Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            ROY E. HONEYWELL, II,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :        File No. 833232
 
            ALLEN DRILLING CO.,           :
 
                                          :          A P P E A L 
 
                 Employer,                :
 
                                          :         D E C I S I O N
 
            and                           :
 
                                          :
 
            BITUMINOUS CASUALTY CORP.,    :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 Claimant appeals from an arbitration decision awarding  
 
            permanent partial disability benefits as the result of an 
 
            alleged injury on February 5, 1983.  Defendants 
 
            cross-appeal.  The record on appeal consists of the 
 
            transcript of the arbitration proceeding; and joint exhibits 
 
            A and B.  Both parties filed briefs on appeal.  Both parties 
 
            filed reply briefs.
 
            
 
                                      issues
 
            
 
                 The issues stated by the claimant are:
 
            
 
                 I.  The injury should be evaluated as an injury to 
 
                 the body as a whole.
 
            
 
                 II.  Healing period should continue uninterrupted 
 
                 to June 1986, the time of treatment at Oklahoma 
 
                 Osteopathic Hospital.
 
            
 
                 III.  The treatments and healing period following 
 
                 the August 1985 surgery to remove the plates are 
 
                 causally connected to the injury.
 
            
 
                 IV.  Pre-existing impairment is irrelevant in this 
 
                 case.
 
            
 
     
 
            
 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            Defendants state the following issues on 
 
            cross-appeal:
 
            
 
                 V.  Did the deputy err in determining the extent 
 
                 of permanent partial disability sustained by the 
 
                 claimant as a result of the February 5, 1983 
 
                 incident?
 
            
 
                 VI.  Did the deputy err in assessing an expert 
 
                 witness fee against the employer/insurance carrier 
 
                 when claimant's expert did not appear at trial.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The arbitration decision adequately and accurately 
 
            reflects the pertinent evidence and it will not be set forth 
 
            herein. 
 
            
 
                                CONCLUSIONS OF LAW
 
            The analysis contained in the proposed agency decision is 
 
            adopted herein as set forth below.  Segments designated by 
 
            asterisks (*****) indicate portions of the proposed agency 
 
            decision that have been intentionally deleted and do not 
 
            form a part of this final agency decision.  Segments 
 
            designated by brackets ([  ]) indicate additional analysis.
 
               While a claimant is not entitled to compensation for the 
 
            results of a preexisting injury or disease, the mere 
 
            existence at the time of a subsequent injury is not a 
 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
 
            preexisting condition or disability that is aggravated, 
 
            accelerated, worsened or lighted up so that it results in 
 
            disability, claimant is entitled to recover.  Nicks v. 
 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
 
            (1962).
 
               The Iowa Supreme Court cites, apparently with approval, 
 
            the C.J.S. statement that the aggravation should be material 
 
            if it is to be compensable.  Yeager v. Firestone Tire & 
 
            Rubber Co., 253 Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. 
 
            Workmen's Compensation sec. 555(17)a.
 
               Claimant has met his burden in proving that the February 
 
            5, 1983 amputation injury aggravated his preexisting 
 
            substance abuse disorder and personality disorder.
 
               The claimant has the burden of proving by a 
 
            pre-ponderance of the evidence that the injury of February 
 
            5, 1983 is causally related to the disability on which he 
 
            now bases his claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 
 
            133 N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 
 
            296, 18 N.W.2d 607 (1945).  A possibility is insufficient; a 
 
            probability is necessary.  Burt v. John Deere Waterloo 
 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
            question of causal connection is essentially within the 
 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
            Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). 
 
               However, expert medical evidence must be considered with 
 
            all other evidence introduced bearing on the causal 
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            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).
 
               Section 85.34(l), Code of Iowa, provides that healing 
 
            period benefits are payable to an injured worker who has 
 
            suffered permanent partial disability until (1) he has 
 
            returned to work; (2) is medically capable of returning to 
 
            substantially similar employment or (3) has achieved maximum 
 
            medical recovery.  The industrial commissioner has 
 
            recognized that healing period benefits can be interrupted 
 
            or intermittent.  Willis v. Lehigh Portland Cement Company, 
 
            Vol. 2-1, State of Iowa Industrial Commissioner Decisions, 
 
            485 (1984).
 
               The end of the healing period occurs at the time when the 
 
            physicians indicate that no further improvement is 
 
            forthcoming.  It is not determined by hindsight looking back 
 
            to find the point at which recovery ceased.  Thomas v. 
 
            William Knudson & Son Inc., 394 N.W.2d 124, 126 (Iowa App. 
 
            1984); Armstrong Tire & Rubber Co. v. Kubli, 312 N.W.2d 60 
 
            (Iowa App. 1981).
 
               Claimant has met his burden in proving entitlement to an 
 
            intermittent healing period beginning February 5, 1983 
 
            through April 16, 1985; beginning August 15, 1985 through 
 
            October 15, 1985; and beginning May 13, 1986 through June 
 
            12, 1986.  Further awards of healing period would be 
 
            speculative as the medical evidence does not support any 
 
            other periods of lost time.
 
               Claimant has failed to prove the causal connection of the 
 
            February 5, 1983 injury to the medical expenses listed in 
 
            Exhibit B.
 
               The right of a worker to receive compensation for 
 
            injuries sustained which arose out of and in the course of 
 
            employment is statutory.  The statute conferring this right 
 
            can also fix the amount of compensation to be paid for 
 
            different specific injuries, and the employee is not 
 
            entitled to compensation except as provided by the statute.  
 
            Soukup v. Shores Co., 222 Iowa 272, 268 N.W. 598 (1936).
 
               If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
               Permanent partial disabilities are classified as either 
 
            scheduled or unscheduled.  A specific scheduled disability 
 
            is evaluated by the functional method; the industrial method 
 
            is used to evaluate an unscheduled disability.  Martin v. 
 
            Skelly Oil Co., 252 Iowa 128, 133, 106 N.W.2d 95, 98 (1960); 
 
            Graves v. Eagle Iron Works, 331 N.W.2d 116 (Iowa 1983); 
 
            Simbro v. DeLong's Sportswear, 332 N.W.2d 886, 887 (Iowa 
 
            1983).
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
               A claimant may not recover benefits for industrial 
 
            disability if the injury is to a scheduled member and not to 
 
            the body as a whole even when psychological problems affect 
 
            earning capacity.  A claimant is compensated for any 
 
            reduction in earning capacity through the schedule.  The 
 
            scheduled loss system created by the legislature is presumed 
 
            to include compensation for reduced capacity to labor and to 
 
            earn.  Schell v. Central Engineering Co., 232 Iowa 421, 4 
 
            N.W.2d 399 (1942); Pilcher v. Penick and Ford, file number 
 
            618597 Industrial Commissioner (Appeal Decision October 21, 
 
            1987); Cannon v. Keokuk Steel Casting, file number 795331 
 
            Industrial Commissioner (Appeal Decision January 27, 1988).
 
               Claimant has requested an award of industrial disability.  
 
            Claimant's injury and impairment are limited to the right 
 
            upper extremity.  Psychological impairment and loss of 
 
            earning capacity attributable to the aggravation have not 
 
            been demonstrated.  The undersigned is without jurisdiction 
 
            to award industrial disability in a scheduled member case.  
 
            As a matter of law, the claimant is not entitled to 
 
            industrial disability.
 
               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 Graphics Systems, Inc. v. Prince, 366 N.W.2d 187, 
 
            192 (Iowa 1985).
 
               The Guides of the Evaluation of Permanent Impairment, 
 
            published by the American Medical Association, are adopted 
 
            as a guide for determining permanent partial disability 
 
            under Iowa Code section 85.34(2)"a"-"r".  Rule 343 IAC 2.4.
 
               Upon considering all material factors, it is found that 
 
            the evidence in this case supports an award of 91 percent 
 
            permanent partial disability which entitles the claimant to 
 
            recover 230 weeks of benefits under Iowa Code section 
 
            85.34(2)"m" as a result of the injury to claimant's right 
 
            upper extremity.
 
               The commencement date for permanent partial disability 
 
            shall be April 17, 1985 and such disability shall be paid 
 
            intermittently before and after the healing periods.  
 
               All costs incurred in the hearing before the deputy 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            commissioner shall be taxed in the discretion of the deputy 
 
            commissioner unless otherwise required by the rules of civil 
 
            procedure governing discovery.  Iowa Code section 86.40, 
 
            Rule 343 IAC 4.33.
 
               A deputy commissioner is without jurisdiction to consider 
 
            an issue not listed as an issue on the hearing assignment 
 
            order.  See Joseph Presswood v. Iowa Beef Processors, 
 
            (Appeal Decision filed November 14, 1986) holding an issue 
 
            not noted on the hearing assignment order is an issue that 
 
            is waived.
 
               *****
 
               Claimant has requested reimbursement for costs listed in 
 
            Dr. Bost's letter of June 29, 1990.  Dr. Bost's charges were 
 
            for a section 85.39 medical examination to be used 
 
            exclusively for trial.  
 
               *****
 
            
 
                 [Rule 343 IAC 4.33 sets forth allowable costs.  
 
            Subsection 5 of that rule allows costs for the expenses of 
 
            obtaining a doctor's deposition testimony provided that the 
 
            costs do not exceed the amounts set forth in Iowa Code 
 
            sections 622.69 and 622.72.  Dr. Bost's report was not 
 
            deposition testimony and cannot be awarded as costs under 
 
            rule 4.33(5).
 
            
 
                 Rule 343 IAC 4.33(6) states that costs may be awarded 
 
            for the reasonable costs of obtaining no more than two 
 
            doctors' or practitioners' reports.  Claimant seeks the 
 
            costs of Dr. Bost's services under this rule.  However, the 
 
            rule contemplates the imposition of costs that are otherwise 
 
            justified.  Claimant did not seek prior authorization for an 
 
            85.39 examination, and 85.39 was not listed as an issue at 
 
            the hearing.  Claimant cannot seek an after the fact 
 
            authorization of an 85.39 examination in the form of an 
 
            award for costs.  Costs are in the discretion of the 
 
            commissioner pursuant to Iowa Code section 86.40.  Claimant 
 
            will not be awarded costs for Dr. Bost's fees.]
 
            
 
                 WHEREFORE, the decision of the deputy is affirmed in 
 
            part and modified in part.
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants are to pay claimant one hundred 
 
            twenty-seven (127) weeks of healing period benefits at the 
 
            rate of three hundred eight and 02/100 dollars ($308.02) for 
 
            the periods February 5, 1983 through April 16, 1985; August 
 
            15, 1985 through October 15, 1985; and May 13, 1986 through 
 
            June 12, 1986.
 
            
 
                 That defendants are to pay claimant two hundred thirty 
 
            (230) weeks of permanent partial disability benefits at the 
 
            rate of three hundred eight and 02/100 dollars ($308.02) per 
 
            week commencing April 17, 1985, and to be paid 
 
            intermittently.
 
            
 
                 That defendants are entitled to a credit for any 
 
            benefits previously paid to claimant.
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
                 That defendants are to pay accrued amounts in a lump 
 
            sum.
 
            
 
                 That defendants are to pay interest pursuant to Iowa 
 
            Code section 85.3.
 
            
 
                 That defendants are to pay costs of the hearing 
 
            proceeding pursuant to rule 343 IAC 4.33, and as set out in 
 
            the analysis portion of the decision and the cost of the 
 
            transcription of the hearing proceeding shall be shared 
 
            equally.
 
            
 
                 That defendants are to file claim activity reports as 
 
            required by this agency pursuant to rule 4.33 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of October, 1991.
 
            
 
            
 
            
 
            
 
                                          
 
            ________________________________
 
                                                   BYRON K. ORTON
 
                                              INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Donald Gonnerman
 
            Attorney at Law
 
            4200 University Ave. STE 305
 
            West Des Moines, Iowa 50265
 
            
 
            Mr. David L. Brown
 
            Mr. John E. Swanson
 
            Attorneys at Law
 
            8th Floor Fleming Bldg.
 
            Des Moines, Iowa 50309
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
         5-1802; 5-1803; 5-2204; 5-1803.1;
 
         5-2503; 5-2907
 
         Filed October 31, 1991
 
         Byron K. Orton
 
         MDM
 
         
 
                     before the iowa industrial commissioner
 
         ____________________________________________________________
 
                                       :
 
         ROY E. HONEYWELL, II,         :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :         File No. 833232
 
         ALLEN DRILLING CO.,           :
 
                                       :          A P P E A L
 
              Employer,                :
 
                                       :         D E C I S I O N
 
         and                           :
 
                                       :
 
         BITUMINOUS CASUALTY CORP.,    :
 
                                       :
 
              Insurance Carrier,       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         In that the deputy's decision was adopted verbatim with only 
 
         minor deletions, the headnotes were adopted verbatim as well:
 
         
 
         5-1802, 5-1803
 
         Claimant's right arm was amputated and reattached.  Claimant was 
 
         awarded intermittent healing period and 91 percent permanent 
 
         partial disability.
 
         
 
         5-2204, 5-1803.1
 
         It was found that the injury aggravated claimant's preexisting 
 
         psychological disorder.  Claimant was not awarded industrial 
 
         disability as impairment for the aggravation was not apportioned 
 
         and the scheduled member benefits compensated claimant for his 
 
         loss in earnings capacity.
 
         
 
         5-2503
 
         Claimant failed to establish entitlement to medical expenses 
 
         incurred subsequent to intervening injury.
 
         
 
         5-2907
 
         Costs of an independent medical examination limited to $150 
 
         pursuant to Iowa Code section 622.72.
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            ROY E. HONEYWELL, II,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :         File No. 833232
 
            ALLEN DRILLING CO.,           :
 
                                          :      A R B I T R A T I O N
 
                 Employer,                :
 
                                          :         D E C I S I O N
 
            and                           :
 
                                          :
 
            BITUMINOUS CASUALTY CORP.,    :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by Roy 
 
            Honeywell, II, as a result of injuries to his right arm 
 
            which occurred on February 5, 1983.  Defendants accepted 
 
            compensability  for the injury, paid weekly benefits and 
 
            most of the medical expenses.
 
            
 
                 The case was heard and fully submitted at Des Moines, 
 
            Iowa, on December 4, 1990.  The record in the proceeding 
 
            consists of joint exhibits A and B, defendants' exhibit C, 
 
            the testimony of claimant and Sam Graham, Ph.D.
 
            
 
                                      issues
 
            
 
                 The issues for determination are as follows:
 
            
 
                 1.  Entitlement to healing period or temporary total 
 
            disability.
 
            
 
                 2.  Extent of permanent partial disability and the type 
 
            of permanent partial disability.
 
            
 
                 3.  Entitlement to medical benefits listed in exhibit 
 
            B; and
 
            
 
                 4.  Taxation of costs listed in the statement of costs 
 
            dated June 29, 1990, authored by Richard Bost, Ph.D.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 Having considered all the evidence received, the 
 
            following findings of fact are made:
 
            
 
                 Claimant, Roy Honeywell, II, was age 29 at the time of 
 
            hearing.  His work experience consisted of working as a 
 
            roughneck for a drilling company.  At the time of the 
 
            injury, he was a derrick hand working seven days per week 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            with no instances of absenteeism.  After the injury, 
 
            claimant returned to school and completed a four-year 
 
            college degree.  Claimant was motivated to work both before 
 
            and after the injury.
 
            
 
                 Roy Honeywell, II, received a complete amputation of 
 
            his right upper extremity at the mid-forearm on February 5, 
 
            1983, arising out of and in the course of employment with 
 
            employer Allen Drilling Company.
 
            
 
                 On the same day of the amputation claimant was taken to 
 
            Des Moines, Iowa, where Douglas Reagan, M.D., reattached the 
 
            limb.  The surgery to reattach the extremity was successful.  
 
            A prolonged period of convalescence followed.  While 
 
            hospitalized for the injury claimant was administered 
 
            morphine, codeine and demerol for pain.  Claimant testified 
 
            that he became addicted to the drugs as a result of the 
 
            hospitalization.
 
            
 
                 Defendants asserted that claimant was a poor historian. 
 
            Claimant did have difficulty remembering specifics.  
 
            However, the finding of poor historian must be distinguished 
 
            from a finding of poor credibility.  Claimant's appearance 
 
            and demeanor were observed.  It is found that his testimony 
 
            is credible.  Claimant appeared open and honest when 
 
            questioned about his past. Claimant cooperated completely 
 
            when asked to make a fist with his right hand and to pinch 
 
            his thumb and index finger together.  The fact that claimant 
 
            has a poor memory does not equate to false statements under 
 
            oath.  When claimant could not remember, he would so state.
 
            
 
                 The first issue to be discussed concerns entitlement to 
 
            healing period or temporary total disability.  Claimant was 
 
            off work starting on February 5, 1983.  Karl F. Sauer, M.D., 
 
            the treating physician, gave an impairment rating, maximum 
 
            medical improvement and a return to work on April 17, 1985 
 
            (exhibit A, page 50).  Michael B. Clendenin, M.D., found 
 
            maximum medical improvement to have occurred on April 19, 
 
            1985.  The earlier date of April 17, 1985 is accepted as Dr. 
 
            Sauer was the treating physician who cared for claimant 
 
            continuously for a much longer period of time.  Claimant's 
 
            initial healing period, therefore, starts on February 5, 
 
            1983 and extends through April 16, 1985.
 
            
 
                 The next period starting April 17, 1985 and ending 
 
            August 14, 1985 is not compensable as no doctor authorized 
 
            claimant to be off work.
 
            
 
                 On August 15, 1985, claimant underwent another surgery 
 
            by Dr. Reagan so as to remove the radial and ulnar hardware 
 
            (ex. A, p. 54).  A sugar tong splint was applied after that 
 
            surgery. Claimant returned to Oklahoma under the care of Dr. 
 
            Sauer for follow-up (ex. A, p. 55)
 
            
 
                 On September 9, 1985, claimant was arrested by a police                                                                 
 
            officer for various charges.  Claimant eventually pled 
 
            guilty to resisting arrest as well as other charges.  
 
            Claimant returned to Dr. Sauer on October 15, 1985 and was 
 
            diagnosed as having a "Refracture, right ulna, secondary to 
 
            the injury of 9/8 or 9/9/85."  (ex. A, p. 58).
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            
 
                 It is found that claimant is entitled to healing period 
 
            benefits starting on August 15, 1985 and ending on October 
 
            15, 1985.  The September incident with the police officer is 
 
            an intervening cause that breaks the link to the injury of 
 
            February 5, 1983.  October 15, 1985 is found to be the 
 
            termination date for healing period as that is the first 
 
            time claimant sought and required medical treatment for the 
 
            September 9, 1985 incident with the police officer.  
 
            Therefore, healing period ends on the             date 
 
            claimant's arm became symptomatic as a result of the 
 
            incident with the police officer.  No further disability can 
 
            be awarded as a result of the August 15, 1985 surgery as no 
 
            medical opinion exists which reveals the probable length of 
 
            healing time, but for the accident of September 9, 1985.  A 
 
            further award of healing period would be speculative.
 
            
 
                 It also follows that the medical expenses listed in 
 
            Exhibit B starting on and subsequent to October 15, 1985, 
 
            are not compensable.  Claimant has failed to meet his burden 
 
            in proving that said expenses are casually related to the 
 
            February 5, 1983 injury.  To award such expenses would be 
 
            speculative.
 
            
 
                 The final issue of lost time relates to the aggravation 
 
            of the preexisting personality disorder and substance abuse 
 
            disorder. Dr. Bost opined that the February 5, 1983 injury 
 
            aggravated a preexisting substance abuse disorder.  Sam L. 
 
            Graham, Ph.D., also testified that the injury would have 
 
            aggravated the preexisting conditions.  The factual dispute 
 
            stems from the start date of morphine use.  Dr. Graham 
 
            interpreted the medical history, stated in various exhibits, 
 
            to show pre February 5, 1983 use of morphine.  Dr. Graham's 
 
            interpretation of the records is rejected.  Dr. Graham 
 
            interpreted four years to mean exactly 48 months.  Various 
 
            notes indicate that the statement of four years was an 
 
            approximation.  Examples are as follows: "[O]piate abuse 
 
            last four years or so."  (ex. A, p. 64) "Rt arm severed 4 
 
            years ago - became addicted to morphine then."  (ex. A, p. 
 
            62)
 
            
 
                 The majority of records reveal that four years was used 
 
            to pinpoint the accident of February 5, 1983.  Furthermore, 
 
            these records were created prior to the filing of this 
 
            petition.
 
            
 
                 It is found that claimant's preexisting personality 
 
            disorder and substance abuse disorder were materially 
 
            aggravated by the accident of February 5, 1983.  The 
 
            aggravations are compensable.
 
            
 
                 Only one period of lost time can be linked to the 
 
            aggravation. That being the inpatient treatment for opiate 
 
            addiction starting on May 13, 1986 and ending on June 12, 
 
            1986. Claimant's inpatient treatment was a direct result of 
 
            his addiction to morphine
 
            
 
                 At the time of hearing, claimant testified that he no 
 
            longer uses morphine.  Therefore, it is found that the 
 
            aggravation of the substance abuse disorder has been 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            alleviated by the treatment.
 
            
 
                 Any further award of lost time benefits would be 
 
            speculative and not supported by medical evidence.
 
            
 
                 Claimant's entitlement to permanent partial disability 
 
            is at issue.  Claimant alleges an entitlement to industrial 
 
            disability due to psychological impairment.  The treating 
 
            doctors failed to issue an impairment rating which 
 
            apportioned the impairment allegedly caused by the 
 
            aggravation of the preexisting substance abuse disorder and 
 
            personality disorder, ex. A, p. 176.  Therefore, claimant 
 
            has failed to prove by a preponderance of the evidence that 
 
            the aggravation of the preexisting disorders resulted in 
 
            permanent partial disability.  Claimant's demand for 
 
            industrial disability also fails as a matter of law in that 
 
            the claimant is compensated for any reduction in earning 
 
            capacity through the schedule.
 
            
 
                 All medical records reveal that the situs of the 
 
            disability is located in the right upper extremity.  
 
            Claimant is entitled to compensation pursuant to Iowa Code 
 
            section 85.34(2)"m".  Three impairment ratings were issued.
 
            
 
                 Dr. Reagan rated the impairment at 71 percent (ex. A, 
 
            p. 157).  His opinion was issued without explanation.  Dr. 
 
            Reagan did not follow claimant throughout his entire period 
 
            of convalescence.
 
            
 
                 Dr. Clendenin rated the impairment at 75 percent (ex. 
 
            A, p. 52).  Dr. Clendenin's report reveals the results of 
 
            the examination, but does not explain how his findings 
 
            relate to impairment.  Furthermore, Dr. Clendenin only saw 
 
            claimant on a few occasions.
 
            
 
                 Finally, Dr. Sauer rated the impairment at 91 percent 
 
            to the right upper extremity (ex. A, p. 50).  Dr. Sauer was 
 
            the treating physician during the majority of claimant's 
 
            healing period.  He treated claimant during a longer period 
 
            of time than the other doctors.  Dr. Sauer explains his 
 
            rating in terms of the AMA Guides to the Evaluation of 
 
            Permanent Impairment.
 
            
 
                 Dr. Sauer's rating and evaluation also coincide with 
 
            the current physical limitations of claimant's right upper 
 
            extremity. At hearing, claimant's right hand appeared 
 
            severely atrophied as compared to the left.  Claimant was 
 
            right hand dominant before the injury.  Claimant has lost 
 
            feeling in his right hand. Claimant is unable to pick up 
 
            small objects such as a pen. Claimant could not use his 
 
            right hand to unbutton his left shirt sleeve when displaying 
 
            his hands to the undersigned.  It should be noted that after 
 
            the exhibition of the injury claimant attempted to button 
 
            his left shirt sleeve with his right hand and was unable to 
 
            do so.  Claimant's attempt to attach the button was not 
 
            solicited by either attorney.  Claimant finally gave up and 
 
            simply pulled his sweater sleeve down over the unbuttoned 
 
            sleeve. Claimant's inability to fasten a button on his shirt 
 
            is demonstrative of the very severe disability incurred to 
 
            the right upper extremity.  Claimant no longer uses his 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            right hand for writing.
 
            
 
                 Dr. Sauer's opinion of 91 percent impairment of the 
 
            right upper extremity is accepted for the following reasons:
 
            
 
                 1.  He was the primary treating physician.
 
            
 
                 2.  He related his impairment rating to the AMA 
 
                 Guides.
 
            
 
                 3.  His rating most accurately reflects the 
 
                 severity of claimant's impairment, and;
 
            
 
                 4.  He followed claimant continuously over a 
 
                 longer period of time.
 
            
 
                 Claimant is entitled to 230 weeks of permanent partial 
 
            disability.
 
            
 
                 The final issue concerns the taxation of costs stated 
 
            in the June 29, 1990 letter from Dr. Bost to Attorney 
 
            Gonnerman.
 
            
 
                 Claimant saw Dr. Bost in order to collect evidence to 
 
            be used at the time of hearing.  The report appears to be an 
 
            independent medical examination used to dispute impairment 
 
            (ex. A, pp. 167-177).  Since claimant failed to list Iowa 
 
            Code section 85.39 at the time of prehearing in August 1990, 
 
            it cannot be considered as an issue at the time of hearing.  
 
            The statement of costs can only be considered under Rule 343 
 
            IAC 4.33 and Iowa Code section 622.72.
 
            
 
                 Claimant is entitled to reimbursement for the cost of 
 
            an expert's report up to $150.  Therefore, defendants shall 
 
            reimburse claimant $150 with respect to the June 29, 1990 
 
            statement of costs.  Defendants shall pay all other costs.                       
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 While a claimant is not entitled to compensation for 
 
            the results of a preexisting injury or disease, the mere 
 
            existence at the time of a subsequent injury is not a 
 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
 
            preexisting condition or disability that is aggravated, 
 
            accelerated, worsened or lighted up so that it results in 
 
            disability, claimant is entitled to recover.  Nicks v. 
 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
 
            (1962).
 
            
 
                 The Iowa Supreme Court cites, apparently with approval, 
 
            the C.J.S. statement that the aggravation should be material 
 
            if it is to be compensable.  Yeager v. Firestone Tire & 
 
            Rubber Co., 253 Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. 
 
            Workmen's Compensation sec. 555(17)a.
 
            
 
                 Claimant has met his burden in proving that the 
 
            February 5, 1983 amputation injury aggravated his 
 
            preexisting substance abuse disorder and personality 
 
            disorder.
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of February 5, 
 
            1983 is causally related to the disability on which he now 
 
            bases his claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 
            N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 296, 18 
 
            N.W.2d 607 (1945).  A possibility is insufficient; a 
 
            probability is necessary.  Burt v. John Deere Waterloo 
 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
            question of causal connection is essentially within the 
 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
            Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). 
 
            
 
                 However, expert medical evidence must be considered 
 
            with all other evidence introduced bearing on the causal 
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id. at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
            Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
            
 
                 Section 85.34(l), Code of Iowa, provides that healing 
 
            period benefits are payable to an injured worker who has 
 
            suffered permanent partial disability until (1) he has 
 
            returned to work; (2) is medically capable of returning to 
 
            substantially similar employment or (3) has achieved maximum 
 
            medical recovery.  The industrial commissioner has 
 
            recognized that healing period benefits can be interrupted 
 
            or intermittent.  Willis v. Lehiqh Portland Cement Company, 
 
            Vol. 2-1, State of Iowa Industrial Commissioner Decisions, 
 
            485 (1984).
 
            
 
                      The end of the healing period occurs at the time 
 
            when the physicians indicate that no further improvement is 
 
            forthcoming.  It is not determined by hindsight looking back 
 
            to find the point at which recovery ceased.  Thomas v. 
 
            William Knudson & Son Inc., 394 N.W.2d 124, 126 (Iowa App. 
 
            1984); Armstrong Tire & Rubber Co. v. Kubli, 312 N.W.2d 60 
 
            (Iowa App. 1981)
 
            
 
                 Claimant has met his burden in proving entitlement to 
 
            an intermittent healing period beginning February 5, 1983 
 
            through April 16, 1985; beginning August 15, 1985 through 
 
            October 15, 1985; and beginning May 13, 1986 through June 
 
            12, 1986.  Further awards of healing period would be 
 
            speculative as the medical evidence does not support any 
 
            other periods of lost time.
 
            
 
                 Claimant has failed to prove the causal connection of 
 
            the February 5, 1983 injury to the medical expenses listed 
 
            in Exhibit B.
 
            
 
                 The right of a worker to receive compensation for 
 
            injuries sustained which arose out of and in the course of 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            employment is statutory.  The statute conferring this right 
 
            can also fix the amount of compensation to be paid for 
 
            different specific injuries, and the employee is not 
 
            entitled to compensation except as provided by the statute.  
 
            Soukup v. Shores Co., 222 Iowa 272, 268 N.W. 598 (1936).
 
            
 
                 If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
            
 
                 Permanent partial disabilities are classified as either 
 
            scheduled or unscheduled.  A specific scheduled disability 
 
            is evaluated by the functional method; the industrial method 
 
            is used to evaluate an unscheduled disability.  Martin v. 
 
            Skelly Oil Co., 252 Iowa 128, 133, 106 N.W.2d 95, 98 (1960); 
 
            Graves v. Eaqle Iron Works, 331 N.W.2d 116 (Iowa 1983); 
 
            Simbro v. DeLong's Sportswear, 332 N.W.2d 886, 887 (Iowa 
 
            1983).
 
            
 
                 A claimant may not recover benefits for industrial 
 
            disability if the injury is to a scheduled member and not to 
 
            the body as a whole even when psychological problems affect 
 
            earning capacity.  A claimant is compensated for any 
 
            reduction in earning capacity through the schedule.  The 
 
            scheduled loss system created by the legislature is presumed 
 
            to include compensation for reduced capacity to labor and to 
 
            earn.  Schell v. Central Engineering Co., 232 Iowa 421, 4 
 
            N.W.2d 399 (1942); Pilcher v. Penick and Ford, file number 
 
            618597 Industrial Commissioner (Appeal Decision October 21, 
 
            1987); Cannon v. Keokuk Steel Casting, file number 795331 
 
            Industrial Commissioner (Appeal Decision January 27, 1988).
 
            
 
                 Claimant has requested an award of industrial 
 
            disability. Claimant's injury and impairment are limited to 
 
            the right upper extremity.  Psychological impairment and 
 
            loss of earning capacity attributable to the aggravation 
 
            have not been demonstrated.  The undersigned is without 
 
            jurisdiction to award industrial disability in a scheduled 
 
            member case.  As a matter of law, the claimant is not 
 
            entitled to industrial disability.
 
            
 
                 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.  
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            Rockwell Graphics Systems, Inc. v. Prince, 366 N.W.2d 187, 
 
            192 (Iowa 1985).
 
            
 
                 The Guides of the Evaluation of Permanent Impairment, 
 
            published by the American Medical Association, are adopted 
 
            as a guide for determining permanent partial disability 
 
            under Iowa Code section 85.34(2) "a" - "r".  Rule 343 IAC 
 
            2.4.
 
            
 
                 Upon considering all material factors, it is found that 
 
            the evidence in this case supports an award of 91 percent 
 
            permanent partial disability which entitles the claimant to 
 
            recover 230 weeks of benefits under Iowa Code section 
 
            85.34(2) "m" as a result of the injury to claimant's right 
 
            upper extremity.
 
            
 
                 The commencement date for permanent partial disability 
 
            shall be April l7, 1985 and such disability shall be paid 
 
            intermittently before and after the healing periods.  
 
            
 
                 All costs incurred in the hearing before the deputy 
 
            commissioner shall be taxed in the discretion of the deputy 
 
            commissioner unless otherwise required by the rules of civil 
 
            procedure governing discovery.  Iowa Code section 86.40, 
 
            Rule 343 IAC 4.33.
 
            
 
                 A deputy commissioner is without jurisdiction to 
 
            consider an issue not listed as an issue on the hearing 
 
            assignment order. See Joseph Presswood v. Iowa Beef 
 
            Processors, (Appeal Decision filed November 14, 1986) 
 
            holding an issue not noted on the hearing assignment order 
 
            is an issue that is waived.
 
            
 
                 Witnesses called to testify only to an expert opinion 
 
            shall receive compensation to be fixed by the deputy 
 
            commissioner not to exceed $150 per day while so employed.  
 
            Iowa Code section 62.72.
 
            
 
                 Claimant has requested reimbursement for costs listed 
 
            in Dr. Bost's letter of June 29, 1990.  Dr. Bost's charges 
 
            were for a section 85.39 medical examination to be used 
 
            exclusively for trial.  The undersigned is without 
 
            jurisdiction to decide the section 85.39 issue.  Costs are 
 
            awarded for the June 29, 1990 statement in the amount of 
 
            $150 pursuant to Rule 343 IAC 4.33. All other costs are 
 
            assessed against defendants.
 
            ORDER
 
            
 
                      THEREFORE IT IS ORDERED:
 
            
 
                 Defendants are to pay claimant one hundred twenty-seven 
 
            (127) weeks of healing period benefits at the rate of three 
 
            hundred eight and 02/100 dollars ($308.02) for the periods 
 
            February 5, 1983 through April 16, 1985; August 15, 1985 
 
            through October 15, 1985; and May 13, 1986 through June 12, 
 
            1986.
 
            
 
                 Defendants are to pay claimant two hundred thirty (230) 
 
            weeks of permanent partial disability benefits at the rate 
 
            of three hundred eight and 02/100 dollars ($308.02) per week 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            commencing April 17, 1985, and to be paid intermittently.
 
            
 
                 Defendants are entitled to a credit for any benefits 
 
            previously paid to claimant.
 
            
 
                 Defendants to pay accrued amounts in a lump sum.
 
            
 
                 Defendants to pay interest pursuant to Iowa Code 
 
            section 85.3.
 
            
 
                 Defendants to pay costs pursuant to rule 343 IAC 4.33.
 
            
 
                 Defendants to file claim activity reports as required 
 
            by this agency pursuant to rule 4.33 IAC 3.1.
 
            
 
                 Signed and filed this _______  day of February, 1990.
 
            
 
            
 
            
 
                                          ______________________________
 
                                          MARLON D. MORMANN
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies to:
 
            
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            Mr. Donald Gonnerman
 
            Attorney at Law
 
            4200 University Ave. STE 305
 
            West Des Moines, Iowa 50265
 
            
 
            Mr. David L. Brown
 
            Mr. John E. Swanson
 
            Attorneys at Law
 
            8th Floor Fleming Bldg.
 
            Des Moines, Iowa 50309
 
            
 
 
            
 
            
 
            
 
            
 
            
 
                                          51802; 51803; 52204; 51803.1; 
 
                                          52503; 52907
 
                                          Filed February 5, 1991
 
                                          Marlon D. Mormann
 
            
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                                          :
 
            ROY E. HONEYWELL, II,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :         File No. 833232
 
            ALLEN DRILLING CO.,           :
 
                                          :      A R B I T R A T I O N
 
                 Employer,                :
 
                                          :         D E C I S I O N
 
            and                           :
 
                                          :
 
            BITUMINOUS CASUALTY CORP.,    :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            51802 51803
 
            Claimant's right arm was amputated and reattached.  Claimant 
 
            was awarded intermittent healing period and 91 percent 
 
            permanent partial disability.
 
            
 
            52204 51803.1
 
            It was found that the injury aggravated claimant's 
 
            preexisting psychological disorder.  Claimant was not 
 
            awarded industrial disability as impairment for the 
 
            aggravation was not apportioned and the scheduled member 
 
            benefits compensated claimant for his loss in earnings 
 
            capacity.
 
            
 
            52503
 
            Claimant failed to establish entitlement to medical expenses 
 
            incurred subsequent to intervening injury.
 
            
 
            52907
 
            Costs of an independent medical examination limited to $150 
 
            pursuant to Iowa Code section 622.72.
 
            
 
            
 
 
 
 
 
 
 
 
 
 
 
 
 
 
            BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
_________________________________________________________________
 
ROY E. HONEYWELL, II,      
 
            
 
     Claimant,   
 
            
 
vs.         
 
                                         File No. 833232
 
ALLEN DRILLING CO.,   
 
                                           R E M A N D
 
     Employer,   
 
                                          D E C I S I O N
 
and         
 
            
 
BITUMINOUS CASUALTY CORP.,      
 
            
 
     Insurance Carrier,    
 
     Defendants.      
 
_________________________________________________________________
 
This case is on remand pursuant to Honeywell v. Allen Drilling Co., 506 
 
N.W.2d 434 (Iowa 1983), in which the court concluded that as a matter 
 
of law claimant has established a psychological impairment and loss of 
 
earning capacity as a result of the work-related injury.  This case has 
 
been remanded to the industrial commissioner for a determination of 
 
industrial disability benefits.
 
 
 
The issue on remand is the extent of claimant's industrial disability.  
 
Only the facts germane to this issue will be discussed.
 
 
 
                           FINDINGS OF FACT
 
 
 
Roy E. Honeywell, II, claimant, was born September 14, 1961 and was 21 
 
years old at the time of his February 5, 1983 work injury.  His work 
 
experience consisted of working as a roughneck for a drilling company.  
 
At the time of the injury, he was a derrick hand working seven days per 
 
week with no instances of absenteeism.  After the injury, claimant 
 
returned to school and completed a four-year college degree and 
 
received a bachelor of science in economics with a major/minor in 
 
banking finance, a minor in accounting and a minor in business 
 
administration.  (Transcript, page 23)  At the time of his injury 
 
claimant was earning eight per hour plus $30 a day for expenses.  (Tr., 
 
p. 52)  After the injury claimant worked in jobs that paid $7-8 per 
 
hour. (Tr., p. 63)  Claimant was motivated to work both before and 
 
after the injury.
 
 
 
Roy Honeywell, II, received a complete amputation of his right upper 
 
extremity at the mid-forearm on February 5, 1983, arising out of and in 
 
the course of employment with employer Allen Drilling Company.
 
 
 
On the same day of the amputation claimant was taken to Des_Moines, 
 
Iowa, where Douglas Reagan, M.D., reattached the limb.  The surgery to 
 
reattach the extremity was successful.  A prolonged period of 
 
convalescence followed.  While hospitalized for the injury claimant was 
 
administered morphine, codeine and demerol for pain.  Claimant 
 
testified that he became addicted to the drugs as a result of the 
 

 
 
 
 
 
 
 
 
 
hospitalization.  Prior to claimant's work injury he had used alcohol, 
 
marijuana and other "street" drugs.
 
 
 
From his records, Dr. Reagan on March 25, 1987 rated claimant as having 
 
a permanent partial disability of 71 percent of the right upper 
 
extremity.  (Ex. A, p. 157)  Karl F. Sauer, M.D., on April 17, 1985 
 
rated claimant as having sustained a 92 percent impairment of the right 
 
upper extremity.  (Ex. A, p. 50)  On April 19, 1985 Michael B. 
 
Clendenin, M.D., rated claimant as having a 75 percent permanent 
 
partial impairment of the right upper extremity.  Claimant testified 
 
that he has adapted so that he can paint and hang sheetrock.  (Tr., p. 
 
40)
 
 
 
The deputy industrial commissioner observed the following at the 
 
evidentiary hearing.  Claimant could not use his right hand to unbutton 
 
his left shirt sleeve when displaying his hands.  After the exhibition 
 
of the injury claimant attempted to button his left shirt sleeve with 
 
his right hand and was unable to do so.  Claimant's attempt to attach 
 
the button was not solicited by either attorney.  Claimant finally gave 
 
up and simply pulled his sweater sleeve down over the unbuttoned 
 
sleeve.
 
 
 
In 1978 when claimant was 18 years old he was admitted to Sparks 
 
Medical Center at the request of his parents.  Regular alcohol use, 
 
some THC use and an episode of an overdose of Elavil a year prior were 
 
noted.  The final diagnosis was adolescent adjustment reaction.  (Ex. 
 
A, pp. 2, 3)
 
 
 
In May 1986 (after the February 5, 1983 work injury) claimant was 
 
arrested for public intoxication, subsequently made a suicide gesture 
 
and was transferred to the Oklahoma Osteopathic Hospital Drug Treatment 
 
Center.  The diagnosis was drug dependency.  (Ex. A, pp. 61, 73)  A 
 
history of opiate drug abuse for the last four years and some cocaine 
 
abuse at times were noted.  (Ex. A, p. 64)  David A. Harris, D.O., 
 
referred claimant to Richard Bost, Ph.D., clinical health psychologist 
 
and licensed psychologist.  Dr. Harris' diagnosis, as attending 
 
physician, was multiple drug abuse.  (Ex. A, p. 90)
 
 
 
On April 11, 1988 claimant was committed to Carl Albert Community 
 
Mental Health Center in McAlester, Oklahoma pursuant to a petition 
 
filed by his wife alleging physical abuse.  It was noted that claimant 
 
had been treated for chemical dependence at Eastern State Hospital, 
 
Sparks Hospital and Oklahoma Osteopathic Hospital.  The diagnosis by 
 
Lawrence H. Trombka, M.D., included:  Axis I:  Alcohol abuse; sedative, 
 
hypnotic or anxiolytic abuse; and cannabis abuse and Axis II:  
 
Antisocial personality disorder.  (Ex. A, pp. 161-165)
 
 
 
Dr. Bost wrote a psychological evaluation of claimant following 
 
evaluations on December 12, 1989; April 2, 1990; and May 11, 1990.  Dr. 
 
Bost noted that claimant's good intellectual ability, as indicated by 
 
his ability to complete a college degree, was likely to be helpful in 
 
managing his impulsiveness.  Dr. Bost also noted a moderate depression 
 
which was not likely to impair claimant's ability to carry out his 
 
daily activities.  (Ex. A, p. 173)  Dr. Bost's diagnosis included:  
 
Axis I:  Psychoactive Substance Use Disorder and Axis II:  Antisocial 
 
Personality Disorder.  (Ex. A, p. 175)  It was Dr. Bost's opinion that 
 
claimant's work injury trauma may have precipitated an acute worsening 
 
of the personality disorder and the substance use disorder.  (Ex. A, p. 
 
76)  Dr. Bost noted: 
 
 
 
The Personality Disorder experienced by the patient almost certainly 
 
impairs his ability to relate successfully to co-workers.  It is 
 
probably the major reason he has had such difficulty securing a job 
 
appropriate to his college-level education.  In addition, the physical 
 
activity that the patient finds helpful in reducing his emotional 
 
distress from the Personality Disorder is incompatible with the 
 
sedentary activities usually expected of someone engaged in a business 
 

 
 
 
 
 
 
 
 
 
or finance-related job.  The construction-related jobs to which he has 
 
gravitated allow him to engage in more physical activity and allow him 
 
to avoid the extensive social contacts involved in the sedentary work 
 
activities appropriate to his education.  This impairment has probably 
 
been a major factor in his being under-employed.  
 
 
 
(Ex. A, p. 177)  Dr. Bost rated claimant's collect impairment as 
 
moderate to severe - 55 to 75 percent.  (Ex. A, p. 177)
 
 
 
Claimant was evaluated by Samuel L. Graham, Ph.D., a licensed 
 
psychologist on November 12, 1990.  Dr. Graham offered opinions within 
 
a reasonable degree of psychological certainty.
 
 
 
Mr. Honeywell's primary psychological disorders are his Drug Abuse and 
 
a Personality Disorder with Mixed Schizoid and Anti-social Features.  
 
His anxiety and depressive symptoms would appear to be secondary to his 
 
substance abuse and personality disorder.  It is likely that all, or 
 
most, of these symptoms would clear with a cessation of his drug abuse. 
 
 
 
If they did not, then there is a good probability that they would be 
 
amenable to psychiatric and psychological treatment....
 
 
 
It is my opinion that the Primary Personality Disorder and Substance 
 
Abuse Disorder are pre-existing conditions, which clearly predate his 
 
work-related accident.  The work-related accident does appear to have 
 
played a aggravating role in terms of his drug abuse and antisocial 
 
behavior, but quantitatively, the aggravation does not appear great.  
 
If Mr. Honeywell continues his pattern of drug abuse, it is likely that 
 
he will continue to experience problems securing and maintaining 
 
employment.  If he were to discontinue his pattern of drug abuse and if 
 
his psychological discomforts continued and were treated aggressively 
 
with psychological and psychiatric treatment, it is quite likely that 
 
he would be able to maintain employment within the limitations of his 
 
current phsyical [sic] capabilities.
 
 
 
(Ex. A, p. 180)
 
 
 
Dr. Graham thought that claimant was capable of employment (Tr., p. 
 
102) but that the probability of securing and maintaining employment 
 
would be much better if claimant were to eliminate his drug use 
 
behavior.  (Tr., p. 98)  It was Dr. Graham's opinion that claimant had 
 
a 20 to 30 percent psychological/psychiatric impairment.  (Tr., p. 129)
 
 
 
                       CONCLUSIONS OF LAW
 
 
 
The sole issue to be resolved on remand is the extent of claimant's 
 
industrial disability.
 
 
 
The party who would suffer loss if an issue were not established has 
 
the burden of proving that issue by a preponderance of the evidence.  
 
Iowa R. App. P. 14(f).
 
 
 
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 the employee is fitted.  Olson v. Goodyear Serv. 
 
Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963); Barton v. Nevada Poultry, 
 
253 Iowa 285, 110 N.W.2d 660 (1961).
 
 
 
A finding of impairment to the body as a whole found by a medical 
 
evaluator does not equate to industrial disability.  Impairment and 
 
disability are not synonymous.  The degree of industrial disability can 
 
be much different than the degree of impairment because industrial 
 
disability references to loss of earning capacity and impairment 
 
references to anatomical or functional abnormality or loss.  Although 
 
loss of function is to be considered and disability can rarely be found 
 
without it, it is not so that a degree of industrial disability is 
 
proportionally related to a degree of impairment of bodily function.
 

 
 
 
 
 
 
 
 
 
 
 
Factors to be considered in determining industrial disability include 
 
the employee's medical condition prior to the injury, immediately after 
 
the injury, and presently; the situs of the injury, its severity and 
 
the length of the healing period; the work experience of the employee 
 
prior to the injury and after the injury and the potential for 
 
rehabilitation; the employee's qualifications intellectually, 
 
emotionally and physically; earnings prior and subsequent to the 
 
injury; age; education; motivation; functional impairment as a result 
 
of the injury; and inability because of the injury to engage in 
 
employment for which the employee is fitted.  Loss of earnings caused 
 
by a job transfer for reasons related to the injury is also relevant.  
 
 
 
Likewise, an employer's refusal to give any sort of work to an impaired 
 
employee may justify an award of disability.  McSpadden v. Big Ben Coal 
 
Co., 288 N.W.2d 181 (Iowa 1980).  These are matters which the finder of 
 
fact considers collectively in arriving at the determination of the 
 
degree of industrial disability.
 
 
 
There are no weighting guidelines that indicate how each of the factors 
 
are to be considered.  Neither does a rating of functional impairment 
 
directly correlate to a degree of industrial disability to the body as 
 
a whole.  In other words, there are no formulae which can be applied 
 
and then added up to determine the degree of industrial disability.  It 
 
therefore becomes necessary for the deputy or commissioner to draw upon 
 
prior experience as well as general and specialized knowledge to make 
 
the finding with regard to degree of industrial disability.  See 
 
Christensen v. Hagen, Inc., Vol. 1 No. 3 State of Iowa Industrial 
 
Commissioner Decisions 529 (App. March 26, 1985); Peterson v. Truck 
 
Haven Cafe, Inc., Vol. 1 No. 3 State of Iowa Industrial Commissioner 
 
Decisions 654 (App. February 28, 1985).
 
 
 
Compensation for permanent partial disability shall begin at the 
 
termination of the healing period.  Compensation shall be paid in 
 
relation to 500 weeks as the disability bears to the body as a whole.  
 
Iowa Code section 85.34.
 
 
 
Claimant was 21 at the time of his injury.  The injury resulted in a 
 
severe functional loss of the right upper extremity.  The functional 
 
loss ratings of the right upper extremity range from 71 percent to 92 
 
percent.  Claimant is a high school graduate who completed college 
 
after the injury.  Claimant has the intellectual capability of being 
 
retrained.  His prior work experience was limited because of his age.  
 
Claimant is employable and testified to adapting his work to the 
 
demands of physical labor.  Claimant's earnings are approximately the 
 
same after the injury as before.
 
 
 
Claimant has psychological conditions that were aggravated by his work 
 
injury.  (The supreme court noted as a matter of law that claimant had 
 
established a psychological impairment as a result of the work-related 
 
injury.  Honeywell v. Allen Drilling Co., 506 N.W.2d 434 at 438)  
 
Claimant's psychological impairment ratings range from 20 to 75 
 
percent.  He has been diagnosed as having a substance abuse disorder 
 
and a personality disorder.  Dr. Bost was of the opinion that 
 
claimant's personality disorder resulted in under-employment.  Dr. 
 
Graham was of the opinion that the substance abuse disorder hampers 
 
claimant's employment prospects.  There is insufficient evidence in 
 
this record to find that claimant's psychological disorders were 
 
disabling prior to his work injuries.  When all relevant factors are 
 
considered claimant has suffered a 60 percent industrial disability as 
 
a result of his February 5, 1983 work injury.
 
 
 
                            ORDER
 
 
 
THEREFORE, it is ordered:
 
 
 
That defendants are to pay claimant three hundred (300) weeks of 
 

 
 
 
 
 
 
 
permanent partial disability benefits at the rate of three hundred 
 
eight and 02/100 dollars ($308.02) per week commencing April 17, 1985 
 
and to be paid intermittently as interrupted by the healing period 
 
ordered in the October 31, 1991 appeal decision.
 
 
 
That defendants shall pay accrued weekly benefits in a lump sum.
 
 
 
That defendants shall pay interest on unpaid weekly benefits awarded 
 
herein as set forth in Iowa Code section 85.30.
 
 
 
That defendants are to be given credit for benefits previously paid.
 
 
 
That defendants shall file claim activity reports as required by this 
 
agency pursuant to rule 343 IAC 3.1(2).
 
 
 
Signed and filed this ____ day of December, 1994.      
 
                               ________________________________                 
 
                               BYRON K. ORTON          
 
                               INDUSTRIAL COMMISSIONER
 
 
 
Copies To:
 
 
 
Mr. Donald Gonnerman
 
Attorney at Law
 
3398 335th St.
 
Waukee, Iowa 50263
 
 
 
Mr. John E. Swanson
 
Attorney at Law
 
Eighth Floor, Fleming Bldg.
 
218 Sixth Ave.
 
Des Moines, Iowa 50309
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                  1803
 
                                  Filed December 22, 1994
 
                                  Byron K. Orton
 
 
 
           BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
_________________________________________________________________
 
            
 
ROY E. HONEYWELL, II,      
 
            
 
     Claimant,   
 
            
 
vs.         
 
                                       File No. 833232
 
ALLEN DRILLING CO.,   
 
                                        R E M A N D
 
     Employer,   
 
                                       D E C I S I O N
 
and         
 
            
 
BITUMINOUS CASUALTY CORP.,      
 
            
 
     Insurance Carrier,    
 
     Defendants.      
 
_________________________________________________________________
 
 
 
1803
 
 
 
This case was remanded by the Iowa Supreme Court, Honeywell v. Allen 
 
Drilling Co., 506 N.W.2d 434 (Iowa 1993), to determine claimant's loss 
 
of earning capacity.
 
 
 
Claimant was 22 at time of injury to right upper extremity.  Claimant 
 
had functional loss ratings of 71-92 percent of the upper extremity.  
 
Claimant's substance abuse disorder and personality disorder were 
 
aggravated by his work injury.  Claimant's psychological impairment 
 
ratings ranged from 20 to 75 percent.  Claimant was employable.  
 
Claimant was found to have sustained a 60 percent industrial disability 
 
as a result of his work-related injury.
 
 
 
 
         
 
         Page   1
 
         
 
         
 
         
 
         
 
         before the iowa industrial commissioner
 
         _________________________________________________________________
 
                                       :
 
         ROY E. HONEYWELL, II,         :
 
                                       :
 
              Claimant,                :
 
                                       :      File No. 833232
 
         vs.                           :
 
                                       :         O R D E R
 
         ALLEN DRILLING CO.,           :
 
                                       :          N U N C  
 
              Employer,                :
 
                                       :           P R O     
 
         and                           :
 
                                       :          T U N C
 
         BITUMINOUS CASUALTY CORP.,    :
 
                                       :
 
              Insurance Carrier,       :
 
              Defendants.              :
 
         _________________________________________________________________
 
         The arbitration decision filed February 5, 1991, contained an 
 
         error in computation.  The arbitration decision and the appeal 
 
         decision filed October 31, 1991 incorporating the arbitration 
 
         decision are hereby amended as follows:
 
         Defendants are to pay claimant two hundred twenty-seven and 
 
         five/tenths (227.5) weeks of permanent partial disability 
 
         benefits at the rate of three hundred eight and 02/100 dollars 
 
         ($308.02) per week commencing April 17, 1985, and to be paid 
 
         intermittently. 
 
         Signed and filed this ____ day of March, 1992.
 
         
 
         
 
         
 
         
 
                   ________________________________
 
                            BYRON K. ORTON
 
                       INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Donald Gonnerman
 
         Attorney at Law
 
         4200 University Ave., Ste 305
 
         West Des Moines, Iowa 50265
 
         
 
         Mr. David L. Brown
 
         Mr. John E. Swanson
 
         Attorneys at Law
 
         8th Floor Fleming Bldg.
 
         Des Moines, Iowa 50309
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         VICKI L. FERDIG,
 
         
 
              Claimant,
 
                                                      File No. 833234
 
         vs.
 
                                                   A R B I T R A T I O N
 
         JOHN MORRELL & COMPANY,
 
                                                      D E C I S I O N
 
              Employer,
 
         
 
         and                                             F I L E D
 
         
 
         NATIONAL UNION FIRE                            APR 27 1988
 
         INSURANCE COMPANY,
 
                                               IOWA INDUSTRIAL COMMISSIONER
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by the claimant, 
 
         Vicki L. Ferdig (Witkowski), against her employer, John Morrell & 
 
         Company, and its insurance carrier, National Union Fire Insurance 
 
         Company, to recover benefits under the Iowa Workers' Compensation 
 
         Act as a result of an injury sustained on August 8, 1986.  This 
 
         matter came on for hearing before the undersigned deputy 
 
         industrial commissioner at Sioux City, Iowa on February 1, 1988.  
 
         A first report of injury was filed on October 28, 1986.
 
         
 
              The record in this proceeding consists of the testimony of 
 
         claimant, of Rexanne Smith, R.N., and of claimant's exhibits 1 
 
         through 5 and 9 through 12 as well as of joint exhibits 1 through 
 
         12.
 
         
 
                                     ISSUES
 
         
 
              Pursuant to the pre-hearing report, the parties stipulated 
 
         that claimant's rate of weekly compensation is $231.41; that 
 
         claimant did receive an injury arising out of and in the course 
 
         of her employment on the injury date; and, that the provider of 
 
         medical services would testify that the charges were reasonable 
 
         charges and were for reasonable and necessary services.
 
         
 
              The issues remaining for resolution are:
 
         
 
              Whether a causal relationship exists between claimant's 
 
         injury and her claimed disability;
 
         
 
              Whether claimant is entitled to benefits and the nature and 
 
                                                
 
                                                         
 
         extent of any benefit entitlement, including the commencement 
 
         date for any permanent partial disability and time off work for 
 
         which temporary total disability should be paid; and,
 
         
 
              Whether claimant is entitled to payment of certain medical 
 
         costs as causally connected to the work injury and authorized by 
 
         the defendants.
 
         
 
                           REVIEW OF THE EVIDENCE
 
         
 
              Claimant, Vicki L. Ferdig Witkowski, testified that she is 
 
         currently married and has three children.  She reported that she 
 
         is a high school graduate who attained a "C" average during her 
 
         high school course work.  Claimant reported that she had been 
 
         employed in the Sioux City Parks and Recreation Department during 
 
         her last two years in high school and that, while there, she was 
 
         a playground helper who worked with children doing crafts as well 
 
         as arranging equipment for different activities.  Claimant's 
 
         initial post-high school employment was at Iowa Beef where she 
 
         initially ran a tipper machine packaging 10-pound sirloins.  She 
 
         reported that she worked eight hours per day, six days per week 
 
         and went from a salary of $3.50 per hour initially to $8.45 per 
 
         hour when she left.  Also, at Iowa Beef, claimant worked as a 
 
         trimmer of top sirloin using an eight-inch blade trimming knife.  
 
         She characterized the knife as weighing a couple of pounds.  
 
         Claimant left that employment voluntarily and took a job as a 
 
         bank teller earning approximately $100 per week.  At the bank, 
 
         she worked with customers, handled cash and checks and filed 
 
         checks as they were returned.
 
         
 
              Claimant began work at Iowa Meat Processors, which is now 
 
         John Morrell, in 1981.  She reported that she worked on the 
 
         boning line for approximately six months using a wizard knife and 
 
         then went to the kill floor where she trimmed hog snouts.  She 
 
         also used a wizard knife for this job.  She was trimming cheeks 
 
         when injured.  Claimant reported that she had work-related 
 
         trigger finger and tendonitis of the left wrist in 1984.  She 
 
         required two surgeries for the left wrist condition and had 
 
         received workers' compensation benefits for both conditions, but 
 
         denied having continuing problems.  Claimant denied that she had 
 
         ongoing headache or neck or shoulder pain prior to August 8, 
 
         1986. Claimant reported that, on that date, at approximately 5:45 
 
         a.m., she injured herself when her feet went out from under her 
 
         as she was descending stairs to her locker.  Claimant reported 
 
         that she landed on her elbow and right side and went down 
 
         approximately eight steps.  Claimant stated that she went to the 
 
         nurse's office where she was bandaged for an abrasion of her 
 
         right elbow and then returned to work and finished her work day.  
 
         Claimant stated that, on the following day, a Saturday, her neck 
 
         was stiff and she had a slight headache.  On Monday morning she 
 
         saw Milton D. Grossman, M.D., the company doctor.  She continued 
 
         working, but received heat treatments for four days.  Claimant 
 
         reported she had daily headaches at the base of her skull for 
 
         which she took approximately 9-12 Advil per day.  She indicated 
 
         that she saw her family doctor, Cecil G. Cunningham, D.O.  She 
 
                                                
 
                                                         
 
         reported that Dr. Cunningham took her off work and connected 
 
         headache complaints to her fall at work.  Dr. Cunningham 
 
         apparently prescribed manipulative treatment, Flexeril and 
 
         Halcion.  Claimant returned to work on November 24, 1986.  She 
 
         worked until the plant's strike on March 9, 1987, but reported 
 
         she did so with daily headache and neck stiffness.  She reported 
 
         that she continued to have intermittent sleeping problems, that 
 
         is, approximately two or three times per week.  After the strike, 
 
         claimant initially worked as a bartender for approximately five 
 
         months and has subsequently worked at Pack Fabricators since 
 
         September 2, 1987.  She trims hams for 60 hours per week, albeit 
 
         while still having headaches. Claimant reported that her 
 
         headaches do not decrease in frequency when she does not work.  
 
         Claimant reported that she is now treating with Brian McCloy, 
 
         D.C., approximately once per week and still takes 9-12 aspirin 
 
         per day.  Claimant self-reported that she cannot get her head 
 
         back as far as she once could and that she has strain when she 
 
         tries to look to the left or right or tilt her head upward.
 
         
 
              On cross-examination, claimant denied that her counsel had 
 
         referred her to Dr. Cunningham and opined that she did not 
 
         believe her headaches had improved, even if Dr. Cunningham's 
 
         notes would so reflect.
 
         
 
              Claimant reported that she had seen Dr. McCloy a total of 
 
         six times and stated that, while she had seen him weekly until 
 
         last month, she could no longer do so since her employer does not 
 
         let her off to see a medical practitioner.
 
         
 
              Claimant is now earning $5.75 per hour.
 
         
 
              Claimant denied that she had been thinking of leaving the 
 
         meat packing industry subsequent to her 1983 left arm surgery.  
 
         She could not recall either having a 10-pound lifting restriction 
 
         following that injury or having been told that she had deQuavain's 
 
         disease at that time.  She reported that she did discuss 
 
         vocational rehabilitation with state counselors, but decided she 
 
         could not quit her job to learn something else.  Claimant did 
 
         agree that she had taken and passed a typing course, however.
 
         
 
              Claimant reported that she is a John Morrell union member 
 
         and indicated that, if the work stoppage at the plant is 
 
         resolved, she plans to return to work at John Morrell.  Claimant 
 
         agreed that she had never asked anyone at John Morrell if she 
 
         could see Dr. Cunningham, stating that she went to see Dr. 
 
         Cunningham because of her headaches and not because she had 
 
         fallen down stairs.
 
         
 
              Claimant agreed that she landed on her right side, 
 
         approximately three inches from the waist, with her elbow on the 
 
         steps.  She did not hit her head in the fall.  Claimant agreed 
 
         that she had never discussed seeing a specialist for headache 
 
         with anyone at John Morrell.  Claimant denied that she had had 
 
         headaches with ear infections, although she said she was off work 
 
         one time for an ear infection.
 
                                                
 
                                                         
 
         
 
              Rexanne Smith, R.N., reported that she is employed at John 
 
         Morrell and was working for the company in August, 1986.  Ms. 
 
         Smith reported that nursing notes relative to claimant do not 
 
         reflect that claimant requested to see Dr. Cunningham.  Ms. Smith 
 
         stated that, had claimant so requested, claimant would have been 
 
         told she could see only the authorized company doctor.
 
         
 
              Cecil G. Cunningham, M.D., testified by way of his 
 
         deposition taken January 26, 1988.  Dr. Cunningham is a certified 
 
         general surgeon who has practiced in the Sioux City area since 
 
         1965 having graduated from osteopathic college in 1957.  The 
 
         doctor reported that, after determining that claimant had a 
 
         whiplash type injury through x-ray evaluation, he started a 
 
         program of osteopathic manipulative treatment with soft tissue 
 
         massage to achieve more neck range of motion.  He reported he 
 
         also tried intermittent cervical traction, spinalator and 
 
         diathermy.  He reported that claimant's symptoms persisted, 
 
         notwithstanding treatment rendered. The doctor reported his 
 
         diagnosis as cervical whiplash suboccipital, neuralgia and 
 
         cephalalgia, all caused by the fall down stairs and resulting in 
 
         the 12% permanent partial impairment or disability previously 
 
         stated.
 
         
 
              In a report of Dr. McCloy, Dr. Cunningham characterized 
 
 
 
                           
 
                                                         
 
         statements that claimant may have no permanent impairment as 
 
         being contradictory.  Dr. Cunningham explained that future 
 
         treatment referred to would indicate some permanent impairment.  
 
         Dr. Cunningham agreed that he had referred claimant to Dr. McCloy 
 
         for manipulative therapy only, but that he himself remained 
 
         claimant's primary treating physician for her condition.
 
         
 
              Dr. Cunningham reported claimant had stated (on an initial 
 
         visit of September 23, 1984) that she had headaches for two weeks 
 
         off and on following a fall approximately a month earlier.  He 
 
         reported he had not questioned her as to whether she had had 
 
         headache immediately after the fall.  The doctor reported that he 
 
         supposed he had checked claimant's active and passive neck range 
 
         of motion, but he had not recorded it.  [The doctor did record 
 
         severe muscle spasm throughout the cervical spine on the 
 
         September 23, 1986 examination of claimant.]  The doctor reported 
 
         that headaches have many common causes and can occur from 
 
         accidents, allergies, ordinary tension, work posture, stresses 
 
         and strains of ordinary life, from shoveling snow, from 
 
         environmental factors such as hot and cold, from toothache, and 
 
         from eye problems.  The doctor reported he had not considered as 
 
         necessary a myelogram or CT scan or other diagnostic procedures 
 
         as the "accident quite evidently caused the thing."  He indicated 
 
         he had found nothing, other than the accident, by visually 
 
         looking at the patient, that caused "it."
 
         
 
              Dr. Cunningham reported that, on February 12, (1987), he 
 
         gave claimant an antibiotic and decongestant for cold and for 
 
         throat inflammation and that, on October 13, 1987, he treated her 
 
         for bilateral earache with antibiotic and cough syrup.  The 
 
         doctor reported he has not made subsequent x-rays and agreed that 
 
         the only way to tell absolutely that a patient has reversal of 
 
         the cervical curve would be with further x-rays and by comparing 
 
         them with the original x-rays.  The doctor reported that his 
 
         impairment rating was based upon his personal experience with 
 
         large numbers of patients over time and was not based on either 
 
         the AMA guides or orthopaedic guide.  The doctor reported that he 
 
         distinguished between impairment and disability in that an 
 
         impairment would probably be impairment of function and 
 
         disability would be what you could not do because of this 
 
         impairment and this his rating would probably be a "disability 
 
         rating."
 
         
 
              In an earlier report of June 29, 1987, Dr. Cunningham stated 
 
         that injuries such as claimant's take considerable time, often as 
 
         much as two or three years, to resolve.  In notes of November 28, 
 
         1986 and December 8, 1986, he reported claimant's headache as 
 
         having gone.
 
         
 
              Dr. Cunningham identified claimant's exhibit 5 as a 
 
         statement of account for his services and stated that it included 
 
         charges for three manipulations performed by Dr. McCloy for which 
 
         he had already paid Dr. McCloy.  Exhibit 5 reports medical 
 
         service not related to the work-related injury of $31.00 and 
 
         otherwise includes charges of $758.00, generally for manipulation 
 
                                                
 
                                                         
 
         and other services, but also for x-rays.
 
         
 
              On August 11, 1986, Milton D. Grossman, M.D., reported that 
 
         claimant had fallen down stairs with complaints in her right arm, 
 
         neck and leg.  He reported that claimant had pain in the right 
 
         shoulder and elbow on motion, but complete range of motion of 
 
         shoulder and elbow, an abrasion on the right elbow and a muscle 
 
         bruise on the right thigh.  Diagnosis was of a right contusion of 
 
         the right shoulder and elbow.  On September 24, 1986, Dr. 
 
         Grossman reported that claimant complained of neck pain since 
 
         falling down stairs and that she had had occipital headache since 
 
         September 20, 1986.  Claimant had full range of motion of the 
 
         neck.  Dr. Grossman opined that claimant could return to work 
 
         September 26, 1986 without restrictions.
 
         
 
              On September 24, 1986, G. Shay, M.D., a radiologist, 
 
         interpreted films apparently of Drs. Krigsten and Grossman taken 
 
         on September 24, 1986 of claimant's cervical spine in flexion and 
 
         extension as demonstrating no evidence of fracture, dislocation 
 
         or subluxation.  He reported there was no evidence of subluxation 
 
         or slippage in either flexion or extension with alignment perfect 
 
         and interspaces normal and lipping negligible.
 
         
 
              John J. Dougherty, M.D., of Orthopaedic Associates of Sioux 
 
         City, P.C., evaluated claimant on October 26, 1987.  The doctor 
 
         characterized as "a little unusual" that claimant would fall 
 
         down, land on her "rump," bruise her elbow and then her shoulder 
 
         bothered her with her neck apparently not bothering her for some 
 
         time.  He stated that claimant apparently did not have any 
 
         headache at that time.  The doctor did not believe that claimant 
 
         had a reversal of her cervical curve.  He reported that her disc 
 
         spaces worked okay with the possible exception of minimal 
 
         narrowing at C6-7.  The doctor then stated:
 
         
 
              With regard to your question as to whether the complaints 
 
              she has now are related to her fall, I guess one would be 
 
              hardput to say they're not.  However, I certainly would 
 
              question to say they are taking into account the mechanism 
 
              of injury.
 
         
 
              The doctor stated he did not think complaints with reference 
 
         to her neck are really associated with the fall.
 
         
 
              On December 11, 1984, William M. Krigsten, M.D., reported 
 
         that claimant could walk or stand for five to eight hours per 
 
         day; that claimant could lift up to 10 pounds frequently; that 
 
         claimant could use her hand for repetitive movements, including 
 
         simple grasping and fine manipulation, but not for pushing or 
 
         pulling; and, that claimant could use repetitive movement of her 
 
         feet, as in operating foot controls.  He reported that claimant 
 
         was able to bend, climb and kneel frequently and carry 
 
         occasionally and that claimant could reach above shoulder level 
 
         and could work an eight-hour day plus overtime.  The doctor was 
 
         then unsure of the expected duration of modified duty 
 
         restrictions.
 
                                                
 
                                                         
 
         
 
                         APPLICABLE LAW AND ANALYSIS
 
         
 
              Our first concern is the causal relationship issue.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of August 8, 1986 is causally 
 
         related to the disability on which she now bases her claim.  
 
         Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  
 
         Lindahl v. L. O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The question of causal connection is essentially within 
 
         the domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman 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; the 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 may be considered.  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 187, 192 (Iowa 1985).
 
         
 
              An expert's opinion based upon an incomplete history is not 
 
         necessarily binding on the commissioner, but must be weighed with 
 
         other facts and circumstances.  Musselman v. Central Telephone 
 
         Company, supra.
 
         
 
              Dr. Cunningham, who has treated claimant for her headaches 
 
         and neck pain, has causally related those to her fall in August, 
 
                                                
 
                                                         
 
         1986. Dr. Dougherty, who examined claimant on October 26, 1987, 
 
         has characterized as "a little unusual" that claimant would fall, 
 
         land on her "rump," bruise her elbow and then her shoulder 
 
         bothered her with her neck apparently not bothering her for some 
 
         time.  Dr. Dougherty did not believe claimant had a reversal of 
 
         her cervical curve as Dr. Cunningham believed.  Dr. Dougherty 
 
         reported that claimant disc spaces were working okay, meaning 
 
         apparently that they were normal with the possible exception of 
 
         minimal narrowing at C6-7.  Dr. Dougherty questioned whether 
 
         claimant's complaints were related to her fall, given the 
 
         mechanism of injury.  Dr. Dougherty is an orthopaedic physician.  
 
         Dr. Cunningham is a general surgeon.  Dr. Grossman, the company 
 
         physician, rendered no opinion as to causation.  Claimant 
 
         testified at hearing that she had a stiff neck and a slight 
 
         headache on the Saturday following her Friday work incident.  
 
         While claimant reported neck complaints when she saw Dr. Grossman 
 
         on August 11, 1986, she did not mention having headache at that 
 
         time.  Dr. Grossman then reported no objective findings regarding 
 
         the neck.  He did find complete range of motion of the shoulder 
 
         and elbow and made a diagnosis of right contusion of the right 
 
         shoulder and elbow.  On September 24, 1986, Dr. Grossman reported 
 
         that claimant had a continued complaint of neck pain and had had 
 
         occipital headaches since September 20, 1986.  Dr. Grossman found 
 
         that claimant then had full range of motion of the neck.  On 
 
         September 23, 1986, Dr. Cunningham had not recorded claimant's 
 
         neck range of motion, but reported that she had had severe spasm 
 
         throughout the cervical area.  The findings of Drs. Grossman and 
 
         Cunningham, not more than a day apart, appear somewhat 
 
         inconsistent.  Likewise, Dr. Cunningham made his diagnosis, in 
 
         part, on x-ray findings he interpreted as showing a reversal of 
 
         the cervical curve.  Dr. Shay, a radiologist, interpreted x-rays 
 
         approximately contemporaneous with Dr. Cunningham's as showing no 
 
         evidence of fracture, dislocation, subluxation or slippage in 
 
 
 
                         
 
                                                         
 
         either flexion or extension, with alignment perfect, interspaces 
 
         normal and lipping negligible.  We find it curious that Dr. Shay, 
 
         a radiologist, does not interpret x-rays taken in near proximity 
 
         to Dr. Cunningham's in a similar manner as Dr. Cunningham.  Dr. 
 
         Dougherty's interpretation of the x-rays is more consistent with 
 
         Dr. Shay than with Dr. Cunningham.
 
         
 
              Also, it appears curious that claimant, had she had 
 
         continuing neck pain and headache from her injury onward, would 
 
         not have sought additional medical care through John Morrell from 
 
         August 11, 1986 until seeking care from Dr. Cunningham on 
 
         September 23, 1986.  Having sought care from Dr. Grossman per 
 
         instructions of the company, she certainly was aware that such 
 
         care was available for her, were she having continuing 
 
         complaints. We find that the fact that claimant failed to do so 
 
         diminishes the weight that can be given to her testimony as 
 
         regards headaches from the injury onward.  It is also 
 
         inconsistent with her statement to Dr. Cunningham, upon initial 
 
         examination on September 23, 1986, that she had had headaches for 
 
         two weeks off and on.  We note that, even if claimant had 
 
         headaches for two weeks off and on prior to seeing Dr. 
 
         Cunningham, such headaches would then have had their onset 
 
         approximately one month following her work incident. Such 
 
         remoteness in time would generally make the causal relationship 
 
         between the headache and the work incident more tenuous.  Dr. 
 
         Cunningham, himself, indicated that headaches have many common 
 
         causes and can occur from, among other things, accidents, 
 
         allergies , ordinary tension, work posture and stresses and 
 
         strains of ordinary life as well as from numerous other factors. 
 
          He reported that he had not done other diagnostic studies to 
 
         look for causes beyond claimant's work incident as claimant's 
 
         work incident had "quite evidently caused the thing."
 
         
 
              We believe that the remoteness in time from the injury to 
 
         claimant's first report of headache complaints; claimant's 
 
         failure to report such complaints to the John Morrell medical 
 
         department on a timely basis; the inconsistencies in her reports 
 
         as to the onset of the headaches, vis-a-vis her testimony at 
 
         hearing, her report to Dr. Grossman on September 24, 1986 and a 
 
         report to Dr. Cunningham on September 23, 1986; and, the lack of 
 
         objective physical findings relative to her neck condition make 
 
         it less certain that claimant's work incident caused her 
 
         subjective complaints of headache and neck pain.  We note that 
 
         Dr. Dougherty has greater expertise in the area of orthopaedic 
 
         injury and its sequilla than does Dr. Cunningham.  That fact, as 
 
         well as the numerous inconsistencies outlined above, incline us 
 
         to accept Dr. Dougherty's opinion that, given her mechanism of 
 
         injury, it is questionable that claimant's complaints, as of 
 
         October 26, 1987, related to her fall.  We accept this opinion 
 
         over Dr. Cunningham's account as to causation.  While Dr. 
 
         Dougherty did not expressly so state, we find it also unlikely 
 
         that claimant's complaints at time of initial treatment with Dr. 
 
         Cunningham on September 23, 1986 related to her work incident for 
 
         the reasons stated above.  The evidence presented as regards that 
 
         question, at best, raises an issue as to causal connection 
 
                                                
 
                                                         
 
         between claimant's then-current complaints and claimant's work 
 
         injury of almost six weeks earlier. The evidence does not show 
 
         such connection by a preponderance. Claimant is required to prove 
 
         her case by a preponderance of the evidence; her burden is not 
 
         satisfied by the creation of an equipoise.  Volk v. International 
 
         Harvester, 252 Iowa 298, 106 N.W.2d 649 (1960).
 
         
 
              As claimant has not shown the requisite causal connection 
 
         between her work incident and her claimed disability, she has not 
 
         shown an entitlement to healing period, permanent partial 
 
         disability or temporary total disability benefits.  Hence, the 
 
         question of whether claimant is entitled to temporary total or 
 
         healing period benefits for time off work from September 23, 1986 
 
         to November 24, 1986, as prescribed by Dr. Cunningham, is moot. 
 
         Likewise, claimant has not shown an entitlement to payment of 
 
         medical costs with Dr. Cunningham.  We note in passing that 
 
         claimant was certainly aware, having had a previous workers' 
 
         compensation injury, that such was not authorized.  We find it 
 
         most curious that she sought treatment with Dr. Cunningham prior 
 
         to attempting any type of additional examination or treatment 
 
         through her John Morrell physicians.
 
         
 
                               FINDINGS OF FACT
 
         
 
              WHEREFORE, IT IS FOUND:
 
         
 
              Claimant had an incident at work on August 8, 1986 when she 
 
         fell down stairs while descending to her locker.
 
         
 
              Claimant went down approximately eight steps and landed on 
 
         her right side, approximately three inches from the waist with 
 
         her elbow on the steps.  Claimant did not hit her head in the 
 
         fall.
 
         
 
              Claimant complained of right arm, neck and leg pain on 
 
         August 11, 1986.  On August 11, 1986, claimant had complete range 
 
         of motion of the shoulder and elbow with abrasion of the right 
 
         elbow and muscle bruise of the right thigh.
 
         
 
              On September 23, 1986, claimant reported to Dr. Cunningham 
 
         that she had had headaches for approximately two weeks after 
 
         having fallen at work approximately one month earlier.
 
         
 
              On September 24, 1986, claimant reported to Dr. Grossman 
 
         that she had had occipital headaches from September 20, 1986 
 
         onward.
 
         
 
              At hearing, claimant testified that she had had a slight 
 
         headache from the Saturday following her Friday work incident.
 
         
 
              Claimant's accounts of the onset of her headache condition 
 
         are inconsistent.
 
         
 
              Claimant did not report headaches to John Morrell officials 
 
         or seek medical care from John Morrell officials from August 11, 
 
                                                
 
                                                         
 
         1986 until September 24, 1986.
 
         
 
              Claimant independently sought medical care from Dr. 
 
         Cunningham on September 23, 1986.
 
         
 
              Interpretations by Dr. Cunningham and Dr. Shay of 
 
         chronologically proximate x-rays are dissimilar.
 
         
 
              Dr. Dougherty's x-ray interpretations are more consistent 
 
         with Dr. Shay's x-ray interpretations.
 
         
 
              Claimant has had a prior workers' compensation injury.
 
         
 
              Claimant was aware of the procedure for reporting medical 
 
         conditions and seeking medical attention on account of her 
 
         work-related injury.
 
         
 
              Dr. Cunningham is an osteopathic physician and general 
 
         surgeon.
 
         
 
              Dr. Dougherty is an orthopaedic specialist.
 
         
 
              Dr. Shay is a radiologist.
 
         
 
              Headaches can be produced by a variety of conditions.
 
         
 
              Dr. Cunningham did not do further diagnostic studies or look 
 
         for other causes of claimant's headaches besides claimant's 
 
         report of her work incident.
 
         
 
              Claimant was reported to have severe muscle spasm in the 
 
         cervical area on September 23, 1986, but was reported to have 
 
         full range of motion of the neck on September 24, 1986.
 
         
 
              On September 24, 1986, Dr. Grossman released claimant for 
 
         work as of September 26, 1986.
 
         
 
              Dr. Cunningham took claimant off work on September 23, 1986 
 
         to November 24, 1986.
 
         
 
              Claimant's continuing complaints are inconsistent with the 
 
         mechanism of injury.
 
         
 
                             CONCLUSIONS OF LAW
 
         
 
                  THEREFORE, IT IS CONCLUDED:
 
         
 
              Claimant has not established a causal relationship between 
 
         her injury of August 8, 1986 and her claimed disability.
 
         
 
              Claimant is not entitled to temporary total disability 
 
         benefits, healing period benefits or permanent partial disability 
 
         benefits.
 
         
 
              Claimant is not entitled to payment of costs with Dr. 
 
                                                
 
                                                         
 
         Cunningham.
 
         
 
                                  ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Claimant take nothing from this proceeding.
 
         
 
              Claimant pay costs of this proceeding pursuant to Division 
 
         of Industrial Services Rule 343-4.33.
 
         
 
              Signed and filed this 27th day of April, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                            HELEN JEAN WALLESER
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Michael P. Jacobs                    Ms. Judith Ann Higgs
 
         Attorney at Law                          Attorney at Law
 
         300 Toy National Bank Bldg               200 Home Federal Bldg
 
         Sioux City, Iowa  51101                  P.O. Box 3086
 
                                                  Sioux City, Iowa  51102
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 1108
 
                                                 Filed April 27, 1988
 
                                                 HELEN JEAN WALLESER
 
         
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         VICKI L. FERDIG,
 
         
 
              Claimant,
 
         
 
         vs.
 
                                                     File No. 833234
 
         JOHN MORRELL & COMPANY,
 
                                                 A R B I T R A T I 0 N
 
              Employer,
 
                                                     D E C I S I 0 N
 
         and
 
         
 
         NATIONAL UNION FIRE
 
         INSURANCE COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         1108
 
         
 
              Claimant, who gave discrepant stories regarding the onset of 
 
         her symptoms, failed to establish causal relationship between 
 
         alleged headache and neck pain and work injury.