by the 
 
         greater weight of evidence presented a causal connection of the 
 
         work injury to his facial numbness.  This condition appears to be 
 
         permanent and results in functional impairment against working in 
 
         below freezing temperatures.  The evidence was too sketchy to 
 
         find a causal connection of his hearing loss or his neck or 
 
         shoulder problems to the work injury.  His complaints and 
 
         symptomatology after the injury alone without treatment and 
 
         without supportive causal connection medical opinions does not 
 
         alone establish the causal connection.  Also, it is difficult to 
 
         separate functional impairments allegedly caused by these 
 
         conditions from his long-standing low back problems.
 
         
 
              II.  Claimant must establish by a preponderance of the 
 
         evidence the extent of weekly benefits for permanent disability 
 
         to which claimant is entitled.  As the claimant has shown that 
 
         the work injury was a cause of a permanent physical impairment or 
 
         limitation upon activity involving the body as a whole, the 
 
         degree of permanent disability must be measured pursuant to Iowa 
 
         Code section 85.34(2)(u).  However, unlike scheduled member 
 
         disabilities, the degree of disability under this provision is 
 
         not measured solely by the extent of a functional impairment or 
 
         loss of use of a body member.  A disability to the body as a 
 
         whole or an "industrial disability" is a loss of earning capacity 
 
         resulting from the work injury.  Diederich v. Tri-City Railway 
 
         Co., 219 Iowa 587, 593, 258 N.W. 899 (1935).  A physical 
 
         impairment or restriction on work activity may or may not result 
 
         in such a loss of earning capacity.  The extent to which a work 
 
         injury and a resulting medical condition has resulted in an 
 
         industrial disability is determined from examination of several 
 
         factors.  These factors include the employee's medical condition 
 
         prior to the injury, immediately after the injury and presently; 
 
         the situs of the injury, its severity and the length of healing 
 
         period; the work experience of the employee prior to the injury, 
 
         after the injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 

 
         
 
         
 
         
 
         SMITH V. BOYS & GIRLS HOME/FAMILY SERVICES
 
         PAGE   5
 
         
 
         
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         Olson, 255 Iowa 1112, 1121, 125 N.W.2d 251, 257 (1963).  See 
 
         Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, February 
 
         28, 1985).
 
         
 
              Claimant's medical condition before the work injury was not 
 
         excellent and he had severe low back problems since 1972.  
 
         Claimant also has had severe bronchitis and asthma problems 
 
         before August, 1985.  Both of these conditions are disabling and 
 
         remain disabling today according to claimant's own testimony.
 
         
 
              Claimant has shown that his ability to earn a living has 
 
         been mildly affected by his facial paralysis due to an inability 
 
         to work in cold weather and difficulties in dealing with the 
 
         general public due to an inability to wear upper false teeth.  
 
         This condition, however, for the most part does not prevent him 
 
         from returning to his former work or to most other work he has 
 
         performed in the past.
 
         
 
              Claimant is 50 years of age and due to a lack of education 
 
         is not a good candidate for retraining.  However, retraining was 
 
         not necessitated by this work injury.  Claimant has not shown a 
 
         great deal of motivation to seek employment outside of his 
 
         self-employment business.
 
         
 
              After examination of all the factors found as a  matter of 
 
         fact that claimant has suffered a five percent loss of earning 
 
         capacity from his work injury.  Based upon such a finding, 
 
         claimant is entitled as a matter of law to 25 weeks of permanent 
 
         partial disability benefits under Iowa Code section 85.34(2)(u) 
 
         which is five percent of 500 weeks, the maximum allowable number 
 
         of weeks for an injury to the body as a whole in that 
 
         subsection.
 
         
 
              III.  Pursuant to Iowa Code section 85.27, claimant is 
 
         entitled to payment of reasonable medical expenses incurred for 
 
         treatment of a work injury.  According to the prehearing report, 
 
         claimant seeks only the payment of the unpaid charges from Thomas 
 
         L. Coriden, M.D., between August 8, 1985 and August 27, 1986.  
 
         Dr. Coriden treated claimant immediately after the injury and is 
 
         also claimant's family physician.  The bill submitted does not 
 
         describe the treatment given for the charges.  One of the charges 
 
         was for claimant's wife.  It appears that various amounts have 
 
         been paid on this bill by some entity since 1985.  Claimant did 
 
         not discuss these charges at hearing or the bill which is exhibit 
 
         12.  Consequently, there was no evidence offered at the hearing 
 
         upon which to base any finding that the unpaid charges are 
 
         related to the work injury.
 
         
 
              In the prehearing report, claimant requests an order 
 
         directing defendants to designate a treating physician for 
 
         claimant's sinus and shoulder problems.  Neither of these 
 
         conditions were found to be work related.  Defendants, however, 
 
         are directed to designate a physician for claimant's facial and 
 
         denture problems which are work related.
 
         
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  The work injury of August 5, 1985 was a cause of a mild 
 
         permanent partial impairment to the facial nerves and of 
 

 
         
 
         
 
         
 
         SMITH V. BOYS & GIRLS HOME/FAMILY SERVICES
 
         PAGE   6
 
         
 
         
 
         permanent restrictions upon claimant's physical activity 
 
         consisting of limited work in subzero temperatures.
 
         
 
              2.  The work injury of August 5, 1985 and the resulting 
 
         permanent partial impairment was a cause of a five percent loss 
 
         of earning capacity.  Claimant's medical condition before the 
 
         work injury was not excellent and he had severe low back pain 
 
         since 1972.  Claimant has had severe bronchitis and asthma 
 
         problems before August, 1985.  Both the lung problems and the low 
 
         back problems are disabling and remain so today.  Claimant's 
 
         ability to earn a living has been mildly affected by his facial 
 
         paralysis caused by the work injury due to an inability to work 
 
         in cold weather and difficulty in dealing with the general public 
 
         from an inability to wear upper false teeth.  This condition, for 
 
         the most part, does not prevent claimant from returning to his 
 
         former work or most other work he has performed in the past.  
 
         Claimant is 50 years of age and, due to his lack of education, is 
 
         not a good candidate for retraining.  However, retraining was not 
 
         necessitated by this work injury.  Claimant has not shown a great 
 
         deal of motivation to leave his current roofing and snow removal 
 
         business.  This aspect has also adversely affected his earning 
 
         capacity which would be unrelated to the work injury.
 
         
 
              3.  Claimant is in need of continuing treatment for his work 
 
         related facial numbness and denture problems.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 

 
         
 
         
 
         
 
         SMITH V. BOYS & GIRLS HOME/FAMILY SERVICES
 
         PAGE   7
 
         
 
         
 
              Claimant has established under law entitlement to the 
 
         specific disability and medical benefits awarded below.
 
         
 
                                      ORDER
 
         
 
              1.  Defendants shall pay to claimant twenty-five (25) weeks 
 
         of permanent partial disability benefits at the rate of 
 
         seventy-five and 50/100 dollars ($75.50) per week from August 12, 
 
         1985.
 
         
 
              2.  Defendants shall designate a treating physician and/or 
 
         specialist for the facial numbness and denture problems due to 
 
         his facial paralysis.
 
         
 
              3.  Defendants shall pay accrued weekly benefits in a lump 
 
         sum.
 
         
 
              4.  Defendants shall pay interest on weekly benefits awarded 
 
         herein as set forth in Iowa Code section 85.30.
 
         
 
              5.  Defendants shall pay the costs of this action pursuant 
 
         to Division of Industrial Services Rule 343-4.33.
 
         
 
              6.  Defendants shall file activity reports on the payment of 
 
         this award as requested by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 9th day of December, 1988.
 
         
 
         
 
         
 
         
 
         
 
                                          LARRY P. WALSHIRE
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         P. O. Box 1194
 
         Sioux City, Iowa 51102
 
         
 
         Mr. G. Daniel Gildemeister
 
         Ms. Alice S. Horneber
 
         Attorneys at Law
 
         400 1st National Bank Bldg.
 
         P. O. Box 1768
 
         Sioux City, Iowa 51102
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                               1800
 
                                               Filed December 9, 1988
 
                                               LARRY P. WALSHIRE
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         WILLIAM E. SMITH,
 
         
 
              Claimant
 
         
 
         vs.                                       File No. 821647
 
         
 
         BOYS & GIRLS HOME/FAMILY               A R B I T R A T I O N
 
         SERVICES,
 
                                                   D E C I S I O N
 
              Employer,
 
         
 
         and
 
         
 
         CONTINENTAL INSURANCE COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         1800
 
         
 
              Only a portion of claimant's complaints were found to be 
 
         work related, however, one of the complaints of facial numbness 
 
         was found to cause a small amount of industrial disability as a 
 
         result of an inability to work in cold weather and difficulty in 
 
         dealing with customers in a small business due to an inability to 
 
         wear dentures.  Defendants were ordered to provide a treating 
 
         physician for the facial numbness and denture problems.
 
         
 
 
                                            
 
 
 
 
 
 
 
 
 
 
 
                                            5-2209
 
                                            January 16, 1990
 
                                            MICHELLE A. McGOVERN
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         THOMAS ALLAN ZOCH,
 
                                              File Nos. 821611 & 804579
 
              Claimant,
 
                                               A R B I T R A T I 0 N
 
         vs.
 
                                                  D E C I S I 0 N
 
         WILSON FOODS CORPORATION,
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         5-2209
 
         
 
              Claimant is entitled to four percent permanent partial 
 
         disability as the result of two work related injuries sustained 
 
         on September 16, 1985 and on May 3, 1986.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         WANDA HAWORTH,
 
         
 
              Claimant,                      File Nos. 821734 & 804588
 
         
 
         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,                          F I L E D
 
         
 
         and                                        FEB 22 1989
 
                                                      
 
         SECOND INJURY FUND OF IOWA,        IOWA INDUSTRIAL COMMISSIONER
 
                                                 
 
              Defendants.
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by Wanda Haworth 
 
         Cedar, claimant, against Wilson Foods Corporation, self-insured 
 
         employer, and the Second Injury Fund of Iowa, defendants, to 
 
         recover benefits under the Iowa Workers' Compensation Act as a 
 
         result of injuries sustained on March 27, 1985, August 30, 1985, 
 
         and January 17, 1986.  This matter came on for hearing before the 
 
         undersigned deputy industrial commissioner on the 22nd day of 
 
         August, 1988 at the Buena Vista County Courthouse in Storm Lake, 
 
         Iowa.  The record in this case consists of claimant's exhibits 
 
         3-31 and defendant's exhibit B.  Also in the record is the 
 
         testimony of claimant and the testimony of Thelma Rimmer.
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the prehearing report submitted and approved on 
 
         August 22, 1988, the issues presented are:
 
         
 
              1)  Whether claimant sustained an injury on January 17, 1986 
 
         which arose out of and in the course of employment with employer;
 
         
 
              2)  Whether there is a causal relationship between the 
 
         alleged injury and the disability;
 
         
 
              3)  Whether claimant is entitled to permanent partial or 
 
         total disability benefits; and,
 
         
 
              4)  Whether claimant is entitled to benefits from the second 
 
         injury fund.
 
         
 
              The parties stipulated that as of August 22, 1988, claimant 
 
         had no permanent partial disability or an industrial disability 
 
         because of any back injury allegedly occurring on August 30, 
 
         1985.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                                 FACTS PRESENTED
 
         
 
              Claimant, age 32, testified she graduated from high school. 
 
         She is married and she has two children in her custody.  Since 
 
         graduation from high school, claimant had been employed as a 
 
         check-out operator, a dry cleaning attendant, a temporary 
 
         employee scooping grain from bins, a waitress, and she had 
 
         voluntarily worked for nearly four years as an emergency medical 
 
         technician. Claimant had also been employed by IBP from October 
 
         of 1982 until February of 1984 where she earned $6.50 per hour.
 
         
 
              In October of 1984, claimant began working at defendants' 
 
         place of business.  She started at a rate of $6.00 or $6.50 per 
 
         hour.  Claimant's first assignment was to pull the black gut from 
 
         sows.  She performed this task until January of 1985.  At that 
 
         time, claimant was reassigned.  She was required to shave front 
 
         hams, shave hair from the ham and cut the Shackleforth mark with 
 
         a chain glove and an arm guard.  Claimant performed this task 
 
         with her left hand for eight hours per day.  Claimant also shaved 
 
         eyelids using a wizard knife where she shaved between 300 to 600 
 
         animals per hour.
 
         
 
              Claimant testified that in March of 1985, she sustained a 
 
         carpal tunnel injury to her left hand.  Claimant stated she was 
 
         off work in June and July of 1985 and that her hand was 10 
 
         percent disabled.  An agreement for settlement was approved by 
 
         the Division of Industrial Services in September of 1985.  
 
         Claimant reported she returned to work in August of 1985 where 
 
         she was engaged in "dropping heads."
 
         
 
              Claimant testified she was required to cut heads from the 
 
         animal bodies, with the exception of a piece of skin.  Claimant 
 
         described the process.  She was required to grip a knife in her 
 
         left hand.  She grabbed the animal ear with her right hand.  She 
 
         wore an arm guard but no mesh glove.  She made six to eight cuts 
 
         on the hog head.  Claimant stated she worked at a height near 
 
         waist level.
 
         
 
              On January 17, 1986, claimant stated she felt her right hand 
 
         going numb.  She testified her hand had tingled, she could not 
 
         grip, and her hand had fallen asleep.  On January 17, 1986, 
 
         claimant recalled, she visited with the plant physician, Keith 0. 
 
         Garner, M.D.
 
         
 
              Claimant was referred to Scott B. Neff, D.O., from Dr. 
 
         Garner in April of 1986.  Surgery on the right hand was performed 
 
         by Dr. Neff.  Claimant was released to return to work in June of 
 
         1986 but because defendant had discontinued its "kill floor 
 
         operation", claimant was unable to return to work at defendant's 
 
         plant in her former capacity.  Claimant did pass on certain jobs.
 
              
 
              Claimant testified in May of 1986, she had received 
 
         unemployment insurance benefits.  Claimant acknowledged she was 
 
         ready, willing and able to work at that time.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant testified she had only worked intermittently since 
 
         June of 1986.  From January or February of 1987 to May of 1987, 
 
         claimant worked in a lounge for minimum wage.
 
         
 
              In May of 1987, claimant cooked and cleaned while traveling 
 
         with a crew harvesting wheat.  She received $500.00 a month for 
 
         the months of June, July and August of 1987.  Claimant commenced 
 
         employment with a nursing home in the early part of 1988.  She 
 
         worked as a nurses' aide until May of 1988.  There claimant 
 
         changed linens and assisted patients with walking.
 
         
 
              In June of 1988, claimant again traveled with a harvesting 
 
         crew.  She reported she was not paid a wage for that summer.  She 
 
         cooked and did the laundry for seven people.
 
         
 
              Claimant stated she had wanted to become a nurse, but she is 
 
         unable to perform CPR because of her injuries.  Claimant 
 
         maintains she cannot perform chest compressions.
 
         
 
                           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 injuries on August 30, 1985 and 
 
         January 17, 1986 which arose out of and in the course of her 
 
         employment. McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 
 
         1976); Musselman v. Central Telephone Co., 261 Iowa 352, 154 
 
         N.W.2d 128 (1967).
 
         
 
              The 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 words "out of" refer to the cause or source of the 
 
         injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 
              The words "in the course of" refer to the time and place and 
 
         circumstances of the injury.  McClure v. Union et al. Counties,
 
         188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 402, 68 N.W.2d 63 
 
         (1955).
 
              "An injury occurs in the course of the employment when it is 
 
         within the period of employment at a place the employee may 
 
         reasonably be, and while he is doing his work or something 
 
         incidental to it."  Cedar Rapids Comm. Sch. Dist. v. Cady, 278 
 
         N.W.2d 298 (Iowa 1979); McClure, 188 N.W.2d 283 (Iowa 1971); 
 
         Musselman, 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              In the case at bar, claimant has established she has 
 
         received injuries arising out of and in the course of her 
 
         employment.  She testified about the repetitive type of 
 
         activities she was performing while she was employed by 
 
         defendant.  These activities included repetitive motion 
 
         activities using knives.  Claimant testified she was not 
 
         performing repetitive activities with her hands outside the scope 
 
         of her employment.  There was no evidence disputing her 
 
         testimony.  The problems with the right hand increased as the 
 
         extent of repetitive activities increased. Claimant sought 
 
         medical attention on January 17, 1986.  This is the injury date.  
 
         McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 1985).
 

 
         
 
 
 
 
 
 
 
 
 
 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Next, there is the issue of a causal relationship.  The 
 
         claimant has the burden of proving by a preponderance of the 
 
         evidence that the injury of January 17, 1986 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, 261 Iowa 352, 154 
 
         N.W.2d 128 (1967).
 
         
 
              Claimant has established there is a causal relationship 
 
         between the alleged injury to the right hand and the claimed 
 
         disability to the right hand.  Claimant testified about the 
 
         numbness, the tingling and the other problems she.was 
 
         experiencing on the 17th of January.  The problems exacerbated as 
 
         the length of claimant's employment increased.
 
         
 
              Additionally, there is medical testimony which supports a 
 
         causal connection between the alleged injury to the right hand 
 
         and the claimed disability.  Dr. Neff, in his letter of April 9, 
 
         1986, writes:
 
         
 
              She tells me that she has had anti-inflammatory medication, 
 
              splints, and none of these have helped.
 
         
 
              Certainly she acts as if she has a carpal tunnel, and we 
 
              will prove that electrically and then schedule her 
 
              outpatient surgery.  As is our usual case, this will not 
 
              result in any permanent impairment or disability, and should 
 
              result in a period of time being off work of approximately 
 
              four to six weeks.  She does have a vigorous job, and I 
 
              would send her back to work not quite as rapidly as I would 
 
              an office worker.
 
         
 
              A. J. Wolbrink, M.D., corroborated the causal relationship 
 
         between the alleged injury of the right hand and the claimed 
 
         disability.  His letter of February 19, 1987, states:
 
         
 
              I saw and examined Wanda Haworth on February 18, 1987.  Her 
 
              main problem was her right wrist.  Patient relates that she 
 
              had had problems with her right wrist for about 3 years, but 
 
              about 1 year ago she developed increasing problems so that 
 
              it was keeping her awake at night and significantly limiting 
 
              her activity.  Therefore, May 19, 1986, she had carpal 
 
              tunnel release surgery....
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
              There are also the "problems & findings" of Dr. Garner. 
 
         Records for February of 1986, indicate:
 
         
 
              2/14/86  Pareses - R hand - loss of grip.  Tenderness & 
 
              numbness volar surface.
 
                      Minimal swelling of the thenar region
 
                      Probably needs referral to Dr. Ferlic.
 
         
 
              2/19/86  R wrist sore - wear snap
 
                      wrist brace
 
         
 
              Claimant has established the requisite causal connection to 
 
         the claimed disability.
 
         
 
              The third issue to address is whether claimant has sustained 
 
         any permanent disability to her right hand.  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).
 
         
 
              Medical testimony is not in agreement.  The treating 
 
         surgeon, Dr. Neff, did not find any evidence of permanency.  As 
 
         of June 16, 1986, he writes:  "...In my opinion, she does not 
 
         have any permanent impairment or disability with reference to her 
 
         carpal tunnel syndrome and its subsequent surgery."
 
         
 
              In his letter of October 15, 1986, Dr. Neff opines:
 
         
 
              Based on these findings of normal range of motion and normal 
 
              functioning median nerve, there would be no percentage of 
 
              impairment.  The grip strength certainly can be improved 
 
              upon with activity, and we do not see any permanency 
 
              established based on this.
 
         
 
              Later in his letter of May 28, 1987, Dr. Neff writes:
 
         
 
              Because she has excellent median nerve function, and full 
 
              wrist range of motion, she does not have any significant 
 
              impairment with reference to the carpal tunnel.  We will 
 
              document her grip strength and range of motion for a precise 
 
              impairment, although it is not possible to give you a 
 
              thorough and absolutely accurate impairment rating unless we 
 
              have a repeat EMG.
 
         
 
              She has no median nerve symptoms, and consequently, that 
 
              impairment rating, in my opinion, would be 0.
 
         
 
              Pursuant to a request from Dr. Neff, Thomas W. Bower, 
 
         L.P.T., performed various tests on claimant.  Mr. Bower evaluated 
 
         claimant for a functional impairment.  He disagreed with Dr. 
 
         Neff.  He writes in his letter of June 1, 1987:
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Physical examination today reveals range of motion activity 
 
              for wrist extension of 45 degrees, passively 60 degrees, 
 
              active palmar flexion of 70 degrees, and passive motion 70 
 
              degrees, radial deviation active 25 degrees and passively 25 
 
              degrees, and ulnar deviation of 30 degrees actively as is 
 
              the passive motion.  This would represent activity a 15 
 
              degree limitation in full motion but passively normal.  
 
              Phalen's maneuver reveals tingling over the ring, little, 
 
              and middle fingers of the right hand.  The Tinel's sign is 
 
              local and does not seem to cause radiating tingling.  Grip 
 
              strengths measured today demonstrate in five successive 
 
              positions an average of 6 kilograms.  It is noted that the 
 
              only torque generated was at the mid position of the grip, 
 
              dynamometer, and all other testing positions registered 0.  
 
              She averages on the left side 21.6 kilograms.  Pinch grasp 
 
              demonstrates an average on the right side of .27 kilograms 
 
              and on the left side an average of 6.7 kilograms.  In 
 
              addition, conduction studies to the median and ulnar nerves 
 
              demonstrated a 4.0 millisecond latency at a 5 millivolt 
 
              amplitude and the median sensory portion a 3.76 millisecond 
 
              latency at 40 microvolts amplitude.  Orthodromic palmar 
 
              stimulation demonstrated 2.16 at 40 microvolts.  The ulnar 
 
              nerve demonstrated a 2.6 millisecond latency with a 10 
 
              millivolt amplitude and ulnar sensory was 3.20 milliseconds 
 
              at 50 microvolts.  The median sensory and palmar stimulation 
 
              for the median nerve are abnormal.
 
         
 
              It is noted in an exam done in October of 1986 by this 
 
              office, no percentage of impairment was given based on the 
 
              findings.  This was based simply on the fact that there was 
 
              full range of motion and that the conduction findings for 
 
              the median nerve all demonstrated normal conduction 
 
              findings. This has changed as of this date based on our 
 
              examination today.  It appears that the patient is 
 
              demonstrating a very mild median neuropathy distal to the 
 
              carpal ligament based on these conduction findings, 
 
              specifically the median sensory and palmar stimulation.
 
         
 
              Based on these findings, the sensory findings.specifically, 
 
              the patient has incurred approximately a 12 percent 
 
              impairment to the hand using these figures.
 
         
 
              Because claimant was dissatisfied with the 0 functional 
 
         impairment rating which she received from Dr. Neff, claimant 
 
         sought the opinion of A. J. Wolbrink, M.D.  Dr. Wolbrink did not 
 
         treat claimant.  He only saw claimant for purposes of evaluating 
 
         claimant in anticipation of litigation.  Dr. Wolbrink opines in 
 
         his letter of February 19, 1987, to claimant's attorney:
 
         
 
              ...Also, she had normal range of motion of the shoulders and 
 
              elbows in both arms.  Thoracic outlet testing was normal.  
 
              The left hand had a well-healed scar along the thenar 
 
              crease, but otherwise was normal with good opponens' 
 
              strength and 4 mm., 2 point discrimination throughout the 
 
              hand.  The right hand had normal circulation, but increased 
 
              sweating throughout the palm.  She had a measured 400 of 
 
              dorsiflexion and 500 of palmar flexion of the wrist.  She 
 
              had good deviation.  She had symmetrical rotation, or 
 
              supination and pronation, of the forearms of both arms, but 
 
              rotation of the right arm did seem to cause some discomfort.  
 
              There was a well-healed scar along the thenar crease and 
 
              Tinel's sign was negative along this scar.  Phalen's test 
 
              was positive.  She had 4 mm., 2 point discrimination in the 
 
              median nerve distribution, but 8 to 12 mm. 2 point 
 
              discrimination along both sides of the ring finger and 
 

 
              
 
 
 
 
 
 
 
 
 
 
 
              little finger.  She did seem to have function and reasonably 
 
              good strength in the intrinsic muscles of the right hand.  I 
 
              measured grip strength in the right hand at 2 and 3 Kg. and 
 
              in the left hand it was 35 and 34 Kg.  Pinch strength 
 
              measured .1 Kg. in the right hand and .8 Kg. in the left 
 
              hand.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
                 ...
 
         
 
              At the present time, Ms. Haworth has an impairment of 9 
 
              percent of the upper extremity due to loss of sensation and 
 
              motion, and an additional 6 percent due to loss of strength. 
 
              This is according to the "Guide to the Evaluation of 
 
              Permanent Impairment," American Medical Association, Second 
 
              Edition.
 
         
 
              This may not be a permanent impairment.  If nothing further 
 
              is done, it will probably stay as it is.  However, further 
 
              evaluation to determine the cause of the ulnar nerve problem 
 
              and alleviating it may provide significant improvement....
 
         
 
              Therefore, 1) based upon all of the foregoing 
 
         considerations; 2) based upon the permanent functional impairment 
 
         ratings assigned by Dr. Neff, Dr. Wolbrink and Mr. Bower; 3) 
 
         based upon personal observation of claimant; 4) based upon 
 
         claimant's testimony; and, 5) based upon agency expertise, (Iowa 
 
         Administrative Procedure Act 17A.14(s)), it is determined that 
 
         claimant has sustained a 15 percent permanent functional 
 
         impairment of the right hand.  In determining permanent partial 
 
         disability in the case of a scheduled member, claimant's 
 
         testimony and demonstrated difficulties may be considered in 
 
         determining the actual loss of use so long as loss of earning 
 
         capacity is not considered.  Soukup, 222 Iowa 272, 268 N.W. 598 
 
         (1936); Langrehr v. Warren Packaging Corporation, Thirty-fourth 
 
         Biennial Report of the Industrial Commissioner 179 (January 22, 
 
         1980).  Defendant employer, therefore, is liable for 28.5 weeks 
 
         (190 x .15) of permanent partial disability for the injury to the 
 
         right hand which occurred on January 17, 1986.
 
         
 
              The next consideration is whether the second injury fund is 
 
         applicable here.  Iowa Code section 85.64 provides, in part:
 
         
 
              If an employee who has previously lost, or lost the use of, 
 
              one hand, one arm, one foot, one leg, or one eye, becomes 
 
              permanently disabled by a compensable injury which has 
 
              resulted in the loss of or loss of use of another such 
 
              member or organ, the employer shall be liable only for the 
 
              degree of disability which would have resulted from the 
 
              latter injury if there had been no pre-existing disability.  
 
              In addition to such compensation, and after the expiration 
 
              of the full period provided by law for the payments thereof 
 
              by the employer, the employee shall be paid out of the 
 
              "Second Injury Fund" created by this division the remainder 
 
              of such compensation as would be payable for the degree of 
 
              permanent disability involved after first deducting from 
 
              such remainder the compensable value of the previously lost 
 
              member or organ.
 
         
 
              Under Iowa Code sections 85.63 through 85.69, three 
 
         requirements must be met in order to establish fund liability: 
 
         First, claimant must have previously lost or lost the use of a 
 
         hand, an arm, a foot, a leg or an eye; second, through another 
 
         compensable injury, claimant must sustain another loss or loss of 
 
         use of another member; and third, permanent disability must exist 
 
         as to both injuries.  If the second injury is limited to a 
 
         scheduled member, then the employer's liability is limited to the 
 
         schedule and the fund is responsible for the excess industrial 
 
         disability over the combined scheduled losses of the first and 
 
         second injuries.  Simbro v. Delong's Sportswear, 332 N.W.2d 886 
 
         (Iowa 1983), and Fulton v. Jimmy Dean Meat Company, file number 
 
         755039, Nos. 87-1567/87-1518 (Affirmed by the Iowa Supreme Court 
 
         on February 22, 1989.)
 

 
         
 
 
 
 
 
 
 
 
 
 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant has established she had previously sustained a loss 
 
         of the use of her left hand as a result of an injury sustained on 
 
         March 27, 1985.  Claimant has also established she had sustained 
 
         a.loss of the use of her right hand as a result of the injury 
 
         sustained on January 17, 1986.  However, claimant has failed to 
 
         meet the third requirement under sections 85.63 through 85.69. 
 
         Claimant has failed to establish that she has sustained a 
 
         permanent disability to her left hand as a result of the March 
 
         27, 1985 injury.
 
         
 
              Dr. Neff, as of April 9, 1986, reports to Dr. Garner:  "The 
 
         symptoms on the left side have completely disappeared."
 
         
 
              Claimant's own physician, Dr. Wolbrink, in his evaluation 
 
         states:  "...The left hand had a well-healed scar along the 
 
         thenar crease, but otherwise was normal with good opponens' 
 
         strength and 4 mm., 2 point discrimination throughout the hand."
 
         
 
              Claimant offered no testimony that she was experiencing 
 
         problems with her left hand.  In fact, claimant testified to the 
 
         contrary.  She was able for two years to clean and cook for a 
 
         harvest crew of seven individuals.  If claimant's left hand had 
 
         been disabled, she would have had difficulties with the positions 
 
         she held subsequent to the surgery she had on the left hand. 
 
         Claimant reported no difficulties in performing tasks associated 
 
         with her varied positions.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, based on the evidence presented, the following 
 
         findings of fact are made:
 
         
 
              1.  Claimant sustained a work injury on March 27, 1985 to 
 
         her left hand which resulted in a 10 percent impairment to the 
 
         left hand per an agreement for settlement.
 
         
 
              2.  Claimant, subsequent to this injury, was able to return 
 
         to work in her usual occupation.
 
         
 
              3.  Claimant sustained no work injury to her back as a 
 
         result of any back injury allegedly occurring on August 30, 1985.
 
         
 
              4.  Claimant sustained a work injury on January 17, 1986 to 
 
         her right hand which resulted in surgery on that hand.
 
         
 
              5.  Claimant has worked a number of positions subsequent to 
 
         the surgery on her right hand, including waitress work, working 
 
         as a nurses' aide, and cleaning and cooking for a harvest crew.
 
         
 
              6.  Claimant is currently employed in a delicatessen for 
 
         minimum wage.
 
         
 
              7.  Claimant's left hand is now normal.
 
              
 

 
         
 
 
 
 
 
 
 
 
 
 
 
              8.  Claimant's right hand has a functional impairment.
 
              
 
              9.  Claimant has a permanent partial disability to the right 
 
         hand.
 
         
 
                                  CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based on the principles of law previously stated, 
 
         the following conclusions of law are made:
 
         
 
              1.  The compensable value of the permanent injury to the 
 
         right hand is 28.5 weeks.
 
         
 
              2.  Claimant no longer has a permanent partial disability to 
 
         the left hand.
 
         
 
              3.  There is no permanent partial disability to the back as 
 
         a result of the alleged injury on August 30, 1985.
 
         
 
              4.  The second injury fund is not liable for any benefits.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That defendant employer pay twenty eight and one half (28.5) 
 
         weeks of permanent partial disability benefits to claimant at the 
 
         rate of one hundred ninety-five and 98/100 dollars ($195.98) per 
 
         week.
 
         
 
              That these amounts are to be paid in a lump sum.
 
         
 
              That defendant employer is entitled to a credit for 
 
         twenty-two point eight (22.8) weeks of permanent partial 
 
         disability paid prior to hearing at the rate of one hundred 
 
         ninety-five and 98/100 dollars ($195.98) per week plus interest 
 
         in the amount of four hundred two and 15/100 dollars ($402.15).
 
         
 
              That interest on the unpaid amount will accrue pursuant to 
 
         Iowa Code section 85.30.
 
         
 
              That the costs of this action are assessed against defendant 
 
         employer.
 
         
 
              That defendant employer file its claim activity report 
 
         pursuant to Division of Industrial Services Rule 343-3.1.
 
         
 
              Signed and filed this 22nd of February, 1989.
 
         
 
         
 
         
 
         
 
                                       MICHELLE A. McGOVERN
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Copies To:
 
         
 
         Mr. Steve Hamilton
 
         Attorney at Law
 
         606 Ontario St.
 
         P. 0. Box 188
 
         Storm Lake, Iowa  50588
 
         
 
         Mr. David L. Sayre
 
         Attorney at Law
 
         223 Pine St.
 
         P. 0. Box 535
 
         Cherokee, Iowa  51012
 
         
 
         Ms. Shirley Ann Steffe
 
         Assistant Attorney General
 
         Hoover Bldg.
 
         Des Moines, Iowa  50319
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
                                                 
 
 
 
 
 
 
 
 
 
 
 
                                                 1803.1; 1804; 3202
 
                                                 Filed February 22, 1989
 
                                                 MICHELLE A. McGOVERN
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         WANDA HAWORTH,
 
         
 
              Claimant,
 
         
 
         vs.
 
                                             File Nos. 821734 & 804588
 
         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
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         
 
         1803.1
 
         
 
              Claimant sustained a 15 percent permanent partial disability 
 
         to the hand as a result of an injury occurring on January 17, 
 
         1986.
 
         
 
         1804
 
         
 
              Claimant stipulated she had no permanent partial disability 
 
         because of any back injury allegedly occurring on August 30, 
 
         1985.
 
         
 
         3202
 
         
 
              Claimant failed to establish liability of second injury fund 
 
         as one of the two injuries to the hands was not permanent in 
 
         nature.