Page   1
 
            
 
            
 
            
 
            
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            MELANIE K. LIGHT-PRIMASING,   :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 825148
 
            IOWA DEPARTMENT OF HUMAN :
 
            SERVICES, :
 
                      :        A P P E A L
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            STATE OF IOWA, :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            The record, including the transcript of the hearing before 
 
            the deputy and all exhibits admitted into the record, has 
 
            been reviewed de novo on appeal.  The decision of the deputy 
 
            filed March 30, 1990 is affirmed and is adopted as the final 
 
            agency action in this case, with the following additional 
 
            analysis:
 
            The standard for determining whether a mental injury arose 
 
            out of and in the course of employment was discussed in 
 
            Ohnemus v. John Deere Davenport Works, (Appeal Decision, 
 
            February 26, 1990).
 
               In order to prevail claimant must prove that he suffered 
 
            a non-traumatically caused mental injury that arose out of 
 
            and in the course of his employment.  This matter deals with 
 
            what is referred to as a mental-mental injury and does not 
 
            deal with a mental condition caused by physical trauma or 
 
            physical condition caused by mental stimulus.  The supreme 
 
            court in Schreckengast v. Hammer Mills, Inc., 369 N.W.2d 809 
 
            (Iowa 1985), recognized that issues of causation can involve 
 
            either causation in fact or legal causation.  As stated in 
 
            footnote 3 at 369 N.W.2d 810:
 
               We have recognized that in both civil and criminal 
 
            actions causation in fact involves whether a particular 
 
            event in fact caused certain consequences to occur.  Legal 
 
            causation presents a question of whether the policy of the 
 
            law will extend responsibility to those consequences which 
 
            have in fact been produced by that event.  State v. Marti, 
 
            290 N.W.2d 570, 584-85 (Iowa 1980).  Causation in fact 
 
            presents an issue of fact while legal causation presents an 
 
            issue of law.  Id.
 
            That language was the basis of the language in Desgranges v. 
 
            Dept of Human Services, (Appeal Decision, August 19, 1988) 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            which discussed that there must be both medical and legal 
 
            causation for a nontraumatic mental injury to arise out of 
 
            and in the course of employment.  While Desgranges used the 
 
            term medical causation the concept involved was factual 
 
            causation.  Therefore, in this matter it is necessary for 
 
            two issues to be resolved before finding an injury arising 
 
            out of and in the course of employment - factual and legal 
 
            causation.  Proving the factual existence of an injury may 
 
            be accomplished by either expert testimony or nonexpert 
 
            testimony.
 
               ....
 
               Not only must claimant prove that his work was the 
 
            factual cause of his mental injury, claimant must also prove 
 
            that the legal cause of his injury was his work.  In order 
 
            to prove this legal causation claimant must prove that his 
 
            temporary mental condition "resulted from a situation of 
 
            greater dimensions than the day to day mental stresses and 
 
            tensions which all employees must experience."  Swiss Colony 
 
            v. Department of ICAR, 240 N.W.2d 128, 130 (Wisc. 1976).
 
            In the instant case, Robert E. Smith, M.D., had an accurate 
 
            history and medical records available to him.  It was his 
 
            opinion that claimant's psychological symptoms were only 
 
            minimally related to work stress.  Claimant has the burden 
 
            of proving the factual cause of her mental condition was her 
 
            work.  Claimant has not met her burden of proof that her 
 
            work was the factual cause of her mental condition.  Merely 
 
            because her condition manifested itself during claimant's 
 
            tenure of employment does not mean that claimant's work was 
 
            the factual cause of her mental condition and that she 
 
            suffered an injury that arose out of and in the course of 
 
            her employment.
 
            Even if claimant had proved that her work was the factual 
 
            cause of her mental condition, claimant must also prove that 
 
            it was the legal cause.  The standard for making this 
 
            determination is whether claimant proved that her condition 
 
            resulted from a situation of greater dimensions than day to 
 
            day mental stresses and tensions which all employees must 
 
            experience.  When all the evidence, including claimant's 
 
            coworkers' testimony, claimant's absences from work (250 
 
            hours of sick leave from May 20, 1985 through March 27, 
 
            1986), and claimant's lacking of ability to cope, is 
 
            considered claimant has not proved that her work was the 
 
            legal cause of her mental condition.  Claimant has not 
 
            proved that she suffered a mental injury that arose out of 
 
            and in the course of her employment.
 
            Claimant shall pay the costs of the appeal, including the 
 
            preparation of the hearing transcript.
 
            Signed and filed this ____ day of August, 1991.
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                               BYRON K. ORTON
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. David A. Lemanski
 
            Attorney at Law
 
            200 Security Bldg.
 
            Dubuque, Iowa 52001
 
            
 
            Mr. Charles S. Lavorato
 
            Assistant Attorney General
 
            Tort Claims Division
 
            Hoover State Office Bldg.
 
            Des Moines, Iowa 50319
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
            9999
 
            Filed August 29, 1991
 
            Byron K. Orton
 
            HJW
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            MELANIE K. LIGHT-PRIMASING,   :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 825148
 
            IOWA DEPARTMENT OF HUMAN :
 
            SERVICES, :
 
                      :        A P P E A L
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            STATE OF IOWA, :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            9999
 
            Summary affirmance of deputy's decision filed March 30, 
 
            1990, with short additional analysis.
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         MELANIE K. LICHT-PRIMASING,
 
          
 
                Claimant,
 
          
 
          VS.
 
                                               File No. 825148
 
          IOWA DEPARTMENT OF HUMAN
 
          SERVICES,                            A R B I T R A T I 0 N
 
          
 
                Employer,                      D E C I S I 0 N
 
          
 
          and
 
          
 
          STATE OF IOWA,
 
          
 
                Insurance Carrier,
 
                Defendants.
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by the 
 
         claimant, Melanie K. Licht-Primasing, against her employer, Iowa 
 
         Department of Human Services, and its insurance carrier, State of 
 
         Iowa, to recover benefits under the Iowa Workers' Compensation 
 
         Act as the result of an injury allegedly sustained on March 24, 
 
         1986.  This matter came on for hearing before the undersigned 
 
         deputy industrial commissioner at Dubuque, Iowa, on July 6, 1989.  
 
         A first report of injury was filed in August, 1988.  Filings with 
 
         this agency and the prehearing report reflect that claimant has 
 
         not received workers' compensation benefits relative to this 
 
         claim.
 
         
 
              The record in this proceeding consists of the testimony of 
 
         claimant as well as that of Dennis Primasing, Carol Rounds, and 
 
         Arlene Shanahan, and of joint exhibits 1 through 18 and 20 as 
 
         well as defendants' exhibit 19. Claimant's hearsay objection to 
 
         defendants' exhibit 19 is overruled.  We give only minimum weight 
 
         to defendants' exhibit 19 in that the exhibit appears not to have 
 
         been supplied in its entirety, however.  Both parties submitted 
 
         briefs.
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 2
 
         
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the prehearing report and the oral stipulations 
 
         of the parties at hearing, the parties stipulated that claimant 
 
         received a gross weekly wage of $296.80 and was married and 
 
         entitled to three exemptions at the time of her injury.  They 
 
         further stipulated that claimant left work on March 24, 1986 and 
 
         has not returned, that the provider of medical services would 
 
         testify that the fees were reasonable and that the care was 
 
         reasonable and necessary.
 

 
         
 
 
 
 
 
 
 
 
 
 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Issues remaining to be decided are:
 
         
 
              1. Whether claimant received an injury which arose out of 
 
         and in the course of her employment;
 
         
 
              2. Whether a casual relationship exists between the alleged 
 
         injury and the claimed disability;
 
         
 
              3. Whether claimant is entitled to benefits and the nature 
 
         and extent of any benefit entitlement;
 
         
 
              4. Whether claimant is entitled to payment of certain 
 
         medical costs pursuant to section 85.27 as casually related to 
 
         her alleged injury; and,
 
         
 
              5. Whether defendants are entitled to credit for 
 
         employer-provided benefits pursuant to section 85.38(2).
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              Claimant is married, apparently in her early 30's, and has 
 
         obtained a high school diploma.  She testified she had also had 
 
         some community college training in computers and keyboarding as 
 
         well as on-the-job training for the position of Income 
 
         Maintenance Worker I.  Claimant had previous work experience as a 
 
         store clerk, bartender, waitress and bookkeeper.  She began work 
 
         as an income maintenance worker with the Jackson County 
 
         Department of Human Services on July 16, 1982.  Income 
 
         Maintenance Workers I and II do intake and ongoing case 
 
         supervision of Aid to Dependant Children, Aid to Dependant 
 
         Children, Unemployed Parent, food stamps, county medical care, 
 
         and SSI programs that the Iowa Department of Human Services 
 
         administers.  Jackson County employed four income maintenance 
 
         workers when claimant was hired.  Two of the workers administered 
 
         the various Aid to Dependant Children programs (ADC), another 
 
         performed other duties.  Claimant throughout her tenure with the 
 
         Jackson County department administered the Non-public Assistance
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 3
 
         
 
         
 
         Food Stamp Program (NPAFS).  She also ran the county commodity 
 
         program (cheese program) while the county itself administered 
 
         that program.
 
         
 
              An additional income maintenance worker was hired in 1984.  
 
         Claimant testified that in August 1984 she requested a transfer 
 
         to an ADC slot since the ADC case workers' workload was lighter 
 
         than the non-public assistance food stamp workers' case load.  
 
         She reported that John Dorsey, Director of the Iowa Department of 
 
         Human Services local office in Jackson County, refused her 
 
         request on the ground that the office was going to go "generic" 
 
         in that each income maintenance worker would be trained to 
 
         fulfill all income maintenance worker functions.  The case weight 
 
         for a Jackson County income maintenance worker administering ADC 
 
         programs in August 1984 equalled 226.15.  The case weight for a 
 
         Jackson County income maintenance worker administering non-public 
 
         assistance food stamps in May 1984 equalled 149.6.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant reported that the non-public assistance food stamp 
 
         worker had to collect data concerning and verify all assets and 
 
         expenses of the household seeking food stamps in order to 
 
         determine if the applying household was eligible for stamps.  She 
 
         stated that in July 1982 households once declared eligible were 
 
         certified eligible for a six-month period.  In 1984 the automatic 
 
         benefit calculation system was implemented.  Claimant testified 
 
         that that program required recalculation of each case each month.  
 
         Also in 1984, a new computerized benefit calculation system (the 
 
         ABC system) was implemented.  Claimant stated that the new 
 
         computer "ate" people's identify numbers and therefore closed 
 
         cases which subsequently had to be reopened.  She reported that 
 
         the local economy declined and that that resulted in an increase 
 
         in the number of potential local food stamp recipients.  Claimant 
 
         reported that she had approximately one dozen clients to whom she 
 
         had to make home visits.  She reported that local meetings were 
 
         held for potential farm recipients in March 1986 and that she had 
 
         to process applicants from those meetings as well as deal with 
 
         farmer "walk-in" applicants in February 1986.  Claimant also 
 
         stated that the number of fraudulent food stamp applications 
 
         increased and that she had increased duties regarding 
 
         investigation and testifying as to those cases.
 
         
 
              Claimant reported that she had asked Mr. Dorsey about 
 
         hiring more help and that Mr. Dorsey had said that was not 
 
         possible while the work was being done and that to ask for 
 
         additional help would "make him look bad."  Claimant reported 
 
         that expedited food stamps had to be processed
 
         
 
         
 
         
 
         LICHT-PRIMASING V. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 4
 
         
 
         
 
         immediately, even if the applicant came in at closing time on 
 
         apparently Friday.  She reported that she also had to process 
 
         free hot lunch applications at the beginning of the school year.  
 
         Claimant reported that she investigated alleged fraud and over 
 
         and under issues as well as processed paper work on appeals and 
 
         appeared at appeal hearings.  She reported that she reviewed tax 
 
         returns of self-employed applicants and that such took a 
 
         substantial amount of time and expertise.
 
         
 
              Claimant's case load in July 1982 consisted of 107 actual 
 
         cases with no monthly reporters but for new applicants.  In March 
 
         1986 claimant had 250 actual cases with 187 monthly reporters.  
 
         Claimant testified that Carol Round, an ADC income maintenance 
 
         worker, had 143 actual cases with 83 monthly reporters in March 
 
         1986 and that Arlene Shanahan, another ADC income maintenance 
 
         worker, had 140 actual cases with 78 monthly reporters in March 
 
         1986.  Further testimony and a review of case weight 
 
         documentation in the record reflects that in other months all or 
 
         almost all of the ADC recipients were monthly reporters.  
 
         Likewise, in some months case weights for ADC workers were 
 
         substantially more than case weights for the non-public 
 
         assistance food stamp worker.  Claimant denied that Carol Round 
 
         and Arlene Shanahan had assumed the non-public assistance food 
 
         stamp case load as well as continuing their regular ADC case load 
 
         duties after claimant left her employment.  Claimant stated that 
 
         Barb Teymer, the new ADC income maintenance worker, assisted 
 
         Carol and Arlene.  Claimant agreed that Barb had been on sick 
 
         leave for approximately a month subsequent to her training, but 
 
         denied that it took at least five months to train an income 
 
         maintenance worker.
 

 
         
 
 
 
 
 
 
 
 
 
 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Personnel records in evidence reflect that from May 1985 to 
 
         March 1986, claimant took 250 hours of sick leave. one hundred 
 
         fifty-two of those hours related to surgery she had on her foot.  
 
         Apparently, during that time, a substitute worker from the 
 
         regional office in Davenport did non-public assistance food stamp 
 
         processing.
 
         
 
              Claimant stated that she did not report all overtime 
 
         worked, although all overtime was approved.  She stated that she 
 
         always stayed late and rarely did not work a Saturday or Sunday 
 
         and at times worked both.
 
         
 
              Claimant testified that she developed stress-related 
 
         colitis, migraines, a skin rash, and appetite loss as a result of 
 
         her increased work stress in 1984.  She denied nonwork-related 
 
         stress in that period, although she had
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 5
 
         
 
         
 
         recently remarried, was building a home, and was involved in 
 
         proceedings to terminate her son's natural father's parental 
 
         rights.  Her son apparently was also having medical problems at 
 
         that time.
 
         
 
              Claimant's family physician referred her to Allen D. 
 
         Harves, M.D., a dermatologist, who diagnosed lichen planus.  
 
         Claimant described lichen planus as a red rash with oozing purple 
 
         warts which she developed over her body.  Claimant reported that 
 
         she had to wear loose-fitting clothing and could not leave her 
 
         house on account of this disorder.  Claimant testified that John 
 
         Dorsey sent her to John Curtis, Ph.D, a licensed psychologist 
 
         with the Jackson County Mental Health Center, for work stress 
 
         counseling.  Claimant recited that Dr. Harves advised her to 
 
         leave her job.  Claimant last worked on March 20, 1986 and 
 
         apparently on March 24, 1986 began an unpaid leave of absence.  
 
         Claimant subsequently applied for and received long-term 
 
         disability benefits from the state.  She was denied an extension 
 
         of her unpaid leave of absence since it is not possible to 
 
         receive both long-term disability benefits and the unpaid leave 
 
         of absence from state employment.
 
         
 
              Claimant testified that her lichen planus subsided 
 
         approximately one year after she left state employment and that 
 
         her migraine headaches also gradually subsided.
 
         
 
              Claimant reported that after 1986, her mental condition 
 
         improved, but that she continues to get depressed and have 
 
         anxiety attacks.  She characterized herself as not as outgoing as 
 
         she had been prior to 1984.  Claimant stated that she is ready to 
 
         return to work and stated she had contacted both the local 
 
         Jackson County and the regional Davenport offices of the 
 
         Department of Human Services regarding a work return.  She stated 
 
         that neither office had told her how to report to work.  Her 
 
         classification is as an active nonpaid employee.  She agreed that 
 
         she has received an application from apparently the Iowa 
 
         Department of Personnel for merit rehiring.  Claimant stated she 
 
         was unaware that she was on a preferential hiring list.  She 
 
         agreed that there were three openings for income maintenance 
 
         worker I in the Davenport district, but stated that she did not 
 
         know if she wished to work in Davenport as such would involve 
 
         additional travel as well as hiring a baby-sitter.  Davenport is 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         approximately 42 miles from, claimant's home, apparently in 
 
         Maquoketa.  Dubuque is approximately 33 miles from claimant's 
 
         home.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Dennis Primasing testified that he married claimant on July 
 
         26, 1985 and had known her for approximately three
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 6
 
         
 
         
 
         years prior to their marriage.  He reported that claimant's 
 
         personality changed dramatically in that time.  He reported that 
 
         she gained weight, required additional sleep, and withdrew from 
 
         public activities including grocery shopping subsequent to 
 
         developing her rash.  He reported that claimant worked beyond her 
 
         regular 8:30 a.m. to 5:00 p.m. hours and worked Saturday or 
 
         Sunday or both.
 
         
 
              Carol Round testified that she has worked for the 
 
         Department of Human Services in Jackson County for approximately 
 
         17 1/2 years and became an income maintenance worker I with the 
 
         county in approximately 1974.  In 1988, all county income 
 
         maintenance workers I were upgraded to income maintenance workers 
 
         II, but their duties did not change.  While claimant was employed 
 
         with the Department of Human Services, Round worked as an ADC 
 
         income maintenance worker.  Round reported that the ADC income 
 
         maintenance worker also worked food stamps, child medical 
 
         assistance, the medical needy, and the county general relief 
 
         program.  She testified that each program had its own rules and 
 
         regulations which changed periodically.  The worker had to be 
 
         aware of the rules, the regulations, and the periodic changes.  
 
         The worker had to verify the eligibility of an applicant for each 
 
         program as well as the client's eligibility for multiple 
 
         programs.  Round testified that under the ABC monthly reporting 
 
         system, the client completes a report monthly and the income 
 
         maintenance worker screens the form and acts on any changes.  
 
         Under the ABC system, all income maintenance workers were trained 
 
         as to how to complete the computer forms.  Problems developed as 
 
         a result of the form completers' and the data entry operators' 
 
         need to learn correct computer codes.  Round reported that it 
 
         took several months to master the computer codes and that 
 
         claimant very seldom attended computer training sessions.  Round 
 
         denied having problems with clients disappearing from the 
 
         computer and stated that one could reinstate a computer 
 
         cancellation of a client for lack of timely receipt of the 
 
         monthly report in 10 minutes if one understood the computer.
 
         
 
              Round reported that the ADC worker also had to review 
 
         self-employed clients' tax returns, but that only forms F and G 
 
         needed to be reviewed.  She reported that doing so was not 
 
         difficult since one uses a set formula and.therefore the process 
 
         takes only about 10 minutes.  Such reviews were done on a yearly 
 
         basis with income averaging for the next twelve months.
 
         
 
              Round stated that the ADC application did not automatically 
 
         determine whether the applicant was eligible for other programs.  
 
         She reported that the ADC worker had to
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 7
 
         
 
         
 
         review each program separately and that each program had to have 
 
         separate monthly reporting.  Round characterized public 
 
         assistance programs as more detailed and as having more 
 
         eligibility factors than did [non-public assistance food stamps].  
 
         Round stated that monthly reporting clients had to supply the 
 
         income maintenance worker with information by the fifth or sixth 
 
         of each month and that the worker then had four or five days in 
 
         which to place the data in the computer.  Round agreed that she 
 
         and Arlene Shanahan had picked up claimant's case load while 
 
         claimant was off for her foot problem in that they answered the 
 
         phone and saw claimant's clients, but did not take over the 
 
         actual case load.  She agreed that when claimant left, she and 
 
         Arlene had taken over claimant's case load, each acquiring 
 
         approximately 80-90 cases.  She characterized herself and Arlene 
 
         as "upset" because the case load involved a substantial amount of 
 
         monthly reporters.  She stated that it included only one shut-in 
 
         home visitation case, however.  Round stated that a heavy case 
 
         load for an income maintenance worker was not unusual, but having 
 
         a large block of cases assigned at one time was unusual.
 
         
 
              Round stated that the work stress at the Jackson County 
 
         office was not so unusual while claimant was working that she and 
 
         Arlene could not handle it.  Round reported that she took only 
 
         five hours of overtime [apparently in 1985] and did not work 
 
         nights or weekends.  She reported that she was not required to 
 
         work beyond authorized overtime to make Mr. Dorsey look good.  
 
         She did not notice a personality change in claimant from spring 
 
         1985 to March 1986.  Round agreed that the income maintenance 
 
         worker staff increased to five subsequent to claimant's leaving, 
 
         but denied that such decreased work in that while case loads were 
 
         decreased, each worker then did a better job.
 
         
 
              Arlene Shanahan reported that she has worked in the Jackson 
 
         County office of the Department of Human Services for 
 
         approximately 17 years.  She became an income maintenance worker 
 
         on May 9, 1977.  She did non-public assistance food stamp 
 
         processing from that time to claimant's hire in 1988.  During 
 
         that time, she also did monthly in-office food stamp sales, and 
 
         SSI food stamps.  Shanahan reported that she requested a transfer 
 
         from nonpublic assistance food stamp processing because that job 
 
         had lost its challenge.  Shanahan reported:that income 
 
         maintenance workers were given two hours of daily computer 
 
         training in June 1984 and that by the end of July 1984 things 
 
         were running pretty smoothly relative to the computer.  She 
 
         agreed that monthly reporting in July 1984 increased income 
 
         maintenance workers' work load.  She
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 8
 
         
 
         
 
         reported that a heavy case load is to be expected for an income 
 
         maintenance worker.  She stated she never sought medical care or 
 
         took a leave of absence or time off because of stress during 
 
         claimant's employment.  She could recall no other income 
 
         maintenance worker doing so.  Shanahan opined that medical 
 
         assistance programs with public assistance were the most 
 
         difficult since they involved a variety of programs, each with 
 
         different rules.  Shanahan reported that she had never lost a 
 
         client in the computer and stated that a client can be cancelled 
 
         and reinstated in the computer within minutes.
 
         
 
              John Dorsey testified by way of his deposition taken June 
 
         23, 1989.  Dorsey has been director of the Jackson County office 
 
         of the Iowa Department of Human Services for eight years.  Dorsey 
 
         discussed income maintenance worker case load and case weight.  
 
         He characterized as incorrect the statement that the non-public 
 
         assistance food stamp worker would process a lot more applicants 
 
         than would the ADC food stamp worker.  He reported that the case 
 
         weight for the non-public assistance food stamp worker was 
 
         probably fair at the time that such case weight was established 
 
         by committee in Des Moines.  Dorsey agreed that prior to hiring 
 
         the fifth income maintenance worker, the case weight for ADC 
 
         workers was consistently higher than the case weight for 
 
         non-public assistance food stamp workers.  He reported that he 
 
         did not feel a need to hire another income maintenance worker 
 
         after Barbara Teymer was hired in 1985 since the average case 
 
         weight in the county did not justify an additional hiring.
 
         
 
              Dorsey testified that monthly reporting was neither more 
 
         nor less difficult for the non-public assistance food stamp 
 
         worker than for ADC workers, but that monthly reporting did 
 
         increase the work load for all income maintenance workers by 10 
 
         to 15 percent.  Dorsey characterized eligibility for non-public 
 
         assistance food stamps as being a function of monthly income and 
 
         household size.  Changes in either of those would be reported 
 
         monthly with monthly reporting.  He stated that approximately 80 
 
         percent of non-public assistance food stamp cases were on monthly 
 
         reporting.  Documents concerning case weights and monthly 
 
         reporting were reviewed in the course of the deposition.  It 
 
         appears that all but two or three cases for each worker were on 
 
         monthly reporting.  He agreed that subsequent to Barbara Teymer's 
 
         hire as a third ADC worker and subsequent to her approximately 
 
         two months' sick leave and several months' training the case 
 
         weight for the other ADC workers decreased.  Dorsey stated that 
 
         the work load for income maintenance workers was always such that 
 
         any
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Page 9
 
         
 
         
 
         compensatory time acquired by working additional hours in one 
 
         period could be taken as requested.  Dorsey reported that from 
 
         July 1985 to March 1986, Carol Round had taken 5 hours overtime; 
 
         Arlene Shanahan had taken 8.75 hours overtime; and, claimant had 
 
         taken 17 hours overtime.
 
         
 
              Mr. Dorsey substantiated that only a couple of nonpublic 
 
         assistance food stamp clients required home visits and stated 
 
         that claimant had never had a case load of 300-400 cases.  Dorsey 
 
         stated that in fraud investigations, the income maintenance 
 
         worker gathers information from the client's file and makes 
 
         copies of that information.  He reported that the income 
 
         maintenance worker may have to testify at hearings also.  He 
 
         denied that fraud investigations had at least doubled and that 
 
         there had been a substantial increase in the number of hearings 
 
         that the income maintenance worker would need to attend.  Dorsey 
 
         stated that each income maintenance worker had one basket for 
 
         mail and always had only one basket for mail.  Dorsey did not 
 
         recall Round and Shanahan being upset when claimant's case load 
 
         was split between them.  Dorsey stated that ADC workers start 
 
         with the most inclusive program for which an applicant may be 
 
         eligible and work down to the least inclusive program, including 
 
         non-public assistance food stamps.  Dorsey reported that Round 
 
         and Shanahan took applications, did interviews, processed the 
 
         interviews, and determined client eligibility regarding the 
 
         farmers, meeting.  He reported that while income maintenance 
 
         workers who processed ADC clients had a tape which their clients 
 
         reviewed, that the income maintenance worker also talked with 
 
         each applicant at the time of the application.  Claimant had 
 
         stated that she had to talk to her applicants whereas the income 
 
         maintenance workers dealing with ADC applicants had only to 
 
         request that the applicant review the tape.
 
         
 
              Dorsey could not recall any other income maintenance worker 
 
         filing a workers' compensation claim, taking a leave of absence, 
 
         being hospitalized, or being off the job on account of 
 
         job-related stress.  Dorsey did state that at times the stress on 
 
         the income maintenance workers was very extraordinary for all the 
 
         workers, however.
 
         
 
              Dorsey stated that claimant had informed him of her lichen 
 
         planus and that she was seeing Dr..Curtis in December 1985.  He 
 
         reported that it was not apparent that claimant had any physical 
 
         problems before that time.  Dorsey stated that claimant told him 
 
         her lichen planus was stress related.  He reported he had no 
 
         reason to doubt claimant was under a great deal of stress at work 
 
         and he took her statement in
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 10
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         that regard at face value.  Dorsey stated that he and claimant 
 
         had no other conversations regarding her lichen planus disorder 
 
         until claimant applied for her leave of absence in March 1986.  
 
         Dorsey denied he had suggested to any of his staff members that 
 
         they see Dr. Curtis for stress-related counseling.  He reported 
 
         he was unaware of nonwork-related stressors in claimant's life 
 
         and stated claimant had never told him she had daily migraines or 
 
         colitis while she was an income maintenance worker.
 
         
 
              Non-medical documentary exhibits in evidence reflect the 
 
         following:
 
         
 
              Claimant received monthly long-term disability benefits of 
 
         $771.68 apparently beginning March 22, 1986 with a last benefit 
 
         payment on June 20, 1987.  Claimant received payment for her 
 
         medical costs through Blue Cross/Blue Shield.  Blue Cross/Blue 
 
         Shield advised claimant that if she received a workers' 
 
         compensation award, credit must be given for Blue Cross/Blue 
 
         Shield payments.  From August 12, 1982 through March 20, 1986, 
 
         claimant worked 107.73 hours of overtime.  Claimant worked 60 
 
         hours of overtime prior to June 1, 1984 and 47.73 hours of 
 
         overtime subsequent to June 1, 1984.  From July 5, 1985 through 
 
         March 27, 1986, claimant took 102.75 hours of vacation leave.  
 
         From May 20, 1985 through March 27, 1986, claimant took 250.55 
 
         hours of sick leave.  Non-public assistance food stamp workers 
 
         average monthly case weight was lower than the ADC workers to 
 
         October 1984 and then was higher through June 1985; from July 
 
         1985 through October 1985, the ADC worker had greater case 
 
         weights.  In November and December 1985, the non-public 
 
         assistance food stamp worker's case weight was only slightly 
 
         higher than the ADC worker's.  In January 1986, the nonpublic 
 
         assistance food stamp worker's case weight was 27.67 points 
 
         higher than the ADC worker's; in February 1986 the non-public 
 
         assistance food stamp worker's case weight was 19.87 points 
 
         higher than the ADC worker's.
 
         
 
              Claimant's resume recites that claimant is able to work 
 
         well under pressure, stress and time frames or deadlines.
 
         
 
              The Manual of Skin Diseases, Fifth Edition, Gordon C. 
 
         Sauer, M. D., author, at page 144 recites that the etiology of 
 
         lichen planus is unknown, but that the condition is rather 
 
         frequently associated with nervous or emotional upsets.
 
         
 
              Exhibit 19, a portion of an article entitled "Relation of 
 
         Stress and Anxiety to Oral Lichen Planus," states:
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 11
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
              These findings do not appear to support the concept that 
 
              lichen planus is a condition that is seen in persons who are 
 
              more anxious than normal or who have been under unusually 
 
              high levels of stress.  Of course, this does not rule out 
 
              the possibility that a certain segment of the population may 
 
              be more susceptible to the development of lichen planus and 
 
              that in these persons the disease may be initiated by a 
 
              degree of stress that would not cause the disorder in the 
 
              remainder of the population.
 
         
 
              The first and last page of the article only were available 
 
         for review.
 
         
 
              Exhibit 20 documents claimant's medical bills and costs.
 
         
 
              Claimant's medical progress notes apparently with R. M. 
 
         Hamilton, D.O., her family physician, were reviewed in their 
 
         entirety.  Claimant was treated for a condition diagnosed as 
 
         eczema in spring and summer 1983.  Headaches were reported on 
 
         July 18, 1983.  At approximately that time, claimant had a rash 
 
         under her left arm which was quite exudative and sore.  It 
 
         appeared to be an allergic dermatitis.  On February 22, 1984, 
 
         claimant had infected cysts in the buttocks.  It was reported 
 
         that she had had cysts on the buttocks previously.  On February 
 
         24, 1984, a pilonidal sinus abscess was incised and drained.  On 
 
         April 3, 1984, claimant reported stress at work.  Stress, 
 
         headaches and eczema were diagnosed.  Chronic headache was 
 
         reported on December 5, 1984.  On February 14, 1985, facial 
 
         lesions consisting of a few inflamed follicles probably due to 
 
         makeup were diagnosed.  On July 1, 1985, claimant's eczema was 
 
         characterized as acting up a little bit with such perhaps related 
 
         to stress.  On September 18, 1985, claimant complained of 
 
         recurrent worsening eczema and of "quite a bit of" stress at 
 
         work.  On January 20, 1986 claimant reported headaches and rash.  
 
         On May 14, 1986, claimant was reported as having been off work 
 
         due to lichen planus.  The assessment was of stress, associated 
 
         lichen planus and headaches.  Migraines were reported on August 
 
         18, 1986.  On December 23, 1986, claimant complained of open 
 
         cysts underneath her breasts which were draining and painful.  An 
 
         undated note subsequent to March 19, 198.7 reports that claimant 
 
         has headaches chronically and that these seem to be related to 
 
         stress and anxiety.  Claimant is reporting that she has panic 
 
         attacks, is anxious, has depressive symptoms and is tearful at 
 
         times.  It is noted that claimant attributes her anxiety and 
 
         depression to stress and work
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 12
 
         
 
         
 
         load from.when she was working at social services.  It is 
 
         reported that claimant states she saw many individuals and 
 
         families whom she felt needed assistance, but who were declined 
 
         due to small quirks in the rules.  Claimant is reported as 
 
         stating that she at times still thinks about the cases and 
 
         individual problems from when she was employed.  It is stated 
 
         that claimant has had intermittent problems with pleuritis of the 
 
         skin and itching diagnosed as lichen planus and that this flared 
 
         when her job stress increased.  Migraine headaches were reported 
 
         on November 20, 1987.  On January 21, 1988, claimant complained 
 
         of sores on her breasts.  On March 3, 1988, claimant continued to 
 
         have a lot of headaches.  On July 19, 1988, infrequent headaches 
 
         of several days' duration were reported.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Medical Associates Clinic of Dubuque's progress notes of 
 
         claimant with Drs. Stabenow, Harves, Zoltani and Whitis were 
 
         reviewed in their entirety.  An October 2, 1985 note reported 
 
         that claimant is a social worker under much stress.  On October 
 
         25, 1985, it is reported that claimant's lichen planus seems to 
 
         be spreading to her abdomen, arms, and face.  On March 5, 1986, 
 
         claimant was advised to take an extended leave of absence from 
 
         work as a result of job stress.  On April 2, 1986, claimant's 
 
         lichen planus was reported as no better, even though she has been 
 
         off work one week.  The reporter states that because of refusal 
 
         of compensation, claimant still has much stress.  On June 4, 
 
         1986, it was reported that claimant's lichen planus is 80 percent 
 
         better today.  It.was reported that claimant increased her 
 
         medication approximately two and one-half weeks earlier and had 
 
         been better until approximately three and one-half weeks earlier 
 
         when claimant found out she was going to court on her workers' 
 
         compensation [claim] and the lichen planus became much worse.  On 
 
         August 6, 1986, claimant's lichen planus was reported as good 
 
         with two or three small lesions only.  On September 3, 1986, it 
 
         was reported that claimant was developing some itching at night 
 
         on the arms and lower legs, but no gross lesions at present.  She 
 
         was generally doing fairly well and was to return to work in 
 
         October.  A September 10, 1986 medical note of Dr. Zoltani 
 
         indicates claimant has had headaches over the last ten years 
 
         approximately two or three times per year, but that approximately 
 
         six months ago the headaches increased in frequency.  The 
 
         reporter states that claimant had a work leave of absence and did 
 
         well, but has now returned to work with a recurrence of headaches 
 
         from eight hours to three days [in duration].
 
         
 
              A February 4, 1986 medical report of Dr. Harves states that 
 
         claimant's lichen planus has become very severe over
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 13
 
         
 
         
 
         the last two months due to increased stress in the work place.  
 
         The doctor states that "stress activation and exacerbation of 
 
         this disease is well documented."
 
         
 
              On April 13, 1987, Dr. Harves reported that claimant's 
 
         current diagnosis was: (a) lichen planus which appeared to be 
 
         resolving; (b) cholinergic urticaria; (c) irritant dermatitis of 
 
         the buttocks; (d) intertrigo; and, (e) folliculitis of the chest.  
 
         Dr. Harves then stated that the lichen planus appeared to be 99 
 
         percent resolved and that the only way to know whether work 
 
         stress would reexacerbate the condition would be for claimant to 
 
         return to work.  The doctor reported that lichen planus usually 
 
         has a six-month to three-year duration and then resolves in 90 
 
         percent of patients.  On June 1, 1989, Dr. Harves reported that 
 
         the causative etiology of lichen planus is unknown at this time, 
 
         but that present thought is that the disease is immunologic in 
 
         nature, that is, an allergic reaction of sorts involving antigen 
 
         antibody reactions without a known trigger.  The doctor stated 
 
         that none of the major dermatologic texts mentioned stress as a 
 
         causative factor [in lichen planus] and that none of the texts 
 
         talked about aggravating factors.  He stated that with many other 
 
         skin disorders, stress appears to play a large role in 
 
         aggravating and exacerbating the condition.  As regards permanent 
 
         disability, Dr. Harves reported that in uncomplicated cases of 
 
         lichen planus, once the disease resolves there are no more 
 
         problems.  On June 8, 1989, Dr. Harves stated that considering 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         that lichen planus can be aggravated by stress and that 
 
         claimant's job produced much stress, he opined claimant's work 
 
         place played a great tole in aggravating her lichen planus.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              John D. Curtis, Ph.D., a licensed psychologist, reported 
 
         that claimant was seen initially on January 9, 1986 and on five 
 
         subsequent visits for work stress counseling.  Claimant's 
 
         reported complaints were consistent with her testimony at 
 
         hearing.  Dr. Curtis' impression was that claimant suffered an 
 
         atypical somataform disorder brought about and directly related 
 
         to the psychological stress she encountered in her work 
 
         situation.  The doctor reported that claimant admitted the work 
 
         situation was out of control and agreed that unless she obtains 
 
         significant work relief, it will be difficult for her to manage 
 
         her stress and that she may require a leave of absence.  On April 
 
         11, 1986, Dr. Curtis reported claimant was seen for work stress 
 
         which he believed "is attributed to atypical somataform disorder 
 
         and lesion of lichen planus.  On September 6, 1988, Dr. Curtis 
 
         reported that claimant was seen again on March 20, 1987 with 
 
         complaints of a combination of anxiety and depressive features 
 
         including panic anxiety attacks, loss of short-term
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 14
 
         
 
         
 
         memory, disruptive sleep and appetite and low energy levels, 
 
         sensitivity to physical appearance while seeking employment, and 
 
         loss of sense of self-confidence.  Claimant apparently was 
 
         counseled to look at what triggered her feeling of stress 
 
         including her feelings of inferiority and her feeling that she 
 
         has to perform perfectly in a given situation.  Dr. Curtis then 
 
         felt claimant was experiencing an adjustment disorder with mixed 
 
         emotional features.
 
         
 
              Robert E. Smith, M.D., saw claimant for psychiatric 
 
         assessment on May 3, 1989.  As part of the assessment, medical 
 
         records were reviewed.  In a June 19, 1989 report, he stated the 
 
         following diagnostic impressions:
 
         
 
              Axis I: Dysthymic disorder with concurrent anxiety symptoms 
 
         resolved.
 
         
 
              Axis II: Deferred.  Dramatic and histrionic traits noted.
 
         
 
              Axis III: Obesity, lichen planus, resolved; Histories of 
 
         urticaria, irritant dermatitis, intertrigo and folliculitis per 
 
         Dr. Harves; and migraine headaches.
 
         
 
              Dr. Smith stated the following,
 
         
 
              The patient's inherent psychological makeup places her at 
 
              great risk for coping poorly with any level of stress.  From 
 
              a psychological standpoint, her stress related symptoms will 
 
              primarily be depressive in nature, but transient anxiety 
 
              symptoms may also occur.  The patient's dysthymic symptoms 
 
              occurred from 1985 through well into 1987.  The patient 
 
              focuses on the stress related to work.  However, it should 
 
              be noted that much of her withdrawn behavior and tendency to 
 
              socially isolate was a direct effect of the lichen planus 
 
              condition.  Stresses from her family are excluded by the 
 
              patient as contributing, but I must suspect that some 
 
              contribution was present.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
              Dr. Smith stated that review of the records available to 
 
         him as well as his interview with claimant did not reveal the 
 
         level of stress present in the work setting to be extraordinary.  
 
         He opined that claimant's development of symptoms should not be 
 
         viewed as a direct extension of the level of stress, but that 
 
         more plausibly claimant's inherent psychological status placed 
 
         her at great risk for coping poorly with any level of stress such 
 
         that when multiple factors including medical conditions occurred
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 15
 
         
 
         
 
         simultaneously, the development of the psychological symptoms 
 
         escalated.  He stated that clearly claimant's perceived stress 
 
         were having some contribution to the treatment resistant quality 
 
         of her lichen planus, but felt it inappropriate to view the work 
 
         stress as the sole etiological agent for her dermatological 
 
         condition.  He expressed his understanding that current 
 
         dermatological thinking attributes only a small portion of the 
 
         etiology of lichen planus to stress and its resultant 
 
         physiological changes.
 
         
 
              Dr. Smith reported that at the time of the psychiatric 
 
         interview, claimant had had resolution of both the lichen planus 
 
         and the dysthymic disorder.  Claimant then felt she probably had 
 
         been ready to return to work since some time in 1988.  Dr. Smith 
 
         saw claimant as at risk for a return of psychological symptoms 
 
         because of her inherent poor coping skills.  He expressed his 
 
         belief that because of claimant's tendency to be histrionic and 
 
         dramatic, any symptoms both psychological and physical that are 
 
         present will be overreported and embellished with a severity that 
 
         they do not possess.  Dr. Smith opined that claimant's 
 
         psychological and dermatological symptoms were only minimally 
 
         related to work stress.  He could not determine that that stress 
 
         was out of the ordinary and stated that the primary etiology of 
 
         her psychological symptoms is a life-long 
 
         psychologic/characterologic propensity to cope poorly with any 
 
         and all stresses.
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              Initially, claimant contends she received an injury which 
 
         arose out of and in the course of her employment.
 
         
 
              Claimant has the burden of proving by a preponderance of 
 
         the evidence that she received an injury 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).
 
         
 
              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).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The words "in the course of" refer to the time and place 
 
         and circumstances of the injury.  McClure v. Union et al.  
 
         Counties, 188 N.W.2d 283 (Iowa 1971) ; Crowe v. DeSoto Consol. 
 
         Sch. Dist., 246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 16
 
         
 
         
 
              The additional requirement that the injury arise out of the 
 
         employment relates to the cause and origin of the injury.  
 
         McClure v. Union et al.  Counties, 188 N.W.2d 283, 287 (Iowa 
 
         1971).  The "arising out of" requirement is satisfied by showing 
 
         a casual relationship between the employment and the injury.  
 
         Sheerin v. Holin Co., 380 N.W.2d 415 (Iowa 1986); Musselman v. 
 
         Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              The question of casual connection is essentially within the 
 
         domain of expert testimony.  Bradshaw v. Iowa Methodist Hosp., 
 
         251 Iowa 375, 101 N.W.2d 167 (1960).  A possibility is 
 
         insufficient; a probability of causation is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).
 
         
 
              However, expert medical evidence must be considered with 
 
         all other evidence introduced bearing on the casual connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone Co.
 
         , 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              A treating physician's testimony is not entitled to greater 
 
         weight as a matter of law than that of a physician who later 
 
         examines claimant in anticipation of litigation.  Weight to be 
 
         given testimony of physician is a fact issue to be decided by the 
 
         industrial commissioner in light of the record the parties 
 
         develop.  In this regard, both parties may develop facts as to 
 
         the physician's employment in connection with litigation, if so; 
 
         the physician's examination at a later date and not when the 
 
         injuries were fresh; his arrangement as to compensation; the 
 
         extent and nature of the physician's examination; the physician's 
 
         education, experience, training, and practice; and all other 
 
         factors which bear upon the weight and value of the physician's 
 
         testimony.  Both parties may bring all this information to the 
 
         attention of the factfinder as either supporting or weakening the 
 
         physician's testimony and opinion.  All factors go to the value 
 
         of the physician's testimony as a matter of fact not as a matter 
 
         of law.  Rockwell Graphic Systems, Inc. v. Prince, 366 N.W.2d 
 
         176, 192 (Iowa 1985).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         LICHT-PRIMASING V. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 17
 
         
 
         
 
              An expert's opinion based on an incomplete history is not 
 
         necessarily binding on the commissioner, but must be weighed with 
 
         other facts and circumstances.  Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 360, 154 N.W.2d 128, 133 (1967).
 
         
 
              When an aggravation occurs in the performance of an 
 
         employer's work and a casual connection is established, claimant 
 
         may recover to the extent of the impairment.  Ziegler v. United 
 
         States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591, 595 (1960).
 
         
 
              A cause is proximate if it is a substantial factor in 
 
         bringing about the result.  It need be only one cause of the 
 
         result; it need not be the only cause.  Blacksmith v. 
 
         All-American, Inc., 290 N.W.2d 348, 354 (Iowa 1980).
 
         
 
              The work incident or activity need not be the sole 
 
         proximate cause if the injury is directly traceable to it. Holmes 
 
         v. Bruce Motor Freight, Inc., 215 N.W.2d 296, 297 (Iowa 1974).
 
         
 
              This agency has adopted the "Wisconsin Rule" of 
 
         compensability for psychological injuries as expressed in Swiss 
 
         Colony, Inc. v. Dept of Ind., L. & H. Rel., 240 N.W.2d 128 (Wisc. 
 
         1976) and in School Dist. No. 1 v. Dept of Ind., L. & H. Rel., 
 
         215 N.W.2d 373 (Wisc. 1974); Schreckengast v. Hammer Mills, Inc., 
 
         IV Iowa Industrial commissioner Report 305 (App. Decn. 1983).  
 
         Summarily stated, compensation for psychological injury resulting 
 
         from psychological or mental stress can be awarded where 
 
         proximate cause is shown and also where the psychological stress 
 
         results from situations of greater dimension than the day-to-day 
 
         mental stresses-which all employees must experience by virtue of 
 
         being employed.
 
         
 
              The Iowa court has declined to adopt a standard for 
 
         compensability of psychological injury, but in the case of Newman 
 
         v. John Deere Ottumwa Works of Deere & Co., 372 N.W.2d 199 (Iowa 
 
         1985), it declined to award benefits where there was clear 
 
         psychological injury, but where the employment setting only 
 
         provided the stage or setting in which the psychological 
 
         condition arose.  The court specifically held that imaginary 
 
         trauma cannot be the proximate cause of a compensable injury..
 
         
 
              Defendants argue that this case ought to be treated as a 
 
         purely mental-mental case and that for that reason the "Wisconsin 
 
         Rule" is controlling.  Defendants' point is not altogether well 
 
         taken in that claimant is claiming both
 
         
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         LICHT-PRIMASING V. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 18
 
         
 
         
 
         psychological damage by way of anxiety and depression and 
 
         physical damage as a manifestation of the psychological damage by 
 
         way of allegations of headache, colitis, and a dermatological 
 
         condition, lichen planus.  We believe the "mental-mental" and the 
 
         "mental-physical" aspects of claimant's claim must each be 
 
         addressed separately.
 
         
 
              We shall first address claimant's claim of pure mental 
 
         damage.  In addressing that claim, it appears appropriate to use 
 
         the Swiss Colony rule.  Claimant, her direct supervisor, and two 
 
         other income maintenance workers testified concerning the job 
 
         duties of income maintenance workers during the period of 
 
         claimant's employment.  The described duties of an Income 
 
         Maintenance Worker I might well have been stressful, even though 
 
         claimant's coworkers appeared to be able to handle their duties 
 
         without the degree of difficulty which claimant testified to 
 
         having.  The stress of being an Income Maintenance Worker I may 
 
         have been of a greater dimension than that of the day-to-day 
 
         mental stressors which all employees must experience by virtue of 
 
         being employed.  We find that irrelevant, however, in that 
 
         claimant has not shown the requisite medical causation between 
 
         her alleged psychological conditions of anxiety and depression 
 
         and her work environment.  Dr. Smith was the only medical 
 
         psychiatric expert.  Dr. Smith opined that his interview with 
 
         claimant did not reveal the level of stress present in the work 
 
         setting to be extraordinary.  He further opined that claimant's 
 
         development of symptoms should not be viewed as a direct 
 
         extension of the level of stress, but that claimant's inherent 
 
         psychological status placed her at greater risk for coping poorly 
 
         with any level of stress.  He felt the primary etiology of her 
 
         psychological symptoms was a life-long 
 
         psychologic/characterologic propensity to cope poorly with any 
 
         and all stresses.  The doctor further expressed his belief that 
 
         because of claimant's tendency to be histrionic and dramatic, any 
 
         symptoms both psychological and physiological would be 
 
         overreported and embellished with a severity that they did not 
 
         possess.  Claimant's demeanor at hearing was consistent with the 
 
         demeanor of other claimant's who the undersigned has observed and 
 
         who have been medically described as histrionic.  She did report 
 
         substantially more severe and substantially more serious work 
 
         stressors than did her two coworkers.  Her characterizations of 
 
         her direct supervisor were significantly different and more 
 
         negatively focused than were the characterizations of her two 
 
         coworkers.  Indeed, claimant's characterizations of her direct 
 
         supervisor appeared uncharacteristic of that gentleman, given his 
 
         own testimony.  The direct supervisor, Mr. Dorsey, in his own 
 
         deposition testimony appeared to be direct, straightforward,
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Page 19
 
         
 
         
 
         evenhanded and fair.  He did indeed acknowledge the potential for 
 
         stress on his workers, but appeared to have a rational concern 
 
         for them and to have taken appropriate steps, including the 
 
         hiring of an additional income maintenance worker in order to 
 
         reduce those stressors.  That fact as well as inconsistencies 
 
         between claimant's testimony as to her work duties and 
 
         responsibilities and the testimony of her coworkers as to work 
 
         duties and responsibilities suggests that claimant is indeed not 
 
         credible and does overly embellish and dramatize her life 
 
         situation.  That fact makes claimant's statements to her other 
 
         physicians and to John Curtis, Ph.D., the licensed psychologist 
 
         with whom she visited on six occasions in 1986, suspect.  We note 
 
         initially that Dr. Curtis is a licensed psychologist and is not a 
 
         physician qualified to render causation testimony.  We note, 
 
         however, that in 1986, Dr. Curtis felt that claimant suffered an 
 
         atypical somataform disorder brought about and directly related 
 
         to the psychological stress she encountered in her work 
 
         situation.  Curiously, however, claimant returned to see Dr. 
 
         Curtis on March 20, 1987 with complaints of a combination of 
 
         anxiety and depressive features.  Claimant was not then working 
 
         as an income maintenance worker.  At that time, Dr. Curtis 
 
         reported counseling claimant to look at what triggered her 
 
         feelings of stress including her feelings of inferiority and her 
 
         feelings that she had to perform perfectly in a given situation.  
 
         While Dr. Curtis is as noted not a medical expert, the 
 
         discrepancy between his report and opinion in 1986 and his report 
 
         and opinion relative to the March 20, 1987 visitation supports 
 
         Dr. Smith's view that claimant's primary etiology for her 
 
         psychological symptoms is her life-long propensity to cope poorly 
 
         with any and all stresses.  Also the fact that claimant remained 
 
         in a state of psychological stress almost a year after leaving 
 
         the allegedly excessively stressful work environment and the fact 
 
         that claimant identified different stressors at that 
 
         time--sensitivity to physical appearance while seeking employment 
 
         and loss of self-confidence--suggests that a stressful reaction 
 
         is typical of claimant and not necessarily reflective of the 
 
         inherent nature of the situation in which she finds herself.  
 
         Other items also suggest that while claimant may identify sources 
 
         of stress, she does not necessarily actually experience stress 
 
         from those sources.  Subsequent to March 19, 1987, claimant 
 
         reported to her family physician that she was having panic 
 
         attacks, was anxious and had depressive symptoms and was tearful 
 
         at times.  Claimant attributed her anxiety and depression to 
 
         stress and workload from when she was working at social services.  
 
         Claimant's family doctor reported claimant as stating she saw 
 
         many individuals and families whom she felt needed assistance, 
 
         but who were
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 20
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         declined assistance due to small quirks in the rules.  Claimant 
 
         is reported as stating that at times she still thought about 
 
         those cases and problems.  It is curious that neither Dr. Curtis 
 
         nor Dr. Smith report claimant as attributing her anxiety and 
 
         depression after she left work in March 1986 to continuing 
 
         concern with individuals whose claims she processed while 
 
         working.  It is also curious that claimant never testified at 
 
         hearing to her anxiety, depression and stress at work being 
 
         attributable to those concerns.  That lack of consistency in 
 
         claimant's stated reality supports Dr. Smith's diagnosis.  We 
 
         find that claimant has not shown that her work as an income 
 
         maintenance worker for the Iowa Department of Human Services 
 
         produced her psychological symptoms.  At best, as in Newman v. 
 
         John Deere, claimant's work setting was merely a stage, among 
 
         others, in which her psychological condition manifested itself.
 
         
 
              We now consider whether claimant's work stress produced her 
 
         alleged physical symptoms of headache, colitis, and lichen 
 
         planus.
 
         
 
              Initially, there is no medical evidence supporting 
 
         claimant's allegation that her colitis and her headaches resulted 
 
         from work stress.  Indeed, Dr. Zoltani's September 10, 1986 
 
         report that claimant had had a leave of absence and did well as 
 
         regards her headaches until returning to work with a recurrence 
 
         of headaches from eight hours to three days [in duration] is 
 
         simply not in keeping with the evidence.  There is no indication 
 
         that claimant ever returned to work after her March 24, 1986 
 
         leave of absence.  Hence, Dr. Zoltani's report is an inaccurate 
 
         history and claimant's attribution of her headaches to her work 
 
         situation must be looked at askance and considered relative to 
 
         her overall lack of credibility as a reporter.
 
         
 
              Our only remaining consideration is whether claimant's 
 
         lichen planus resulted from work-related stress.  Dr. Harves was 
 
         claimant's treating dermatologist.  Dr. Harves in essence has 
 
         said that other similar dermatological conditions are reported as 
 
         stress related in medical literature and that therefore he 
 
         attributes claimant's lichen planus to stress.  He further 
 
         attributes the lichen planus to work stress.  Dr. Smith, a 
 
         psychiatrist, reported that clearly claimant's perceived stress 
 
         was having some contribution to the "treatment resistant quality" 
 
         of her lichen planus, but opined it was inappropriate to view 
 
         work stress as the sole etiological agent of the condition.  Dr. 
 
         Smith believed that current dermatological thinking attributed 
 
         only a small portion of the etiology of the
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES 
 
         Page 21
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         lichen planus to stress and its resultant physiological changes.  
 
         We believe it appropriate to defer to Dr. Harves as regards the 
 
         etiology of dermatological disorders.  We, on the other hand, 
 
         believe it appropriate to again defer to Dr. Smith as regards the 
 
         etiology of stress disorders.  Dr. Smith, as a psychiatrist, is 
 
         in a better position than Dr. Harves to assess the 
 
         appropriateness of claimant's perceptions of the stressors 
 
         affecting her.  As noted above, Dr. Smith does not believe that 
 
         claimant's description of her stress and her stressors can be 
 
         given great validity.  That fact seriously discounts the weight 
 
         to be given to Dr. Harves' opinion that claimant's work stressors 
 
         produced her lichen planus.  As claimant cannot be found to be a 
 
         credible historian as regards the level of work stress to which 
 
         she was exposed, we do not find that claimant has established 
 
         that her lichen planus related to her work stress.
 
         
 
              For all the above reasons, claimant has not shown an injury 
 
         arising out of and in the course of her employment on March 24, 
 
         1986.  As claimant has failed to establish this threshold issue, 
 
         we need not consider the other issues presented.  We note in 
 
         passing, however, that even had claimant established an injury 
 
         and the requisite casual connection between the injury and 
 
         claimed disability, claimant's benefit entitlement would have 
 
         been for temporary total disability only.  The record does not 
 
         establish any permanent condition as a result of claimant's 
 
         resolved dermatologic and dysthymic disorders.  As of April 13, 
 
         1987, Dr. Harves.stated that claimant's lichen planus appeared to 
 
         be 99 percent resolved.  The doctor further reported that lichen 
 
         planus usually has a six month to three year duration and then 
 
         resolves in 90 percent of patients.  Hence, the condition appears 
 
         to be largely self-limiting.  On April 13, 1987, Dr. Harves also 
 
         reported that the only way to know whether work stress would 
 
         reexacerbate the condition would be for claimant to return to 
 
         work.  The statements as to resolution of the lichen planus and 
 
         the possibility of work return suggest that claimant reached 
 
         maximum medical improvement as regards the lichen planus on April 
 
         13, 1987.  Claimant's psychological condition as manifested in 
 
         purely mental symptoms simply does not appear to be in any manner 
 
         work related.  Hence, at best claimant would have been entitled 
 
         to temporary total disability benefits through April 13, 1987 on 
 
         account of her lichen planus.
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES
 
         Page 22
 
         
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, IT IS FOUND:
 
         
 
              Claimant began work as an income maintenance worker with 
 
         the Jackson County Department of Human Services on July 16, 1982.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
              Income maintenance workers do intake and ongoing case 
 
         supervision of Aid to Dependent Children (ADC), ADC Unemployed 
 
         Parent, food stamp, county medical care and SSI programs that the 
 
         Iowa Department of Human Services administers.
 
         
 
              Claimant administered the food stamp program while employed 
 
         as an income maintenance worker.
 
         
 
              Two other income maintenance workers administered the ADC 
 
         programs; a fourth and final worker performed other, duties.
 
         
 
              A fifth worker was hired also to administer ADC programs in 
 
         1985.  Case weights did not justify hiring a sixth worker.  The 
 
         fifth worker required training and was off work for substantial 
 
         sick leave.  All workers were then to be trained in all income 
 
         maintenance worker duties.
 
         
 
              Due to a decline in the local economy and implementation of 
 
         a state-wide monthly reporting computer system in July 1984, all 
 
         income maintenance workers had heavy case loads and at times 
 
         worked under stress greater than that to which they might have 
 
         been subject in non-employment life.
 
         
 
              Claimant developed lichen planus and became anxious and 
 
         depressed.
 
         
 
              Claimant also had headaches, colitis and appetite loss.
 
         
 
              While employed as an income maintenance worker, claimant 
 
         remarried, built a home and sought termination of her son's 
 
         natural father's parental.rights.  Her son had medical problems 
 
         as well.
 
         
 
              Claimant attributed her physical condition and her anxiety 
 
         and depression to stress resulting from her work as an income 
 
         maintenance worker.
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES
 
         Page 23
 
         
 
         
 
              Claimant last worked as an income maintenance worker on 
 
         March 20, 1986 and began unpaid leave of absence on March 24, 
 
         1986.
 
         
 
              Dr. Robert Smith was the only psychiatrist to evaluate 
 
         claimant.
 
         
 
              Claimant has histrionic and dramatic traits.  She 
 
         over-reports and embellishes both psychological and physical 
 
         symptoms with a severity they do not possess.
 
         
 
              Claimant's testimony regarding the level of work, degree of 
 
         hardship and extent of stress to which she was subject as an 
 
         income maintenance worker differed substantially from the 
 
         testimony of two other income maintenance workers and from that 
 
         of the Jackson County Human Services Office Director.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant reported a significantly greater workload, more 
 
         difficult work conditions and substantially more factors likely 
 
         to produce stress than did the above named other three 
 
         individuals.
 
         
 
              Claimant was a less credible witness than were her fellow 
 
         workers or her office director.
 
         
 
              Claimant's medical histories are suspect.  They reflect her 
 
         self-reports of significant work stress without regard to her 
 
         histrionic and dramatic traits and her related propensity to 
 
         over-report and embellish symptoms presented.
 
         
 
              Claimant's inherent psychological makeup places her at 
 
         great risk for coping poorly with any level of stress.
 
         
 
              Claimant's limited ability to copy with any stress may have 
 
         contributed to the development of her lichen planus.  Her reports 
 
         of significant work stress to her dermatologist are not accurate, 
 
         however.
 
         
 
              Dr. Harves, opinion as to a casual relationship between 
 
         claimant's work conditions and her development of lichen planus 
 
         is based on an inaccurate history.
 
         
 
              No medical opinion relates claimant's headaches or her 
 
         colitis to her work conditions.
 
         
 
              Claimant's stress reaction and its mental manifestation in 
 
         anxiety and depression results from her lifelong 
 
         psychologic/characterologic propensity to cope poorly with any 
 
         and all stresses and not from her work conditions.
 
         
 
         
 
         
 
         LICHT-PRIMASING v. IOWA DEPARTMENT OF HUMAN SERVICES
 
         Page 24
 
         
 
         
 
              Claimant's development of lichen planus, if related to 
 
         stress, also reflects the above stated propensity and not her 
 
         work conditions.
 
         
 
                                CONCLUSION OF LAW
 
         
 
              THEREFORE, IT IS CONCLUDED:
 
         
 
              That claimant has not established that she received an 
 
         injury on March 24, 1986 which injury arose out of and in the 
 
         course of her employment.
 
         
 
                                      ORDER
 
                                        
 
              THEREFORE, IT IS ORDERED:
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              That claimant take nothing from these proceedings.
 
         
 
              That claimant pay costs of these proceedings pursuant to 
 
         Division of Industrial Services Rule 343-4.33.
 
         
 
              Signed and filed this 30th day of March, 1990.
 
         
 
         
 
         
 
         
 
                                               HELENJEAN WALLESER
 
                                               DEPUTY INDUSTRIAL 
 
         COMMISSIONER
 
         
 
         
 
         
 
         Copies To:
 
         
 
         Mr. David A. Lemanski
 
         Attorney at Law
 
         200 Security Building
 
         Dubuque, Iowa 52001
 
         
 
         Mr. Charles S. Lavorato
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Building
 
         Des Moines, Iowa 50319
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                                               1108.20, 1401, 1402.30
 
                                               2204
 
                                               Filed March 30, 1990
 
                                               HELENJEAN WALLESER
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         MELANIE K. LICHT-PRIMASING,
 
          
 
                Claimant,
 
          
 
          VS.
 
                                               File No. 825148
 
          IOWA DEPARTMENT OF HUMAN
 
          SERVICES,                            A R B I T R A T I 0 N
 
          
 
                Employer,                      D E C I S I 0 N
 
          
 
          and
 
          
 
          STATE OF IOWA,
 
          
 
                Insurance Carrier,
 
                Defendants.
 
         
 
         
 
         1108.20, 1401, 1402.30, 2204
 
         
 
              Claimant alleged that work stress caused her mental 
 
         impairment by way of anxiety and depression and physical 
 
         impairment by way of colitis, headaches, and a dermatological 
 
         condition, lichen planus.  Her treating dermatologist attributed 
 
         the lichen planus to work stress.  Her treating psychologist 
 
         accepted claimant's claim that work stress caused her anxiety and 
 
         depression.  Only one psychiatrist evaluated claimant.  The 
 
         psychiatrist indicated that claimant had histrionic and dramatic 
 
         traits as well as a life-long psychologic/characterologic 
 
         propensity to cope poorly with any and all stresses.  The 
 
         psychiatrist opined that claimant's inherent psychological makeup 
 
         placed her at great risk for coping poorly with any level of 
 
         stress.  Found that claimant had not established that her stress 
 
         reaction and its mental manifestation in anxiety and depression 
 
         resulted from actual work stress, but rather from her inherent 
 
         psychological makeup.  Found that the dermatologist's opinion as 
 
         to casual relationship between the dermatological condition and 
 
         work stress was based on an inaccurate history as claimant's 
 
         self-report of significant work stress was the foundation for 
 
         such opinion and did not take into account her tendency to 
 
         overreport and overembellish.  "Wisconsin Rule" discussed, but 
 
         found inapplicable in that while work stress may have been 
 
         greater than that to which the employee would have been subject 
 
         in her nonwork life, work stress was not established as a medical 
 
         causative factor in the development of claimant's psychological 
 
         condition.  Claimant offered no medical evidence showing a casual 
 
         relationship between her colitis and her headaches and her 
 
         alleged work stress.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            MARY MARTIN,                  :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  821570
 
            UNIVERSITY OF NORTHERN IOWA,  :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            STATE OF IOWA,                :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Mary 
 
            Martin against the University of Northern Iowa based upon 
 
            her development of asthma which was diagnosed on or about 
 
            May 29, 1986.  
 
            
 
                 The primary issues to be determined are claimant's 
 
            entitlement to weekly compensation for healing period and 
 
            permanent partial disability; determination of claimant's 
 
            entitlement to recover medical expenses and the rate of 
 
            compensation.  There is an issue with regard to whether the 
 
            condition is an injury or an occupational disease.  Claimant 
 
            seeks alternate medical care.
 
            
 
                 The case was heard at Waterloo, Iowa, on July 11, 1989.  
 
            The record contains exhibits 1, 3 through 5, 7 through 11, 
 
            15, 18, 19, 21, 22, 25, 30 through 32, 34, 37, 41 through 
 
            46, 48 through 50, A, B, and E.  The record also contains 
 
            testimony from Frank Gersh, Trudy Johnson, Clarence Alling, 
 
            Mitchell Eyres and claimant Mary Martin.  Exhibits 2, 6 and 
 
            27 are with the record as offers of proof only.  
 
            
 
                 Defendants' exhibit D was offered without defendants 
 
            having complied with the 30-day supplementation rule of Iowa 
 
            Rule of Civil Procedure 125(c).  The agency file clearly 
 
            shows that the interrogatories requested the pertinent 
 
            information.  The report itself was not served by defendants 
 
            on the claimant until a date less than 30 days prior to the 
 
            hearing.  During the course of the hearing, defendants 
 
            asserted that the claimant was given the opportunity of 
 
            deposing Hal B. Richerson, M.D., the author of the report.  
 
            Normally, that would be sufficient to remove any prejudice 
 
            which might result from the failure to timely supplement 
 
            responses.  The hearing assignment order issued in this case 
 
            clearly states that compliance with the 15-day witness and 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            exhibit list requirement did not satisfy rule 125(c).  The 
 
            nature of exhibit D is that it seeks to undermine the 
 
            credibility of Theron Randolph, M.D., one of claimant's 
 
            experts.  If exhibit D were received into evidence, it is 
 
            quite predictable that the claimant would then seek to offer 
 
            additional evidence to bolster Dr. Randolph's credibility.  
 
            It is therefore, determined that even though 
 
            cross-examination could have been timely arranged, there 
 
            would not have been a reasonable opportunity for the 
 
            claimant to develop rebuttal evidence prior to the hearing.  
 
            Since the credibility of Dr. Randolph had not been 
 
            previously questioned, nor has the credibility of any other 
 
            practitioner in this case, exhibit D opens an area of 
 
            controversy which had not been previously approached.  To do 
 
            so, less than 30 days prior to the date of the hearing, 
 
            which date had been scheduled for nearly six months, would 
 
            be unfairly prejudicial to the claimant.  It is particularly 
 
            noted that the claimant was previously denied the 
 
            opportunity to raise an issue subsequent to the issuance of 
 
            the hearing assignment order, even though it was requested 
 
            only days following the issuance of the hearing assignment 
 
            order and the fact that the issue had been clearly stated 
 
            and raised in the claimant's petition.  It is therefore, 
 
            determined that the objection to exhibit D is sustained.  
 
            Exhibit D will remain with the file as an offer of proof 
 
            only.
 
            
 
                                 findings of fact
 
            
 
                 Mary Martin, claimant, is a single woman, now age 35, 
 
            who in 1985 was selected to work as a graduate assistant at 
 
            the University of Northern Iowa for the 1985-86 academic 
 
            year in the department of art.  She was paid a stipend of 
 
            $4,250 and also given a credit toward her tuition in the 
 
            amount of $640 for each of the two semesters (exhibits 32 & 
 
            34).  Claimant also worked at the university library 
 
            throughout all of 1985 and the first eight months of 1986.  
 
            During the 12 months ending with the month of May 1986, she 
 
            received a total of $5,442.68 in pay and stipend from the 
 
            university and a tuition credit in the total amount of 
 
            $1,280.  
 
            
 
                 The claimant in this case held a bachelor of fine arts 
 
            degree and was certified to teach art at the elementary and 
 
            high school level prior to entering into the graduate 
 
            program.  She eventually completed the graduate program and 
 
            obtained her masters in art.  
 
            
 
                 Claimant's focus in her art studies was in the area of 
 
            ceramic sculptor.  Claimant has earned some funds from sale 
 
            of her art works.  Clarence Alling, the art director for the 
 
            Waterloo Recreation Center and director of the Waterloo 
 
            Municipal Art Gallery, indicated that claimant's work shows 
 
            talent and is saleable.  He opined that she had the 
 
            potential for developing a following and that with the 
 
            passage of time her following could grow.  Alling also 
 
            indicated, however, that most individuals with advanced 
 
            degrees in art work in the teaching field or, like himself, 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            in the museum industry.  
 
            
 
                 In the fall months of 1985, the ceramic laboratory and 
 
            its kilns were located in a Quonset hut type building which 
 
            was considered to be a somewhat less than fully modern 
 
            facility.  In approximately November 1985 a new laboratory 
 
            was opened which was more technically advanced.  The new 
 
            facility had, however, a defect of some type in the 
 
            ventilation system.  On one occasion it malfunctioned 
 
            sufficiently to cause a number of the students to leave the 
 
            facility.  As a result of the malfunctioning equipment in 
 
            the new facility, Mary Martin was exposed to fumes from the 
 
            kiln and by-products of the glazing process.  At all times 
 
            she had worked with ceramics, she was exposed to a number of 
 
            substances which are known to be hazardous.  The development 
 
            of asthma has been identified as a condition which sometimes 
 
            develops as a result of exposures of the type which Mary 
 
            Martin experienced (ex. 42-45).
 
            
 
                 Exhibit 7 contains records from the University of 
 
            Northern Iowa Student Health Clinic.  Parts of the record 
 
            are illegible.  An entry which appears to be dated May 10, 
 
            1985, appears to contain, "cough" "lungs".  This indicates 
 
            that the claimant may have been having some breathing 
 
            problems at that time.  Also at page 4 of exhibit 7, appears 
 
            a note dated April 1, 1986, which again makes reference to, 
 
            "having congestion and cough-since fall semester."  The note 
 
            also states, "she states new building ceramics may be 
 
            irritating."  A note dated April 8, 1986, appears to read, 
 
            "same irritation-that is exacerbated by ceramics work."  On 
 
            April 22, claimant requested a referral to the University of 
 
            Iowa for medical evaluation (ex. 7, page 5).
 
            
 
                 Claimant was seen at the Occupational Medicine Clinic 
 
            of the University of Iowa on May 19, 1986.  The diagnoses 
 
            made at that time were hypothyroidism, occupational asthma 
 
            with positive Methacholine challenged and a history of skin 
 
            rash and mucosal lesions of the nares and mouth.  The 
 
            history provided by the claimant was consistent with the 
 
            facts that occurred concerning the relocation of the art 
 
            department ceramics facilities.  As a result of that 
 
            evaluation, the claimant was placed on Synthroid.  She was 
 
            given a skin patch test for nickel and chromium.  The patch 
 
            test results for chromates, nickel, rosin, epoxy resin and 
 
            others were all negative.  There was no evidence of contact 
 
            sensitivity (ex. 8, pp. 6 & 7).  Urine testing showed low 
 
            concentrations of lead, arsenic and mercury (ex. 21B, pp. 
 
            142 & 143). She was prescribed an inhaler for her 
 
            hyperreactive airways and she was advised to use an OSHA 
 
            approved mask when working with clay and glaze.  Her 
 
            physicians at that time were James Merchant, M.D., and 
 
            Laurence Fuortes, M.D. (ex. 1).  
 
            
 
                 Dr. Fuortes is board certified in internal medicine and 
 
            board eligible for occupational medicine specialty 
 
            recognition.  Dr. Fuortes is an epidemic intelligence 
 
            service officer with the United States Public Health 
 
            Service, who is assigned to work as a consultant to the Iowa 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            Department of Health in occupational medicine at the 
 
            University of Iowa hospitals (ex. 21A, p. 5).  
 
            
 
                 Dr. Fuortes became involved in the investigation of the 
 
            malfunction at the ceramics laboratory.  He found that the 
 
            vent system had malfunctioned (ex. 21A, pp. 40-42).  He 
 
            found the exposure higher in the new facility than it had 
 
            been in the passively ventilated Quonset hut facility (ex. 
 
            21A, pp. 49-52).  He expressed the opinion that claimant's 
 
            pulmonary and respiratory symptoms were caused by her 
 
            exposures in the art department (ex. 21A, pp. 39, 47, 48 & 
 
            64).  He concluded that she has hyperreactive airway disease 
 
            which is probably permanent (ex. 21A, pp. 46, 60, 62, 134 & 
 
            135).  Dr. Fuortes felt that claimant's asthma condition was 
 
            occupationally induced since there was no evidence of 
 
            preexisting asthma even though approximately 20 percent of 
 
            the population is afflicted by asthma (ex. 21A, pp. 47-53, 
 
            62-65, 73, 74, 78, 115-119 & 144-146).  Dr. Fuortes 
 
            indicated that claimant's hypothyroidism is not related to 
 
            her exposures in the art department, but that it was 
 
            responsible for many of her symptoms (ex. 21A, pp. 46, 47 & 
 
            53-55).  Likewise, Dr. Fuortes found that claimant had been 
 
            exposed to neurotoxins in the laboratory, but that they were 
 
            not present in sufficient concentration to cause 
 
            neurological damage and that she showed no evidence of any 
 
            permanent neurological damage (ex. 21A, pp. 45, 55-61, 71-73 
 
            & 128-130).  
 
            
 
                 Dr. Fuortes reevaluated claimant on January 23, 1989.  
 
            It was his assessment that she appeared markedly improved 
 
            from when he had last seen her in 1986, despite her 
 
            subjective complaints to the contrary (ex. 21B, pp. 
 
            105-109).  
 
            
 
                 When claimant was seen at the Occupational Medicine 
 
            Clinic of the University of Iowa hospitals in 1989, she 
 
            reported continued asthma symptoms with one to three severe 
 
            episodes per month and five to ten lessor episodes per 
 
            month.  The records note that she expressed reluctance to 
 
            using the prescribed inhaler due to it causing anxiety and a 
 
            rapid heart beat.  Claimant reported reacting to a wide 
 
            variety of irritants including cigarette smoke, wood smoke 
 
            and strong perfume (ex. 8, pp. 68, 69 & 79).  
 
            
 
                 Dr. Fuortes explained that asthma would not produce 
 
            neurological symptoms, but that asthma can produce anxiety 
 
            which in turn can produce symptoms such as confusion or loss 
 
            of memory (ex. 21B, pp. 112-115 & 136-140).  He went on to 
 
            explain that claimant approaches a category of people who 
 
            are considered to have multiple chemical sensitivities and 
 
            that it is thought that such individuals often display a 
 
            conditioned response with psychological components.  He 
 
            stated that their physiological response cannot be explained 
 
            other than as a psychological illness such as post-traumatic 
 
            stress disorder or an adjustment disorder.  Dr. Fuortes 
 
            explained that the best treatment for claimant's disorder is 
 
            probably avoidance of treatment since she is functional, but 
 
            that psychotherapy might be helpful (ex. 21B, pp. 150-157).    
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            
 
                 Dr. Fuortes was unwilling to make a medical 
 
            recommendation that claimant completely restrict herself 
 
            from ceramics or art (ex. 21A, pp. 63 & 64; ex. 21B, pp. 148 
 
            & 149).  
 
            
 
                 It is found that the assessment of this case, made by 
 
            Dr. Fuortes, is accurate in all respects.  He is well 
 
            qualified and has a great deal of first hand experience in 
 
            the field of occupational medicine and also in this 
 
            particular case.  
 
            
 
                 In early 1989 claimant began treating with clinical 
 
            psychologist James H. Harding, Ph.D.  He diagnosed claimant 
 
            as having a depressive disorder, an organic mental disorder 
 
            resulting from exposure to toxic heavy metals and low 
 
            thyroid production which, likewise, could be due to heavy 
 
            metal exposure (ex. 3, p. 4).  Harding conducted a number of 
 
            tests, one of which was a computerized stress inventory.  It 
 
            showed many inconsistencies such as her reported pleasures 
 
            of feeling healthy, enjoying sex, having enough money and 
 
            relating well with her lover (ex. 3, p. 22) while noting 
 
            serious problems in those same categories on pages 12, 13 
 
            and 17.  Interestingly, claimant's physical health status 
 
            was shown as being the least stressful of the categories 
 
            evaluated (ex. 3, p. 24).  When deposed, Harding stated that 
 
            his diagnosis concerning organic brain disorder was based 
 
            upon the history which he had been provided by claimant and 
 
            her attorney as well as his observations, but that it was 
 
            not based upon specialized medical testing or other medical 
 
            information (ex. 22, pp. 15-25).  The history which he 
 
            received included that she had suffered permanent brain 
 
            damage and had been informed by her physicians that she 
 
            would have further serious health problems.  The history 
 
            also included that she was compelled to change her vocation 
 
            away from art (ex. 22, pp. 6 & 7).
 
            
 
                 Harding also concluded that claimant has post-traumatic 
 
            stress disorder (ex. 22, pp. 19, 25, 36-34).  Harding felt 
 
            that claimant's depression was due to her health and 
 
            vocational problems.  He related that she demonstrated an 
 
            anxiety reaction when they discussed the potential of her 
 
            performing any kind of art work (ex. 22, pp. 29-33).  
 
            
 
                 Claimant was also evaluated by neuropsychologist Frank 
 
            Gersh, Ph.D., in June 1989.  Dr. Gersh felt that claimant 
 
            was depressed and was suffering from a post-traumatic 
 
            disorder which had been caused by her exposure to fumes in 
 
            the art department and her resulting asthma.  Gersh felt 
 
            that claimant's condition was permanent, but that treatment 
 
            in the nature of counseling and antidepressant medications 
 
            would be appropriate.  
 
            
 
                 In 1987, claimant sought treatment at Randolph Clinic 
 
            in Chicago, Illinois.  While there, she was tested for 
 
            sensitivity to a number of items and was shown to react to 
 
            peanuts, corn, tobacco smoke, chlorine, ethanol, coffee, 
 
            yeast, automotive exhaust, onion, grapefruit, eggs, beets 
 
            and Candida.  In his report, Dr. Randolph indicates that 
 
            claimant's sensitivities are consistent with those commonly 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            seen in art students who have a long-term exposure to the 
 
            solvents, fumes and other chemicals commonly found in art 
 
            schools (ex. 5, pp. 28 & 29).
 
            
 
                 Despite her health ailment, claimant completed her 
 
            masters in art in 1986.  Her transcript shows that she 
 
            carried 12-credit hours and earned a grade point average of 
 
            3.78 during the spring 1986 semester.  During the summer 
 
            semester she carried six-credit hours and had a grade point 
 
            of 3.34.  These were consistent with her pre 1986 course 
 
            loads and grade point averages.  
 
            
 
                 During the later part of 1986 and early 1987, claimant 
 
            engaged in neither training nor employment.  Her testimony 
 
            was that she was extremely lethargic and spent most of her 
 
            time sleeping.  She eventually sought assistance through the 
 
            Iowa Department of Vocational Rehabilitation, received 
 
            funding and attended further post-graduate training at the 
 
            University of Northern Iowa.  At the time of hearing, it was 
 
            expected that claimant would be receiving a masters in 
 
            special education within a few months.  Her transcript 
 
            showed her to have carried 10 hours with a 4.00 grade point 
 
            in the fall of 1987, 14 hours with a 3.14 grade point in the 
 
            spring of 1988 and 8 hours with a 3.75 grade point in the 
 
            summer of 1988 (ex. E).
 
            
 
                 Claimant obtained a half-time position as a special 
 
            education teacher at Lincoln School in Waterloo, Iowa, for 
 
            the 1988-89 school year.  Her performance was evaluated as 
 
            satisfactory (ex. E, p. 15).  At the time of hearing, 
 
            claimant did not know whether she had been selected for a 
 
            full-time position for the 1989-90 school year.  Claimant 
 
            stated that she had experienced difficulty teaching due to 
 
            her reaction to chalk dust and when passing the janitor's 
 
            office where cleaning supplies were kept.  
 
            
 
                 Claimant indicated that if she had been able to work as 
 
            an art teacher with a masters degree her starting salary 
 
            would have been approximately $20,000, the same as the 
 
            starting salary for a special education teacher with a 
 
            masters degree.  Claimant acknowledged that she would not 
 
            want to work as an art teacher unless part of the course 
 
            work involved ceramics.  
 
            
 
                 It is found that claimant's future as a practicing 
 
            artist who earned her living through the sale of art which 
 
            she produced would be quite speculative.  The undersigned is 
 
            quite certain that there are many individuals with artistic 
 
            talent who have unsuccessfully attempted a career as an 
 
            artist.  It is more likely that claimant's future in art 
 
            would have been in the teaching field, or some other related 
 
            field such as museums.  Nevertheless, her sensitivity to art 
 
            materials has eliminated the possibility that she might work 
 
            as a practicing artist.  It would likewise appear that her 
 
            sensitivities would not necessarily eliminate her from many 
 
            art-related professions such as museum work or teaching 
 
            which did not involve ceramics.  The record does not 
 
            disclose whether kilns and ceramics are a part of a typical 
 
            elementary or high school level art program.  It would be 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            expected that most museums would not contain kilns.  
 
            
 
                 While the degree of reactivity, which was described by 
 
            claimant and Mitchell Eyres, is not well corroborated by the 
 
            medical evidence, it is, nevertheless, found that she is 
 
            reactive to a number of nonspecific irritants, all as 
 
            indicated by Dr. Fuortes.  It is further found that there is 
 
            no medical barrier to claimant working in a full-time status 
 
            as a special education teacher.  No physician has required 
 
            that she restrict herself to part-time employment or take 
 
            afternoon naps, contrary to the evidence in the record from 
 
            Trudy Johnson.  
 
            
 
                                conclusions of law
 
            
 
                 The first issue to be addressed is whether claimant's 
 
            asthma is an occupational disease rather than an injury.  A 
 
            close reading of Iowa Code section 85.61(5)(b) provides that 
 
            any condition which qualifies as an occupational disease 
 
            should not be considered to be an injury.  Section 85A.8 and 
 
            McSpadden v. Big Ben Coal Co., 288 N.W.2d 181, 190 (Iowa 
 
            1980), provide guidance for what constitutes an occupational 
 
            disease.  The two requirements are that the disease be 
 
            causally related to the exposure to harmful conditions in 
 
            the field of employment and that those harmful conditions 
 
            are more prevalent in the employment than in everyday life 
 
            or other occupations.  Evidence from Dr. Fuortes, as well as 
 
            exhibits 42-45, clearly demonstrate that the development of 
 
            asthma is a recognized hazard of working with ceramics.  It 
 
            is therefore, concluded that claimant's asthma is an 
 
            occupational disease.  
 
            
 
                 Claimant seeks compensation for healing period under 
 
            the provisions of Code section 85.34(1).  In this case, 
 
            there does not appear to have been any particular time when 
 
            claimant was required to restrict her activities in order to 
 
            recover.  The situation is one that is common when dealing 
 
            with an occupational disease.  There is no evidence showing 
 
            any substantial medical improvement.  There is no medical 
 
            evidence in the record of this case which documents any 
 
            particular period of disability.  Claimant contracted the 
 
            disease and will probably always be afflicted by it.  It is 
 
            therefore, concluded that claimant is not entitled to 
 
            recover compensation for healing period.  
 
            
 
                 Claimant seeks to recover compensation for permanent 
 
            partial disability.  Under Code sections 85A.4 and 5 
 
            compensation is payable when the employee becomes 
 
            incapacitated from performing the employee's work or from 
 
            earning equal wages in other suitable employment due to the 
 
            occupational disease.  In this case, the claimant now is 
 
            capable of earning wages as a special education teacher 
 
            which are comparable to those which she could have earned as 
 
            an art teacher.  This status exists, however, only because 
 
            the claimant obtained further education.  If her 
 
            employability had been evaluated as it existed at the time 
 
            she ceased her ceramic work and her art career she would 
 
            clearly not have been capable of earning comparable wages in 
 
            other employment.  The time at which permanency is evaluated 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            is the time at which compensation for it becomes payable.  
 
            Stewart v. Crouse Cartage Co., file number 738644 (Appeal 
 
            Decision February 29, 1987).  In this case, that time is 
 
            determined to be the end of the spring 1986 semester.  Since 
 
            the record does not disclose the precise date, it is 
 
            determined that the semester ended on May 31, 1986, and that 
 
            the compensation is payable commencing June 1, 1986.  
 
            Compensation for occupational disease is evaluated 
 
            industrially according to loss of earning capacity.  Doerfer 
 
            Division of CCA v. Nicol, 359 N.W.2d 428, 438 (Iowa 1984); 
 
            McSpadden, 288 N.W.2d 181.
 
            
 
                 If claimant has an impairment to the body as a whole, 
 
            an industrial disability has been sustained.  Industrial 
 
            disability was defined in Diederich v. Tri-City Railway Co., 
 
            219 Iowa 587, 593, 258 N.W.2d 899, 902 (1935) as follows: 
 
            "It is therefore plain that the legislature intended the 
 
            term `disability' to mean `industrial disability' or loss of 
 
            earning capacity and not a mere `functional disability' to 
 
            be computed in the terms of percentages of the total 
 
            physical and mental ability of a normal man."
 
            
 
                 Functional impairment is an element to be considered in 
 
            determining industrial disability which is the reduction of 
 
            earning capacity, but consideration must also be given to 
 
            the injured employee's age, education, qualifications, 
 
            experience and inability to engage in employment for which 
 
            he is fitted.  Olson v. Goodyear Service Stores, 255 Iowa 
 
            1112, 1121, 125 N.W.2d 251, 257 (1963).
 
            
 
                 Industrial disability or loss of earning capacity is a 
 
            concept that is quite similar to impairment of earning 
 
            capacity, an element of damage in a tort case.  Impairment 
 
            of physical capacity creates an inference of lessened 
 
            earning capacity.  The basic element to be determined, 
 
            however, is the reduction in value of the general earning 
 
            capacity of the person, rather than the loss of wages or 
 
            earnings in a specific occupation.  Post-injury earnings 
 
            create a presumption of earning capacity.  The earnings are 
 
            not synonymous with earning capacity and the presumption may 
 
            be rebutted by evidence showing the earnings to be an 
 
            unreliable indicator.  Carradus v. Lange, 203 N.W.2d 565 
 
            (Iowa 1973); Holmquist v. Volkswagon of America, Inc., 261 
 
            N.W.2d 516 (Iowa App. 1977) A.L.R.3d 143; Michael v. 
 
            Harrison County, Thirty-fourth Biennial Report of the 
 
            Industrial Commissioner 218 (1979); 2 Larson Workmen's 
 
            Compensation Law, sections 57.21 and 57.31.
 
            
 
                 It is determined that claimant has experienced a 25 
 
            percent reduction in her earning capacity as a result of the 
 
            occupational asthma which she contracted while working at 
 
            the UNI ceramics laboratory.  
 
            
 
                 Claimant seeks alternate medical care under Code 
 
            section 85.27.  There is no indication that the care which 
 
            has been provided to her has been inappropriate.  The care 
 
            provided by the University of Iowa Hospitals and Clinics 
 
            seems well suited to claimant's condition.  It is therefore, 
 
            ordered that claimant's request for alternate care is 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            denied.  The University of Iowa Hospitals and Clinics will 
 
            remain in charge of claimant's treatment.  It is further 
 
            concluded that claimant's care and treatment with Dr. 
 
            Randolph and her treatment and evaluations from 
 
            psychologists Harding and Gersh are unauthorized.  In that 
 
            regard, claimant is not entitled to recover the expenses 
 
            shown on exhibits 9, 10, 11, 15 or 19.  She is entitled to 
 
            recover $33.98 for the two Proventil inhalers shown on page 
 
            3 of exhibit 18.
 
            
 
                 The only remaining issue is claimant's rate of 
 
            compensation.  Claimant's status as a student is not one 
 
            which falls well within Code section 85.36.  The provisions 
 
            which deal with an apprentice or trainee apply to a person 
 
            who is in a program leading to employment with a particular 
 
            employer or group of employers.  Such is not the case with a 
 
            college student.  Claimant's work as a graduate assistant is 
 
            determined to have not provided her with wages or earnings 
 
            which are equal to the usual weekly earnings of a regular 
 
            full-time adult laborer in the teaching industry.  
 
            Therefore, Code section 85.36(10) is determined to be the 
 
            appropriate statutory basis for computing the rate of 
 
            compensation.  It is concluded that the scholarship which 
 
            was provided to claimant for her services as a graduate 
 
            assistant is part of the compensation which she received as 
 
            an employee and should be included when determining her rate 
 
            of compensation.
 
            
 
                 Since it has been found that her date of disablement 
 
            was May 31, 1986, the 12 calendar months on which her 
 
            earnings are computed run from June 1985 through May 1986.  
 
            The total earnings as shown on exhibit 38 are $5,442.68.  
 
            One-fiftieth of that amount of $108.85.  It is noted that 
 
            the workers' compensation benefit schedule performs two 
 
            functions in converting gross weekly wages to the rate of 
 
            compensation.  First, it reduces those wages for taxes.  It 
 
            then further reduces the post-tax earnings by 20 percent 
 
            (ICS 85.37).  Since claimant's scholarship of $1,280 is not 
 
            subject to taxes, it would be inappropriate to simply add 
 
            the sum of $1,280 to the $5,442.68 in actual cash earnings 
 
            and then to apply that sum to the amount in the weekly 
 
            benefits schedule.  A more accurate means of determining the 
 
            appropriate rate of compensation is to apply the $108.85 per 
 
            week actual earnings to the benefits schedule and then add 
 
            to that amount 1/50 of 80 percent of $1,280.  The actual 
 
            earnings when applied under the 1985 benefits schedule show 
 
            a rate of $73.72.  The appropriate amount to be added 
 
            thereto for the scholarship is $20.48 per week.  The total 
 
            rate of compensation is, therefore, $94.20 weekly.  
 
            
 
                                      order
 
            
 
                 IT IS, THEREFORE, ORDERED:
 
            
 
                 That Defendants pay Mary Martin one hundred twenty-five 
 
            (125) weeks of compensation for permanent partial disability 
 
            at the rate of ninety-four and 20/100 dollars ($94.20) per 
 
            week payable commencing June 1, 1986.
 
            
 
                 It is further ordered, that defendants pay claimant 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            thirty-three and 98/100 dollars ($33.98) as reimbursement 
 
            for medical expenses.
 
            
 
                 It is further ordered that defendants pay interest on 
 
            the permanent partial disability compensation at the rate of 
 
            ten (10) percent per annum computed from the date each 
 
            weekly payment came due until the date of actual payment 
 
            pursuant to Iowa Code section 85.30.
 
            
 
                 It is further ordered that claimant's future health 
 
            care be managed by the University of Iowa Hospitals and 
 
            Clinics.  In all other respects claimant's request for 
 
            alternate medical care is denied.  
 
            
 
                 It is further ordered that defendants pay the costs of 
 
            this action as follows:
 
            
 
                 1.  Filing fee - $65.
 
            
 
                 2.  Dr. Fuortes expert witness fee $150.
 
            
 
                 3.  Van Wyngarden and Abrahamson court reporter fees -  
 
            $408.20.
 
            
 
                 4.  Whalen Reporting Service recording fees - $125.
 
            
 
                 5.  Van Wyngarden and Abrahamson - $360.80.
 
            
 
                 6.  James Harding expert witness fee - $150.
 
            
 
                 7.  Dr. Fuortes expert witness fee - $150.
 
            
 
                 8.  Van Wyngarden and Abrahamson - $87.40.
 
            
 
                 9.  James Harding report - $25.00.
 
            
 
                     Total - $1371.40
 
            
 
                 It is further ordered that the employer file claim 
 
            activity reports pursuant to rule 343 IAC 3.1.
 
            
 
                 
 
            
 
                 
 
            
 
                 Signed and filed this ____ day of March, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Thomas Staack 
 
            Mr. J. Scott Bayne
 
            Attorneys at Law
 
            3151 Brockway Rd
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            PO Box 810
 
            Waterloo, Iowa  50704
 
            
 
            Mr. Craig Kelinson
 
            Ms. Joanne Moeller
 
            Assistant Attorneys General
 
            Hoover State Office Bldg.
 
            Des Moines, Iowa  50317