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                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                           :
 
            ROY M. MULLINS,                :
 
                                           :
 
                 Claimant,                 :
 
                                           :         File No. 850438
 
            vs.                            :
 
                                           :      A R B I T R A T I O N
 
            MAYTAG COMPANY,                :
 
                                           :         D E C I S I O N
 
                 Employer,                 :
 
                                           :
 
            and                            :
 
                                           :
 
            UNDERWRITERS ADJUSTING COMPANY,:
 
                                           :
 
                 Insurance Carrier,        :
 
                 Defendants.               :
 
            ____________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Roy M. 
 
            Mullins, claimant, against Maytag Company, employer, and 
 
            Continental Loss Adjusting Company, acting for the insurance 
 
            carrier, for benefits as the result of an alleged injury 
 
            which occurred on May 28, 1987.  A hearing was held on March 
 
            7, 1990 at Des Moines, Iowa and the case was fully submitted 
 
            at the close of the hearing.  Claimant was represented by 
 
            Mark T. Hedberg.  Defendants were represented by Terry L. 
 
            Monson.
 
            
 
                 The record consists of the testimony of Roy M. Mullins, 
 
            claimant; Vern Bryan, senior industrial engineer; and, Randy 
 
            Clausen, workers' compensation administrator.  The exhibits 
 
            are all joint exhibit.  The joint exhibits are divided into 
 
            volume I (prepared by claimant) and volume II (prepared by 
 
            defendants).  Volume I is subdivided into medical exhibits A 
 
            through F and nonmedical exhibits A through E.  Volume II is 
 
            subdivided into medical exhibits 1 through 20 and nonmedical 
 
            exhibits 1 through 4.  The deputy ordered a transcript of 
 
            the hearing.  Both attorneys submitted excellent 
 
            post-hearing briefs.
 
            
 
                                      issues
 
            
 
                 The parties submitted the following issues for 
 
            determination at the time of the hearing.
 
            
 
                 Whether claimant sustained an injury on May 28, 1987 
 
            which arose out of and in the course of employment with 
 
            employer;
 
            
 
                 Whether the injury was the cause of either temporary or 
 
            permanent disability;
 
            
 
                 Whether claimant is entitled to temporary or permanent 
 
            disability benefits, and if so, the extent of benefits to 
 

 
            
 
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            which he is entitled; and,
 
            
 
                 Whether claimant is entitled to medical benefits.
 
            
 
                                 findings of fact
 
            
 
                    INJURY/CAUSAL CONNECTION OF TEMPORARY AND
 
                               PERMANENT DISABILITY
 
            
 
                 It is determined that claimant sustained a cumulative 
 
            injury which arose out of and in the course of his 
 
            employment on May 28, 1987.
 
            
 
                 It is further determined that the injury was the cause 
 
            of both temporary and permanent disability.
 
            
 
                 Claimant is an approximately 20-year employee of 
 
            employer.  He started on February 22, 1966 as a casting 
 
            machine operator.  There was a short hiatus in his 
 
            employment from January 30, 1967 to August 4, 1969.  He was 
 
            then employed continuously by employer from August 4, 1969 
 
            through the date he was forced to leave work due to this 
 
            injury on May 28, 1987.
 
            
 
                 During the last several years, claimant performed 
 
            several repetitive motion jobs for employer such as 
 
            automatic transfer machine operator (the Buhr machine), 
 
            assembler II, and alodizing machine tender.  Claimant 
 
            described and demonstrated that these jobs required a 
 
            considerable amount of bending, turning, stooping and 
 
            lifting.  The repetitive work situation was further 
 
            complicated by the fact that claimant was performing 
 
            incentive work at the time of the injury.  Defendants 
 
            offered testimony through Vern Bryan, industrial engineer, 
 
            that there were some minor discrepancies in claimant's 
 
            description and demonstration.  Nevertheless, claimant 
 
            established that the work was highly repetitive and did 
 
            require bending, turning, some slight twisting and lifting.
 
            
 
                 Claimant admitted that he never did have a specific 
 
            accident or incident or occurrence of a sudden or unusual 
 
            nature at work.  It was also established by defendants that 
 
            claimant was involved in an automobile accident in 1966 
 
            which fractured his pelvis and which may or may not have 
 
            affected his back.  Claimant also experienced back pain in 
 
            1975 while painting his house.  Defendants further 
 
            established that, prior to working for employer, claimant 
 
            performed light manufacturing work, construction work as a 
 
            laborer and worked as a roofer installing both shingles and 
 
            hot tar roofs on buildings.
 
            
 
                 At the time of this injury, claimant was operating the 
 
            Buhr machine on an incentive basis and completed more cycles 
 
            than the company standard in order to receive incentive pay.
 
            
 
                 Claimant saw Scott B. Neff, D.O., a board-certified 
 
            orthopaedic surgeon, as a referral from claimant's personal 
 
            physician on December 11, 1986 when claimant was 43 years of 
 
            age because of pain in his back, left leg and left heel.  On 
 
            December 18, 1986, Dr. Neff said a CT scan was abnormal at 
 

 
            
 
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            L4-5 on the patient's left side.  He said there was 
 
            narrowing of the foramina and nerve root encroachment 
 
            secondary to degenerative disease and lateral recess 
 
            stenosis.  On February 2, 1987, claimant saw William R. 
 
            Boulden, M.D., Dr. Neff's partner.  An epidural injection 
 
            gave relief only for two hours and Dr. Boulden recommended a 
 
            decompression laminectomy of L4-5.
 
            
 
                 The only specific onset of symptoms occurred on May 28, 
 
            1987, when claimant's back locked up while dressing at home.  
 
            Claimant then decided to have the surgery.  Dr. Neff 
 
            performed a bilateral decompressive laminectomy at L4-5 and 
 
            L5-S1 on June 16, 1987.  Claimant attempted to return to 
 
            work in September of 1987, but was unable to do so because 
 
            he could not tolerate the work.  After a period of absence 
 
            from work, defendants provided claimant with a work 
 
            hardening program.  Claimant was subsequently reemployed by 
 
            employer and now works as an inspector in quality control on 
 
            a job within his restrictions after employer tried various 
 
            accommodations in order to employ the employee in some 
 
            capacity.  Claimant testified that he earns $50 less per 
 
            week than he was earning performing incentive work on the 
 
            Buhr machine.
 
            
 
                 Dr. Neff, the treating orthopaedic surgeon, wrote a 
 
            report on October 19, 1987 in which he stated the cumulative 
 
            physical demands of his work were indeed a substantial cause 
 
            contributing to the development of the degenerative disease 
 
            in his spine.  Dr. Neff added that consequently, the 
 
            difficulty with his back would be related to the 20-year 
 
            cumulative history of physical activity required in his job 
 
            at Maytag (vol. 1, A, Dr. Neff deposition exhibit C).  In 
 
            his deposition given on January 15, 1990, Dr. Neff testified 
 
            that the cumulative physical demands of his work at Maytag 
 
            played a substantial or significant role in contributing to 
 
            the condition for which he treated claimant and that 
 
            claimant did in fact sustain a permanent injury (Dr. Neff 
 
            deposition, pages 12 and 14).  Dr. Neff further opined in 
 
            his deposition that claimant's work was a substantial 
 
            contributing factor and the precipitating event which 
 
            necessitated the surgery and subsequent treatment (Dr. Neff 
 
            deposition, page 21).
 
            
 
                 Dr. Neff testified that, even though he was not aware 
 
            that claimant's back locked up while tying his boot at home 
 
            on May 28, 1987, it would nevertheless not change his 
 
            opinion.  Dr. Neff testified that claimant's condition 
 
            occurred over time, gradually, slowly (Dr. Neff deposition, 
 
            page 44).  Dr. Neff acknowledged that other factors had also 
 
            contributed to claimant's degenerative disc disease outside 
 
            of his employment, but felt that the primary factor that 
 
            caused claimant's back problem was the repetitive nature of 
 
            his work over several years of employment with this 
 
            employer.
 
            
 
                 Dr. Neff went so far as to say that claimant's work for 
 
            employer contributed to the progression and development of 
 
            claimant's degenerative disc disease and not just the 
 
            symptoms of the disease (Dr. Neff deposition, pages 51 and 
 
            52).
 

 
            
 
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                 Dr. Neff's final restrictions were no bending, 
 
            stooping, or twisting of his back and no standing or sitting 
 
            for more than 30 or 40 minutes at one time without changing 
 
            his body position.  He said these restrictions were 
 
            permanent and he did not anticipate ever changing them in 
 
            the future (vol. 1, A, Dr. Neff deposition exhibit B-13).
 
            
 
                 Claimant was independently evaluated at claimant's 
 
            request by Jerome G. Bashara, M.D., another board-certified 
 
            orthopaedic surgeon, on October 10, 1989.  Dr. Bashara 
 
            stated that it was his medical opinion based upon a 
 
            reasonable degree of medical certainty that claimant's work 
 
            at Maytag over some 20-year period of bending, twisting and 
 
            lifting, significantly affected his back condition and 
 
            caused a permanent impairment (vol. 1, B, Dr. Bashara 
 
            deposition, pages 15 and 16).  When Dr. Bashara was asked 
 
            for his definition of "substantial" that he used to describe 
 
            the causal factor relating claimant's employment to his back 
 
            injury, Dr. Bashara replied somewhere between 50 and 100 
 
            percent generally and in claimant's case, he said that 
 
            substantial means somewhere around 75 percent (vol. 1, A, 
 
            Dr. Bashara deposition, page 21).  He did not believe that 
 
            the episode at home on May 28, 1987 was significant, but 
 
            rather related claimant's condition to a series of 
 
            repetitive injuries, some prior to his work at Maytag and 
 
            some frequently during his work at Maytag (vol. 1, A, Dr. 
 
            Bashara deposition, page 30).
 
            
 
                 Claimant was evaluated by Ronald K. Bunten, M.D., 
 
            another board-certified orthopaedic surgeon, for defendants 
 
            on February 12, 1988.  At that time, Dr. Bunten stated that 
 
            it was difficult to relate any of claimant's difficulty to a 
 
            specific injury that was sustained while at work from his 
 
            history, physical findings and reported radiographic changes 
 
            (vol. 2, exhibit 4; Dr. Bunten deposition exhibit 3).  Dr. 
 
            Bunten testified to a reasonable degree of medical certainty 
 
            that he could not say that a specific incident while at work 
 
            or the effects of his work over time at Maytag had any cause 
 
            with regard to claimant's degenerative disc disease (Dr. 
 
            Bunten deposition, pages 13 and 14).  He said claimant's 
 
            condition was biochemical and not mechanical.  At another 
 
            point, he added that he could not separate out claimant's 
 
            work activity from all of the other activities of his daily 
 
            living as a causative factor in the development of 
 
            degenerative disc disease (Dr. Bunten deposition, page 15).  
 
            He disagreed with Dr. Neff's opinion (Dr. Bunten deposition, 
 
            page 22).
 
            
 
                 Dr. Bunten did say there was a distinction between an 
 
            aggravation of symptoms and an aggravation of the condition 
 
            of degenerative disc disease (Dr. Bunten deposition, page 
 
            15).  He further indicated that claimant's work might cause 
 
            him to notice an increase in his symptoms (Dr. Bunten 
 
            deposition, pages 18 and 24).
 
            
 
                 The Iowa Supreme Court has defined injury very broadly.  
 
            Lawyer and Higgs, Iowa Workers' Compensation--Law and 
 
            Practice, section 4-1, page 19.
 
            
 

 
            
 
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                 Iowa Code section 85.3(1) requires the payment of 
 
            compensation for any and all personal injuries sustained by 
 
            an employee arising out of and in the course of employment.
 
            
 
                 Personal injury has been defined as an injury to the 
 
            body, an impairment of health, or a disease (degenerative 
 
            disc disease) not excluded by the Act which comes about not 
 
            through the natural building up and tearing down of the 
 
            human body, but because of a traumatic or other hurt or 
 
            damage to the health or body of an employee.  Almquist v. 
 
            Shenandoah Nurseries, Inc., 218 Iowa 724, 732, 254 N.W. 35, 
 
            39 (1934).
 
            
 
                 As pointed out recently by Deputy Industrial 
 
            Commissioner Michael G. Trier, the distinction between 
 
            injury resulting from cumulative trauma which can be 
 
            compensable, an occupational disease which can be 
 
            compensable, and the normal wear and tear incident to a life 
 
            devoted to hard work which is not compensable is not easily 
 
            made.  If carried to its logical extreme, it can be asserted 
 
            that every step, motion or impact a person experiences is a 
 
            single incident of cumulative trauma which plays a part in 
 
            the breakdown of the person's body.  The aging process 
 
            itself also commonly results in a breakdown of the body.  It 
 
            is only when there is some clearly identifiable stress or 
 
            cumulative trauma which produces a premature breakdown of 
 
            the body that there is a right to recover under either the 
 
            injury or occupational disease law.  That situation exists 
 
            in this case as evidenced by the testimony of Dr. Neff and 
 
            Dr. Bashara.  Hoffman v. Second Injury Fund of Iowa, file 
 
            numbers 831136 and 869798 (Arb. Decn., August 10, 1990).
 
            
 
                 Degenerative disc disease is obviously a disease.  It 
 
            is equally obvious that claimant sustained an impairment to 
 
            his health.  Since degenerative disc disease is not an 
 
            occupational disease peculiar to the industrial 
 
            manufacturing of Maytag appliances, it is therefore an 
 
            injury.  Iowa Code section 85.61(4)(b).
 
            
 
                 Almquist further requires that the injury act 
 
            extraneously to the natural processes of nature.  Dr. Neff 
 
            made it clear that 20 years of repetitive bending, stooping 
 
            and lifting for employer increased the wear and tear on 
 
            claimant's back.  He said he would not expect to find this 
 
            much wear and tear from natural processes for another 20 
 
            years until claimant would be approximately 60 or 70 years 
 
            old.
 
            
 
                 Dr. Bashara testified that the evidence became 
 
            demonstrable on x-rays between 1975 and 1986 (vol. 1, A, Dr. 
 
            Bashara deposition, page 11).  He specifically stated that 
 
            bending, twisting and lifting at Maytag significantly and 
 
            substantially affected claimant's back condition (vol. 1, A, 
 
            Dr. Bashara deposition, page 15).  He further indicated that 
 
            claimant's work caused his condition because he would not 
 
            expect to find this much deterioration in a person the same 
 
            age who had led a sedentary form of life (vol. 1, A, Dr. 
 
            Bashara deposition, pages 20 and 21).
 
            
 
                 Thus, claimant's 20-year history of repetitive bending, 
 

 
            
 
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            turning, stooping, some slight twisting and lifting acted 
 
            extraneously to the natural processes of nature and thereby 
 
            impaired his health, overcame the natural aging of his back, 
 
            injured it, interrupted his employment career and destroyed 
 
            the function of his body to the point where he is no longer 
 
            able to perform incentive work or work which is other than 
 
            sedentary.  Almquist v. Shenandoah Nurseries, Inc., 218 Iowa 
 
            724, 731, 254 N.W. 35, 39 (1934).
 
            
 
                 Both Dr. Neff and Dr. Bashara granted that a portion of 
 
            claimant's degeneration was attributable to a life devoted 
 
            to labor and hard work, but indicated that the most 
 
            significant factor was the 20-year history of repetitive 
 
            bending, turning, twisting, stooping and lifting while 
 
            performing production work for employer.
 
            
 
                 In Iowa, an accident is not required.  Olson v. 
 
            Goodyear Serv. Stores, 255 Iowa 1112, 1121, 125 N.W.2d 251, 
 
            257 (1963); Adams v. Douglas & Lomason, Volume 2, Number 2 
 
            State of Iowa Industrial Commissioner Decisions 431 (1985).  
 
            Proof of a special incident or unusual occurrence is not 
 
            required.  Ford v. Goode, 240 Iowa 1219, 38 N.W.2d 158 
 
            (1949).  A personal injury may develop gradually over an 
 
            extended period of time.  Black v. Creston Auto Co., 255 
 
            Iowa 671, 281 N.W. 189 (1938).
 
            
 
                 More recently, the Iowa Supreme Court has adopted the 
 
            cumulative injury rule which applies to situations where the 
 
            disability comes on gradually with the compensable injury 
 
            occurring later.  McKeever Custom Cabinets v. Smith, 379 
 
            N.W.2d 368, 374 (Iowa 1985).
 
            
 
                 The McKeever case reiterated that the workers' 
 
            compensation law is to be interpreted liberally to 
 
            accomplish the beneficent purposes intended by the 
 
            legislature.  Furthermore, the law is intended to cast upon 
 
            the industry in which the worker is employed a share of the 
 
            burden resulting from industrial disability.  Caterpillar 
 
            Tractor Co. v. Shook, 313 N.W.2d 503, 506 (Iowa 1981).
 
            
 
                 The opinions of Dr. Neff and Dr. Bashara are preferred 
 
            over the opinion of Dr. Bunten.  Rockwell Graphics Systems, 
 
            Inc. v. Prince, 366 N.W.2d 187, 192 (Iowa 1985).  Even 
 
            though all three are board-certified orthopaedic surgeons, 
 
            the treating physician had more opportunity to form his 
 
            expert opinion than the one-time examiner of defendants.  
 
            Lemon v. Georgia Pacific Corp., II Iowa Industrial 
 
            Commissioner Report 204, 205 (App. Decn. 1981); Clement v. 
 
            Southland Corp., I Iowa Industrial Commissioner Report 56, 
 
            58 (1981).  Furthermore, it is supported by Dr. Bashara's 
 
            testimony.  The testimonies of Dr. Neff and Dr. Bashara are 
 
            buttressed by claimant's testimony.  McKeever Custom 
 
            Cabinets v. Smith, 379 N.W.2d 368, 374 (Iowa 1985); Bradshaw 
 
            v. Iowa Methodist Hosp., 251 Iowa 375, 380, 101 N.W.2d 167, 
 
            170 (1960).
 
            
 
                 The McKeever case adopted the concept in Larson on 
 
            gradual injury.  When disability develops over a period of 
 
            time, then the compensable injury itself is held to occur at 
 
            a later time.  1B Larson Workmen's Compensation Law, section 
 

 
            
 
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            39.10 beginning at page 7-383 (1985).  McKeever is now shown 
 
            in the footnotes of Larson at page 7-390.
 
            
 
                 Here, the question of whether the diseased condition 
 
            was the cause or whether the employment was a proximate 
 
            contributing cause of the injury was determined by the 
 
            expert testimony of Dr. Neff and Dr. Bashara and supported 
 
            by claimant's testimony in his deposition and at the 
 
            hearing.  Musselman v. Central Telephone Co., 261 Iowa 352, 
 
            354, 154 N.W.2d 128 (1967).
 
            
 
                 Both Dr. Neff and Dr. Bashara stated that claimant's 
 
            employment was a substantial factor in bringing about his 
 
            disability.  A cause is proximate if it is a substantial 
 
            factor in bringing about the result.  A cause only needs to 
 
            be one cause; it does not have to be the only cause.  
 
            Blacksmith v. All-American, Inc., 290 N.W.2d 348, 354 (Iowa 
 
            1980).  The "arising out of" or causal connection in this 
 
            case is further embraced within the more inclusive 
 
            substantial factor definition of injury discussed in Burt v. 
 
            John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 
 
            732 (1955).
 
            
 
                 Even if the employment was not the cause of the 
 
            degenerative disc disease which was accelerated by 
 
            claimant's repetitive employment activities, his injury 
 
            would be compensable even under Dr. Bunten's testimony which 
 
            indicates that claimant had sustained an aggravation of a 
 
            preexisting condition.  Hanson v. Dickenson, 188 Iowa 728, 
 
            732, 176 N.W. 823, 824 (1920); Rose v. John Deere Ottumwa 
 
            Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-61 (1956); 
 
            Nicks v. Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 
 
            812, 815 (1962); Lawyer and Higgs, Iowa Workers' 
 
            Compensation--Law and Practice, section 4-2, page 21).
 
            
 
                 There were discrepancies between claimant's testimony 
 
            and the industrial engineer's testimony about the exact 
 
            amount of bending, twisting and lifting involved in 
 
            claimant's job and the number of cycles performed, but these 
 
            are not serious enough to change the result in the decision 
 
            of the case.  Claimant's credibility, although impaired on 
 
            an extraneous issue about self-inflicted injuries, was not 
 
            impaired on the essential elements of this decision.  
 
            Claimant's use of alcohol, smoking, and his marital, mental 
 
            and emotional problems did not materially contribute to his 
 
            degenerative disc disease or the aggravation of it by the 
 
            repetitive nature of his work.  Anything lacking in the 
 
            history claimant gave to Dr. Neff and Dr. Bashara was 
 
            brought out on cross-examination and neither one of these 
 
            doctors changed their opinions.
 
            
 
                 In conclusion, it is determined that claimant sustained 
 
            a cumulative injury to his lumbar spine which occurred on 
 
            May 28, 1987 (the last day claimant worked) which arose out 
 
            of and in the course of his employment with employer.
 
            
 
                 It is further evident from the testimony of Dr. Neff 
 
            and Dr. Bashara, that the injury is the cause of both 
 
            claimant's temporary disability and his permanent 
 
            disability.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 

 
            
 
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            N.W.2d 867 (1965); Lindahl v. L. O. Boggs, 236 Iowa 296, 18 
 
            N.W.2d 607 (1945).  This finding of fact is supported by the 
 
            foregoing and the following discussion.
 
            
 
                         ENTITLEMENT/TEMPORARY DISABILITY
 
            
 
                 The parties stipulated that, in the event that 
 
            defendants are liable for the injury, claimant is entitled 
 
            to temporary disability benefits from May 28, 1987 to 
 
            November 28, 1987, a period of 26.286 weeks, and again from 
 
            February 13, 1989 to March 1, 1989, a period of 2.286 weeks, 
 
            for a total entitlement of 28.572 weeks of healing period 
 
            benefits (26.286 weeks plus 2.286 weeks equals 28.572 
 
            weeks).
 
            
 
                 Therefore, it is determined that claimant is entitled 
 
            to 28.572 weeks of healing period benefits.
 
            
 
                         ENTITLEMENT/PERMANENT DISABILITY
 
            
 
                 It is determined that claimant has sustained a 15 
 
            percent industrial disability to the body as a whole and 
 
            that he is entitled to 75 weeks of permanent partial 
 
            disability benefits.
 
            
 
                 Claimant, born October 17, 1943, was 43 years at the 
 
            time of the injury, 47 years old at the time of the hearing 
 
            and 48 years old at the time of this decision.  The injury 
 
            occurred at the peak of claimant's earnings career and is 
 
            therefore more serious than if it would have occurred 
 
            earlier or later in his earnings career.  McCoy v. Donaldson 
 
            Co., file numbers 752670 and 805200 (App. Decn. 1989); 
 
            Walton v. B & H Tank Corp., II Iowa Industrial Commissioner 
 
            Report 426 (1981); Becke v. Turner-Busch, Inc., 
 
            Thirty-fourth Biennial Report of the Industrial Commissioner 
 
            34 (App. Decn. 1979).
 
            
 
                 Claimant attended school through the eighth grade and 
 
            later obtained a GED.  Therefore, claimant has the 
 
            equivalent of a high school education.
 
            
 
                 Claimant can no longer perform work involving 
 
            repetitive bending, twisting, stooping and lifting.  He is 
 
            therefore foreclosed from performing his former jobs with 
 
            employer as well as the former occupations of a roofer and 
 
            construction laborer.  Rohrberg v. Griffin Pipe Products 
 
            Co., I Iowa Industrial Commissioner Report 282 (1984); 
 
            Michael v. Harrison County, Thirty-Fourth Biennial Report of 
 
            the Industrial Commissioner, 218 (App. Decn., January 30, 
 
            1979).
 
            
 
                 Claimant testified that he has suffered a loss of $50 
 
            per week through loss of his incentive pay.  This is 
 
            approximately a nine percent loss of actual earnings.
 
            
 
                 Dr. Neff determined that claimant had sustained a 15 
 
            percent impairment to the body as a whole based upon the 
 
            Guides to the Evaluation of Permanent Impairment published 
 
            by the American Medical Association and based on his 
 
            restricted motion, the surgery performed and claimant's 
 

 
            
 
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            continuing back and left leg pain (vol. 1, A, Dr. Neff 
 
            deposition, pages 12 and 13; Dr. Neff deposition exhibit C).  
 
            Dr. Neff's final restrictions were no bending, stooping, or 
 
            twisting of his back and no standing or sitting for more 
 
            than 30 or 40 minutes at one time without changing his body 
 
            position.  He said these restrictions were permanent and he 
 
            did not anticipate ever changing them in the future (vol. 1, 
 
            A, Dr. Neff deposition exhibit B-13).
 
            
 
                 Dr. Bashara determined that claimant had a 15 percent 
 
            permanent functional impairment to his body as a whole 
 
            related to his back condition, 10 percent of which he felt 
 
            was due to repetitive, cumulative trauma at work and 5 
 
            percent to nonwork-related trauma such as the automobile 
 
            accident in 1966 and the painting his house episode in the 
 
            mid-1970s (vol. 1, A, Dr. Bashara deposition, page 14; Dr. 
 
            Bashara deposition exhibits A-3 and A-4).  The final 
 
            restrictions imposed by Dr. Bashara at the time of his 
 
            deposition on January 31, 1990 were that claimant should be 
 
            retrained for sedentary work which did not involve lifting 
 
            over 20 pounds and did not involve any repetitive bending, 
 
            stooping or twisting of his lower back (vol. 1, A, Dr. 
 
            Bashara deposition, pages 16 and 17).
 
            
 
                 Dr. Bunten also believed that claimant had a permanent 
 
            impairment and rated it as a 15 percent permanent functional 
 
            impairment of his back.  He said that claimant should not 
 
            lift more than 50 pounds occasionally and 20 pounds 
 
            frequently (vol. 2, exhibit 4, page 11; deposition exhibit 
 
            3).  He too felt that claimant was limited to sedentary 
 
            work.
 
            
 
                 Even though Dr. Bunten did not feel that any part of 
 
            claimant's condition was based on a specific injury 
 
            sustained at work, it nevertheless could be determined that 
 
            Dr. Bunten's testimony in his deposition would support the 
 
            theory of an aggravation of a preexisting condition.
 
            
 
                 When claimant was totally unemployed, employer 
 
            authorized work hardening and reemployed claimant within his 
 
            limitations upon completion of the work hardening program.  
 
            Furthermore, it should be noted that defendant employer's 
 
            effort to accommodate claimant's restrictions and find 
 
            employment for him on a regular basis with earnings that 
 
            provide a good living wage plus employee benefits greatly 
 
            mitigates and reduces the amount of industrial disability in 
 
            this case.  Erbe v. Iowa State Univ., file number 824057 
 
            (Arb. Decn., July 10, 1991); Lawyer and Higgs, Iowa Workers' 
 
            Compensation--Law and Practice, section 13-5, page 117.
 
            
 
                 Claimant's employment with employer appears to be 
 
            secure and claimant will be eligible for retirement in the 
 
            not too distant future.
 
            
 
                 Wherefore, based upon (1) the foregoing factors, (2) 
 
            all of the factors used to determine industrial disability 
 
            Christensen v. Hagen, Volume 1, Number 3 State of Iowa 
 
            Industrial Commissioner Decisions 529 (App. Decn., March 26, 
 
            1985); Peterson v. Truck Haven Cafe, Inc., Volume 1, Number 
 
            3 State of Iowa Industrial Commissioner Decisions 654, 658 
 

 
            
 
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            (App. Decn., February 28, 1985), and (3) applying agency 
 
            expertise (Iowa Administrative Procedure Act 17A.14(5)) it 
 
            is determined that claimant has sustained a 15 percent 
 
            industrial disability to the body as a whole and is entitled 
 
            to 75 weeks of permanent partial disability benefits.
 
            
 
                                 MEDICAL EXPENSES
 
            
 
                 The parties stipulated that the fees charged for 
 
            medical supplies and services were reasonable and that they 
 
            were reasonable and necessary medical treatment for the 
 
            alleged work injury.  It is now determined that the medical 
 
            expenses were caused by the injury of May 28, 1987.
 
            
 
                 The parties stipulated that the total medical expenses 
 
            amount to $9,630.53.  Claimant therefore is entitled to 
 
            medical expenses in that amount.  However, the parties 
 
            further stipulated that the group health care provider was 
 
            entitled to be reimbursed for $8,779.87 which they had paid 
 
            and that the balance of $850.66 was to be paid to claimant 
 
            (transcript, page 7).
 
            
 
                                conclusions of law
 
            
 
                 WHEREFORE, based upon the foregoing and following 
 
            principles of law, these conclusions of law are made:
 
            
 
                 That claimant sustained a cumulative injury to his 
 
            lumbar spine on May 28, 1987 which arose out of and in the 
 
            course of his employment with employer.  McDowell v. Town of 
 
            Clarksville, 241 N.W.2d 904 (Iowa 1976); Crowe v. DeSoto 
 
            Consol. School Dist., 246 Iowa 402, 68 N.W.2d 63 (1955).
 
            
 
                 That the injury was the cause of both temporary and 
 
            permanent disability.  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).
 
            
 
                 That claimant is entitled to 28.572 weeks of healing 
 
            period benefits as stipulated to by the parties.  Iowa Code 
 
            section 85.34(1).
 
            
 
                 That claimant has sustained a 15 percent industrial 
 
            disability to the body as a whole.  Iowa Code section 
 
            85.34(2)(u).
 
            
 
                 That claimant is entitled to 75 weeks of permanent 
 
            partial disability benefits.
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 That defendants pay to claimant twenty-eight point five 
 
            seven two (28.572) weeks of healing period benefits at the 
 
            stipulated rate of three hundred fifty-one and 06/100 
 
            dollars ($351.06) per week in the total amount of ten 
 
            thousand thirty and 49/100 dollars ($10,030.49) payable 
 
            commencing on May 28, 1987.
 
            
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
                 That defendants pay to claimant seventy-five (75) weeks 
 
            of permanent partial disability benefits at the stipulated 
 
            rate of three hundred fifty-one and 06/100 dollars ($351.06) 
 
            per week in the total amount of twenty-six thousand three 
 
            hundred twenty-nine and 50/100 dollars ($26,329.50) payable 
 
            commencing on November 28, 1987 as stipulated to by the 
 
            parties, but interrupted by the second agreed healing period 
 
            from February 13, 1989 to March 1, 1989.
 
            
 
                 Defendants are entitled to a credit in the amount of 
 
            five thousand five hundred seventy-one and 54/100 dollars 
 
            ($5,571.54) paid to claimant as sick pay under an employee 
 
            nonoccupational group health plan to which the parties 
 
            stipulated defendants are entitled.
 
            
 
                 That all these benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue pursuant to Iowa Code section 
 
            85.30.
 
            
 
                 That defendants pay to claimant eight hundred fifty and 
 
            66/100 dollars ($850.66) in medical benefits and eight 
 
            thousand seven hundred seventy-nine and 87/100 dollars 
 
            ($8,779.87) to the group health carrier as stipulated to by 
 
            the parties.
 
            
 
                 That the costs of this action are charged to defendants 
 
            pursuant to rule 343 IAC 4.33, including the costs of the 
 
            attendance of the court reporter at hearing and the 
 
            transcript of the hearing.  Iowa Code section 86.19(1).
 
            
 
                 That defendants file claim activity reports as 
 
            requested by this agency pursuant to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ______ day of ____________, 1991.
 
            
 
                 
 
            
 
                 
 
                 
 
                                          ______________________________
 
                                          WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Mark T. Hedberg
 
            Attorney at Law
 
            840 Fifth Avenue
 
            Des Moines, Iowa  50309
 
            
 
            Mr. Terry L. Monson
 
            Mr. Mark R. Cory
 
            Attorneys at Law
 
            100 Court Avenue, Suite 600
 
            Des Moines, Iowa  50309
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                           1106; 1108.50; 1401
 
                           1402.20; 1402.30
 
                           5-1402.40; 5-1402.60
 
                           5-1802; 5-1803; 2203
 
                           2206; 2209; 5-2501
 
                           5-2700
 
                           Filed July 22, 1991
 
                           WALTER R. McMANUS, JR.
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                           :
 
            ROY M. MULLINS,                :
 
                                           :
 
                 Claimant,                 :
 
                                           :         File No. 850438
 
            vs.                            :
 
                                           :      A R B I T R A T I O N
 
            MAYTAG COMPANY,                :
 
                                           :         D E C I S I O N
 
                 Employer,                 :
 
                                           :
 
            and                            :
 
                                           :
 
            UNDERWRITERS ADJUSTING COMPANY,:
 
                                           :
 
                 Insurance Carrier,        :
 
                 Defendants.               :
 
            ____________________________________________________________
 
            
 
            1106; 1108.50; 1401; 1402.20; 1402.30; 2203; 2206; 2209
 
            It was determined that claimant sustained a cumulative 
 
            injury arising out of and in the course of employment from 
 
            20 years of repetitive work for employer which required 
 
            bending, turning, some twisting, and lifting, even though 
 
            there was no accident, specific incident or onset at work.  
 
            The only specific onset occurred at home while dressing on 
 
            the injury date.
 
            Dr. Neff, the treating physician, and Dr. Bashara, 
 
            claimant's independent evaluator, clearly and unequivocally 
 
            testified that claimant's repetitive work over 20 years was 
 
            a substantial cause and the most significant cause of 
 
            claimant's back condition.  Dr. Bashara defined substantial 
 
            as 75 percent of the cause.  Dr. Neff said the increased 
 
            wear and tear on his back caused a back condition he would 
 
            expect to find in a person 20 years older.  Dr. Bashara said 
 
            he would not expect this much degeneration in a person who 
 
            had led a sedentary life.
 
            Both doctors said that a life devoted to labor and hard 
 
            work, a previous automobile accident, and other non-work 
 
            incidents that happened to claimant contributed to the back 
 
            condition, but indicated that his long-term repetitive work 
 
            was the most significant cause of his degenerative disc 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            disease.
 
            Dr. Neff specifically testified that the work was the cause 
 
            of the degenerative disc disease and not just an increase of 
 
            symptoms.
 
            The onset while dressing at home was not significant because 
 
            the condition developed slowly, gradually over time.
 
            Dr. Bunten did not think claimant's work caused the 
 
            condition, but indicated that it could increase his symptoms 
 
            and aggravate his condition.
 
            It was determined that claimant's employment and not the 
 
            diseased condition was the cause of the injury and 
 
            disability.
 
            Several cites.
 
            
 
            5-1802
 
            Healing period awarded for the period stipulated to by the 
 
            parties, six months post-surgery, and another month later 
 
            for work hardening.
 
            
 
            5-1402.40; 5-1803
 
            Claimant, age 43, eighth grade education but with a GED, was 
 
            foreclosed from previous jobs with employer as well as most 
 
            past employments.  His permanent restrictions were no 
 
            bending, twisting, or lifting variously 20 or 50 pounds.
 
            Dr. Neff awarded a 15 percent permanent impairment rating.  
 
            Dr. Bashara awarded a 15 percent permanent impairment 
 
            rating, but attributed 10 percent to the employment and 5 
 
            percent to other factors.  Dr. Bunten determined that 
 
            claimant had a 15 percent permanent impairment, but did not 
 
            think it was caused by claimant's employment.
 
            Claimant's actual wage loss was about 9 percent from no 
 
            longer being able to perform incentive work.
 
            Employer allowed claimant to come back to work when he 
 
            wanted to do it, but claimant was unable to do the work.  
 
            Claimant left employer for a period of time, but employer 
 
            nevertheless provided a work hardening program for claimant 
 
            and took him back again.  Employer then tried claimant on 
 
            several jobs to accommodate his restrictions and 
 
            impairments.  Claimant was performing an inspector's job in 
 
            quality control earning good wages with full employee 
 
            benefits at the time of the hearing.  Claimant's job 
 
            appeared to be secure until his possible retirement in the 
 
            not too distant future.
 
            Claimant awarded 15 percent industrial disability.
 
            
 
            5-1108.50; 5-1402.60; 5-2501; 5-2700
 
            Claimant's medical expenses were allowed as stipulated to by 
 
            the parties.
 
             
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            LEONARD SWEET,                :
 
                                          :
 
                 Claimant,                :         File No. 850439
 
                                          :
 
            vs.                           :           A P P E A L
 
                                          :
 
            CARNEY BRIDGE AND DEMOLITION, :         D E C I S I O N
 
            INC.,                         :
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ____________________________________________________________
 
            
 
                 The record, including the transcript of the hearing 
 
            before the deputy and all exhibits admitted into the record, 
 
            has been reviewed de novo on appeal.  The decision of the 
 
            deputy filed May 11, 1990, is affirmed and is adopted as the 
 
            final agency action in this case, with the following 
 
            additional analysis:
 
            
 
                 Defendant argues that the deputy engaged in improper 
 
            speculation in stating that no guarantee exists that his 
 
            employer will remain in business or that his employer will 
 
            retain claimant as an employee.  See Knight v. Prince Mfg. 
 
            Co., File No. 733994 (App. Decn., June 2, 1989).  We agree 
 
            with defendant that the determination of industrial 
 
            disability must be made on claimant's current condition and 
 
            not on what may or may not occur in the future.  Current 
 
            ability or inability to secure and maintain alternate 
 
            employment should claimant desire to do so for either 
 
            personal, professional, or economic reasons is a legitimate 
 
            factor to consider in assessing actual loss of earning 
 
            capacity, however.  As the deputy notes, claimant has 
 
            limited education and has work experience almost wholly in 
 
            heavy industry.  He has a significant back injury.  All of 
 
            such make claimant less able to competitively reenter the 
 
            job market should he choose or be required to do so.  That 
 
            current inability to competitively seek employment reflects 
 
            an actual loss of earning capacity for which the deputy has 
 
            appropriately compensated claimant by maintaining an 
 
            industrial disability benefit award of 30 percent of the 
 
            body as a whole.
 
            
 
     
 
            
 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            Defendant shall pay the costs of the appeal, including the 
 
            preparation of the hearing transcript.
 
            
 
                 Signed and filed this ____ day of December, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                                   BYRON K. ORTON
 
                                              INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Ned A. Stockdale
 
            Attorney at Law
 
            108 North 7th Street
 
            Estherville, Iowa  51334
 
            
 
            Mr. Peter J. Leehey
 
            Attorney at Law
 
            801 Carver Building
 
            P.O. Box 1680
 
            Fort Dodge, Iowa  50501
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                               9999
 
                                               Filed December 19, 1991
 
                                               BYRON K. ORTON
 
                                               DRR
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            LEONARD SWEET,                :
 
                                          :
 
                 Claimant,                :         File No. 850439
 
                                          :
 
            vs.                           :           A P P E A L
 
                                          :
 
            CARNEY BRIDGE AND DEMOLITION, :         D E C I S I O N
 
            INC.,                         :
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ____________________________________________________________
 
            
 
            9999
 
            Summary affirmance of deputy's decision filed May 11, 1990, 
 
            with short additional analysis.
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         LEONARD SWEET,
 
         
 
              Claimant,                          File No. 850439
 
         
 
         vs.
 
                                              A R B I T R A T I O N
 
         CARNEY BRIDGE AND
 
         DEMOLITION, INC.,                       D E C I S I O N
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by Leonard 
 
         Sweet, claimant, against Carney Bridge and Demolition, Inc., 
 
         employer, to recover benefits under the Iowa Workers' 
 
         Compensation Act as a result of an injury sustained on August 15, 
 
         1987.  This matter came on for hearing before the undersigned 
 
         deputy industrial commissioner on June 7, 1988.  The record was 
 
         considered fully submitted at the close of the hearing.  The 
 
         record in this case consists of the testimony of claimant and 
 
         claimant's exhibits 1 through 5, inclusive.
 
         
 
              An examination of the industrial commissioner's file reveals 
 
         an original notice and petition was filed September 10, 1987 and 
 
         delivered to defendant September 17, 1987, return receipt 
 
         requested.  No answer to the original notice and petition was 
 
         filed.  Claimant thereafter filed a motion for default.  In 
 
         response thereto, and specifically on November 12, 1987, Deputy 
 
         Industrial Commissioner Larry P. Walshire ordered defendant to 
 
         file an answer to claimant's petition within 20 days after the 
 
         date of the order.  Records show defendant received that order 
 
         November 19, 1987 and no answer to claimant's petition was 
 
         thereafter filed.  On December 16, 1987, Deputy Industrial 
 
         Commissioner Walshire ordered:  "Under the authority of Division 
 
         of Industrial Services Rule 343-4.36, the record is closed to 
 
         further evidence or activity by defendant."  Therefore, defendant 
 
         did not participate in these proceedings nor did defendant 
 
         present any evidence.
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the hearing assignment order filed January 25, 
 
         1988, the issues presented for resolution are:
 
         
 
              1.  Whether claimant is entitled to temporary disability/ 
 
         healing period benefits or permanent partial or total disability 
 
         benefits;
 
         
 
              2.  The applicability of the odd-lot doctrine; and,
 
              3.  Claimant's entitlement to certain benefits provided by 
 
         Iowa Code section 85.27.
 
         
 
                                 FACTS PRESENTED
 
         
 
              Claimant sustained an injury on August 15, 1987 which arose 
 
         out of and in the course of his employment when a load of 
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   2
 
         
 
         
 
         railroad ties fell over on him.  Claimant explained he was taken 
 
         by ambulance to the hospital where he remained for approximately 
 
         one week.  Claimant testified that he was advised by his 
 
         physicians not to do anything, to "sit around" as he had a 
 
         compression of the seventh "lumbar."  Claimant testified he 
 
         attempted part-time employment in September 1987 pulling a boat 
 
         down to Leavenworth, Kansas, for defendant but found that, 
 
         although he was able to drive, the trip took two days because of 
 
         the number of times it was necessary for him to stop and rest.  
 
         Claimant explained that for a period of time he worked in 
 
         defendant's store doing light duty work for approximately 21 
 
         hours per week.  Claimant testified that he had no work at all 
 
         during the winter months of 1987-88 and that during this period 
 
         of time he had difficulty sitting, standing and bending over.  
 
         Claimant recalled that in January 1988, he worked for defendant 
 
         delivering some trucks with his son.  Claimant maintained that 
 
         his son drove the truck most of the time as claimant was in too 
 
         much pain for him to do any of the driving himself.  Claimant 
 
         could recall two trips to Illinois and one trip to Leavenworth, 
 
         Kansas, that he took for defendant.  Claimant testified that he 
 
         has sought work as an over-the-road truck driver and at one time 
 
         was hired by King Construction in Cedar Rapids but that he had to 
 
         quit this employment after ten days because of pain in his back.  
 
         Claimant also recalled that he applied at Umthun Trucking but 
 
         after taking his physical offered that the physician who was 
 
         conducting the physical told him he was "a mess" and to "go home 
 
         and rest for a year."  At the time of the hearing claimant 
 
         explained that he was currently employed in a seasonal summer job 
 
         driving a gravel truck.  Claimant testified that he is to work 40 
 
         hours per week but because of problems with his back cannot 
 
         always work all the hours expected.  Claimant testified that he 
 
         cannot "stand to sit very long" and that he can drive five to six 
 
         miles before requiring that he stop.  Claimant expressed a 
 
         preference for local, short hauls because of this problem.
 
         
 
              Brian W. Nelson, M.D., orthopedic surgeon, testified he 
 
         first saw claimant on August 16, 1987 and that claimant had signs 
 
         and symptoms compatible with a fairly severe injury to his 
 
         thoracic spine.  Dr. Nelson explained that although claimant was 
 
         neurologically intact, x-rays revealed that claimant fractured 
 
         his seventh thoracic vertebra.  Dr.  Nelson stated there was 
 
         "absolutely no question" that claimant had an acute injury which 
 
         had occurred within 24 hours of when he saw claimant.  Dr. Nelson 
 
         followed claimant on a course of treatment consisting of 
 
         anti-inflammatory and pain medication and bed rest before he 
 
         engaged claimant in a plan of physical therapy.  Claimant was 
 
         also prescribed a back brace which he wore regularly until a 
 
         weaning process began at the end of November 1987.
 
         
 
              Claimant was seen by Dr. Nelson's partner, J. Michael 
 
         Donohue, M.D., beginning in October 1987, who continued the 
 
         conservative treatment originally prescribed by Dr. Nelson.  On 
 
         December 2, 1987, Dr. Donahue reported:
 
         
 
              Mr. Sweet is now 3 1/2 months status post T7 
 
              compression fracture.  He is significantly improved 
 
              with respect to his subjective symptoms.
 
         
 
              ON EXAMINATION:  today, the patient continues to have 
 
              some mild over the T7 region but this is much less to 
 
              palpation as well as heavy percussion.  Neurological 
 
              evaluation is intact.
 
         
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   3
 
         
 
         
 
              PLAN:  We will continue the weaning process out of the 
 
              brace.  The patient is currently spending an hour to an 
 
              hour and a half out of the brace.each day.  We would 
 
              like him to add a few minutes each day so that he 
 
              increases being out of the brace an hour per week more 
 
              each week over the next 6 weeks.  At that time, we will 
 
              plan on discontinuing the brace completely.  He was 
 
              also instructed in some upper extremity and thoracic 
 
              musculature strengthening exercises.  I will plan on 
 
              following up with him in 6 weeks. he remains totally 
 
              disabled at this time.
 
         
 
         (Claimant's Exhibit 1, page 8)
 
         
 
              By January 11, 1988, claimant was reporting to Dr. Donohue 
 
         that he was feeling improved overall and claimant was advised by 
 
         Dr. Donohue that he need not return for three or four months 
 
         unless there was a worsening of the symptoms.  A new x-ray taken 
 
         at this time shows that the compression fracture appeared to be 
 
         healed and Dr. Donohue estimated that the "patient has had 
 
         approximately 50 to 55% loss of the normal vertebral body 
 
         height."
 
         
 
              Claimant was seen again by Dr. Nelson on March 4, 1988 and 
 
         found to still have significant tenderness around the fracture 
 
         site with some muscle spasm.  Dr. Nelson testified claimant was 
 
         also checked for signs of nonorganic pathology and claimant was 
 
         negative in "all of those" which convinced the doctor that 
 
         claimant was telling the truth about his subjective symptoms.  
 
         Claimant again returned to see Dr. Nelson on May 16, 1988 and Dr. 
 
         Nelson stated his recommendation as:
 
         
 
              1)  I feel that I have maximized what I am able to do 
 
              for Leonard in regard to his symptoms.
 
         
 
              2)  I have advised him to continue on his home exercise 
 
              program to keep the muscles in the back strong and 
 
              stretched out but other than this I feel I have nothing 
 
              more to offer him.
 
         
 
              3)  I feel this patient definitely has a permanent 
 
              impairment from this injury which I would presently 
 
              rate based on his physical exam symptoms and x-rays of 
 
              15% of the body as a whole.
 
         
 
              4)  I will follow Leonard up on a prn basis.
 
         
 
         (Cl. Ex. 1, p. 10)
 
         
 
              Dr. Nelson imposed on claimant a permanent 10 to 15 pound 
 
         lifting restriction and "okayed" claimant to drive although he 
 
         opined claimant was certainly capable of being bothered if he 
 
         drove over long distances.  Dr. Nelson also opined that prolonged 
 
         periods" of standing and sitting could be expected to cause 
 
         difficulty and that claimant should avoid repetitive bending and 
 
         anything that would involve his upper body on a repetitive basis.  
 
         Dr. Nelson concluded that in terms of "future employment," 
 
         claimant "would be much better off in a nonmanual-labor type 
 
         position. (Cl. Ex. 3, p. 22)
 
         
 
              Claimant testified he visited with Stanley William Thorpe, 
 
         who identifies himself on his resume as a professional vocational 
 
         specialist and behavioral evaluator.  Mr. Thorpe provided a 
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   4
 
         
 
         
 
         vocational evaluation which concludes:
 
         
 
                 Due to the client's age, his limited vocational 
 
              potential for training, and the various restrictions 
 
              physically I see the 15% permanent impairment as a 
 
              major handicapping condition vocationally.  Certainly 
 
              if the clients [sic] job opportunities have been 
 
              basically eliminated, and other alternatives for 
 
              employment are remote then total disablement may be a 
 
              more realistic description of his situation. (Emphasis 
 
              original)
 
         
 
         (Cl. Ex. 5, p. 6-7)
 
         
 
              Mr. Thorpe added a note to his report which stated:
 
         
 
              Mr. Sweet is presently employed by Syndergaard 
 
              Excavating and grading, Milford, Iowa.  He is working 
 
              approximately 20 hours per week driving a gravel truck.  
 
              This is a job that he is presently able to tolerate, 
 
              but is only seasonal.  The client has also applied for 
 
              cross-county trucking jobs but has not been accepted 
 
              because he has been unable to pass a physical exam.  He 
 
              also stated that he was able to secure employment 
 
              making long hauls, but was unable to handle this 
 
              physically and so had to terminate employment.  The 
 
              presnet [sic] status of the client does not affect the 
 
              evaluation and the end result, because this in no way 
 
              constitutes permanent employment, or full-time 
 
              employment status.
 
         
 
         (Cl. Ex. 5, p. 7)
 
         
 
                                  APPLICABLE LAW
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              As a claimant has an impairment to the body as a whole, an 
 
         industrial disability has been sustained.  Industrial. disability 
 
         was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 
 
         593, 258 N.W. 899, 902 (1935) as follows:  "It is therefore plain 
 
         that the legislature intended the term 'disability' to mean 
 
         'industrial disability' or loss of earning capacity and not a 
 
         mere 'functional disability' to be computed in the terms of 
 
         percentages of the total physical and mental ability of a normal 
 
         man."
 
         
 
              Iowa Code subsection 85.34(2)(u) provides:
 
         
 
                 In all cases of permanent partial disability other 
 
              than those hereinabove described or referred to in 
 
              paragraphs "a" through "t" hereof, the compensation 
 
              shall be paid during the number of weeks in relation to 
 
              five hundred weeks as the disability bears to the body 
 
              of the injured employee as a whole.
 
         
 
                 If it is determined that an injury has produced a 
 
              disability less than that specifically described in 
 
              said schedule, compensation shall be paid during the 
 
              lesser number of weeks of disability determined, as 
 
              will not exceed a total amount equal to the same 
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   5
 
         
 
         
 
              percentage proportion of said scheduled maximum 
 
              compensation.
 
         
 
              Iowa Code subsection 85.34(l) provides:
 
         
 
                 If an employee has suffered a personal injury 
 
              causing permanent partial disability for which 
 
              compensation is payable as provided in subsection 2 of 
 
              this section, the employer shall pay to the employee 
 
              compensation for a healing period, as provided in 
 
              section 85.37, beginning on the date of injury, and 
 
              until the employee has returned to work or it is 
 
              medically indicated that significant improvement from 
 
              the injury is not anticipated or until the employee is 
 
              medically capable of returning to employment 
 
              substantially similar to the employment in which the 
 
              employee was engaged at the time of injury, whichever 
 
              occurs first.
 
         
 
              Iowa Code section 85.27 provides, in part:
 
         
 
                 The employer, for all injuries compensable under 
 
              this chapter or chapter 85A, shall furnish reasonable 
 
              surgical, medical, dental, osteopathic, chiropractic, 
 
              podiatric, physical rehabilitation, nursing, ambulance 
 
              and hospital services and supplies therefor and shall 
 
              allow reasonably necessary transportation expenses 
 
              incurred for such services.
 
         
 
                                 ANALYSIS
 
         
 
              It is not an issue that claimant sustained an injury which 
 
         arose out of and in the course of his employment or that the 
 
         injury is causally connected to the disability on which claimant 
 
         now bases his claim.  Of primary concern is the extent of 
 
         claimant's permanent disability.  Claimant alleges he is an 
 
         "odd-lot employee and therefore entitled to permanent total 
 
         disability benefits under Guyton v. Irving Jensen Co., 373 N.W.2d 
 
         101 (Iowa 1985).
 
         
 
              Under the odd-lot doctrine, which was formally adopted by 
 
         the Iowa Supreme Court in Guyton, supra, a worker becomes an 
 
         odd-lot employee when an injury makes the worker incapable of 
 
         obtaining employment in any well-known branch of the labor 
 
         market.  An odd-lot worker is thus totally disabled if the only 
 
         services the worker can perform are so limited in quality, 
 
         dependability, or quantity that a reasonably stable market for 
 
         them does not exist.  Id., citing Lee v. Minneapolis Street 
 
         Railway Company, 230 Minn.315, 320, 41 N.W.2d 433, 436 (1950).  
 
         The rule of odd-lot allocates the burden of production of 
 
         evidence.  If the evidence of degree of obvious physical 
 
         impairment, coupled with other facts such as claimant's mental 
 
         capacity, education, training or age, places claimant prima facie 
 
         in the odd-lot category, the burden should be on the employer to 
 
         show that some kind of suitable work is regularly and 
 
         continuously available to the claimant.  Certainly in such a case 
 
         it should not be enough to show that claimant is physically 
 
         capable of performing light work and then round out the case for 
 
         non-compensable by adding a presumption that light work is 
 
         available.  Guyton, 373 N.W.2d at 105.
 
         
 
              When a worker makes a prima facie case of total disability 
 
         by producing substantial evidence that the worker is not 
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   6
 
         
 
         
 
         employable in the competitive labor market, the burden to produce 
 
         evidence of suitable employment shifts to the employer.  If the 
 
         employer fails to produce such evidence and the trier of fact 
 
         finds the worker fails in the odd-lot category, the worker is 
 
         entitled to a finding.of total disability.  Even under the 
 
         odd-lot doctrine, the trier of fact is free to determine the 
 
         weight and credibility of the evidence in determining whether the 
 
         worker's burden of persuasion has been carried.  Only in an 
 
         exceptional case would evidence be sufficiently strong to compel 
 
         a finding of total disability as a matter of law.  Guyton, 373 
 
         N.W.2d at 106.  The court went on to state:
 
         
 
                 The commissioner did not in his analysis address any 
 
              of the other factors to be considered in determining 
 
              industrial disability.  Industrial disability means 
 
              reduced earning capacity.  Bodily impairment is merely 
 
              one factor in a gauging industrial disability.  Other 
 
              factors include the worker's age, intelligence, 
 
              education, qualifications, experience, and the effect 
 
              of the injury on the worker's ability to obtain 
 
              suitable work.  See Doerfer Division of CCA v. Nicol, 
 
              359 N.W.2d 428, 438 (Iowa 1984).  When the combination 
 
              of factors precludes the worker from obtaining regular 
 
              employment to earn a living, the worker with only a 
 
              partial functional disability has a total disability.  
 
              See McSpadden v. Big Ben Coal Co., 288 N.W.2d 181, 192 
 
              (Iowa 1980).
 
         
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   7
 
         
 
         
 
              The undersigned cannot conclude that claimant has made a 
 
         prima facie case of total disability by producing substantial 
 
         evidence that he is not employable in the competitive labor 
 
         market.  While it is true that claimant may no longer be able to 
 
         perform the job of an over-the-road truck driver, claimant has 
 
         not shown that the only services he can perform are so limited in 
 
         quality, dependability or quantity that a reasonably stable labor 
 
         market for them does not exist.  Claimant has been employed since 
 
         his injury and he has not shown that any special arrangements 
 
         were made with his current employer to accommodate his 
 
         restrictions.  Claimant testified only that he failed at one 
 
         over-the-road driving job and did not secure another.  Claimant's 
 
         vocational experts report is not convincing.  Therefore, claimant 
 
         is not an odd-lot employee as contemplated by Guyton supra.
 
         
 
              The question thus turns to the extent of claimant's 
 
         disability.  The only physicians to have seen claimant in this 
 
         matter were Dr. Nelson and Dr. Donohue.  Dr. Nelson has rated 
 
         claimant as having a 15 percent permanent partial impairment to 
 
         the body as a whole and has restricted claimant from lifting more 
 
         than 15 pounds.  Dr. Donohue expressed no opinion on claimant's 
 
         permanent impairment.
 
         
 
              Functional disability is an element to  be  considered  in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963).  
 
         Barton v. Nevada Poultry, 253 Iowa 285, 110 N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  This 
 
         is so as impairment and disability are not synonymous.  Degree of 
 
         industrial disability can in fact be much different than the 
 
         degree of impairment because in the first instance reference is 
 
         to loss of earning capacity and in the later to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         These are matters which the finder of fact considers collectively 
 
         in arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   8
 
         
 
         
 
         motivation - five percent; work experience - thirty percent, etc. 
 
          Neither does a rating of functional impairment directly 
 
         correlate to a degree of industrial disability to the body as a 
 
         whole.  In other words, there are no formulae which can be 
 
         applied and then added up to determine the degree of industrial 
 
         disability.  It therefore becomes necessary for the deputy to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, 
 
         February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, 
 
         March 26, 1985).
 
         
 
              Claimant, who has a tenth grade formal education, is 
 
         currently 51 years old and has much of his working career ahead 
 
         of him.  However, his loss of future earnings from employment due 
 
         to his disability may not be as severe as would be the case with 
 
         a younger individual.  See Becke v. Turner-Busch, Inc., 34 
 
         Biennial Report, Iowa Industrial Commissioner 34 (1979).  His age 
 
         could prove to be a problem in securing employment in alternative 
 
         vocations.  Claimant appears to be well motivated as evidenced by 
 
         the fact that he has consistently attempted to secure work since 
 
         the short time after his injury.  Claimant has no other formal 
 
         education and considers his occupation as a truck driver.  
 
         Claimant explained that a regular part of his driving 
 
         responsibilities was to load and unload which, under Dr. Nelson's 
 
         restrictions, he would be prohibited from doing in the future 
 
         unless that product which he hauled weighed less than 15 pounds. 
 
          The only other work experience claimant testified to was work as 
 
         a feed warehouse manager for 18 months back in the early 1960's. 
 
          Claimant is still able to drive although it is necessary for him 
 
         to stop and stretch.  Claimant presented no testimony on his 
 
         earnings either prior to the injury or currently.  Therefore, it 
 
         is difficult for the undersigned to assess what earnings, if any, 
 
         claimant lost as a result of his injury.  The undersigned does 
 
         not dispute, however, that claimant's capacity to earn has been 
 
         hampered as a result of this injury.  Although defendant was 
 
         precluded from presenting evidence in this matter, claimant's own 
 
         testimony established that Mr. Carney has made some attempts to 
 
         employ claimant since his injury.  See Gallardo v. Firestone Tire 
 
         & Rubber Company, (Appeal Decision filed October 21, 1987).  The 
 
         undersigned recognizes that defendant's actions in this case do 
 
         fall short of those taken by defendant in Gallardo as well as the 
 
         fact that claimant is not currently employed by defendant.  
 
         Claimant also failed to present any evidence on his medical 
 
         history although he did indicate prior to his injury he had no 
 
         difficulties performing all of the responsibilities of his job.  
 
         Considering then all of the elements of industrial disability, it 
 
         is determined that claimant has sustained a permanent partial 
 
         disability of 45 percent for industrial purposes entitling him to 
 
         225 weeks of permanent partial disability benefits.
 
         
 
              Claimant next, requests a determination of the extent of his 
 
         healing period.
 
         
 
              Iowa Code section 85.34(l) provides that if an employee has 
 
         suffered a personal injury causing permanent partial disability, 
 
         the employer shall pay compensation for a healing period from the 
 
         day of the injury until (1) the employee returns to work; or (2) 
 
         it is medically indicated that significant improvement from the 
 
         injury is not anticipated; or (3) until the employee is medically 
 
         capable of returning to substantially similar employment.
 
         
 
              It is claimant's burden to establish his entitlement to 
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE   9
 
         
 
         
 
         healing period benefits.  The record establishes claimant was 
 
         injured on August 15, 1987, returned to work "part time in 
 
         September of 1987, that claimant "worked in the store" but did 
 
         not recall.how long, that claimant was "off all winter," and that 
 
         claimant worked for 10 days at King Construction.  Clearly, 
 
         claimant would not be entitled to workers' compensation benefits 
 
         for any of the time that he worked.  Based on claimant's 
 
         testimony, the undersigned cannot know when in "September" 
 
         claimant worked, how long he "worked in the store," what 
 
         constitutes "all winter," how long in "January" he worked or what 
 
         "10 days" he was employed by King Construction without resorting 
 
         to speculation, innuendo, and inference which is clearly 
 
         improper.  Umphress v. Armstrong Rubber Co., Appeal Decision 
 
         filed August 27, 1987.  Consequently, the only definite period of 
 
         time claimant identified he was unable to work was August 15 
 
         through September 1, 1987 and it is for this period he shall be 
 
         entitled to healing period benefits.
 
         
 
              Pursuant to Iowa Code section 85.27, the employer is 
 
         responsible for furnishing reasonable medical services for all 
 
         compensable injuries.  Clearly, the record establishes claimant 
 
         sustained an injury which arose out of and in the course of his 
 
         employment and the employer is liable for claimant's medical 
 
         bills which total $2,784.85 pursuant to claimant's exhibit 2.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Wherefore, based on all of the evidence presented, the 
 
         following findings of fact are made:
 
         
 
              1.  Claimant sustained an injury which arose out of and in 
 
         the course.of his employment on August 15, 1987, when a load of 
 
         railroad ties fell on him.
 
         
 
              2.  Claimant was hospitalized and found to have sustained a 
 
         fracture of the seventh thoracic vertebra.
 
         
 
              3.  Claimant was advised to remain off work, but claimant 
 
         attempted to return to work in September 1987.
 
         
 
              4.  For a period of time claimant worked light duty in 
 
         defendant's store for 21 hours per week.
 
         
 
              5.  Claimant did not work during the winter months of 
 
         1987-88 but returned to work in January 1988 driving for 
 
         defendant and later worked for 10 days for King Construction.
 
         
 
              6.  Claimant reached maximum medical recovery on May 16, 
 
         1988.
 
         
 
              7.  Claimant underwent conservative treatment from his 
 
         physicians.
 
         
 
              8.  Claimant has a permanent impairment as a result of the 
 
         work injury.
 
         
 
              9.  Claimant has work restrictions of not lifting more than 
 
         10 to 15 pounds, has difficulty sitting, standing and bending, 
 
         and has been advised to avoid anything that would involve his 
 
         upper body on a repetitive basis.
 
         
 
             10.  Claimant has been employed since his injury.
 
         
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE  10
 
         
 
         
 
             11.  The services claimant is able to perform are not so 
 
         limited in quality, quantity or dependability that a reasonably 
 
         stable labor market for them does not exist.
 
         
 
             12.  Claimant is 51 years old, has a tenth grade education 
 
         and has primarily earned his living as a truck driver.
 
         
 
             13.  claimant's capacity to earn has been hampered as a 
 
         result of the work injury.
 
         
 
             14.  Claimant has a permanent partial disability of 45 
 
         percent for industrial purposes.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Wherefore, based on the principles of law previously stated, 
 
         the following conclusions of law are made:
 
         
 
              1.  Claimant has not established he is an odd-lot employee.
 
         
 
              2.  Claimant has established he sustained a permanent 
 
         partial disability of 45 percent for industrial purposes as a 
 
         result of the work injury of August 15, 1987.
 
         
 
              3.  Claimant has established his entitlement to healing 
 
         period benefits for the period from August 15, 1987 through 
 
         September 1, 1987, inclusive.
 
         
 
              4.  Claimant has established his entitlement to medical 
 
         benefits pursuant to Iowa Code section 85.27.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That defendant is to pay unto claimant two hundred 
 
         twenty-five (225) weeks of permanent partial disability at the 
 
         stipulated rate of one hundred twenty-seven and 54/100 dollars 
 
         ($127.54) per week commencing September 2, 1987.
 
         
 
              That defendant is to pay unto claimant two point five seven 
 
         one (2.571) weeks of healing period benefits at the stipulated 
 
         rate of one hundred twenty-seven and 54/100 dollars ($127.54) for 
 
         the period from August 15, 1987 through September 1, 1987, 
 
         inclusive.
 
         
 
             That defendant is to pay all disputed medical expenses 
 
         totaling two-thousand seven hundred eighty-four and 85/100 
 
         dollars ($2,784.85) (Claimant's Exhibit 2)
 
         
 
              That defendant shall receive full credit for all disability 
 
         benefits previously paid.
 
         
 
              That payments which have accrued shall be paid in a lump sum 
 
         together with statutory interest thereon pursuant to Iowa Code 
 
         section 85.30.
 
         
 
              That defendant shall file a first report of injury within 
 
         twenty (20) days from the date of this decision.
 
         
 
              That a claim activity report shall be filed upon payment of 
 
         this award.
 
         
 

 
         
 
         
 
         
 
         SWEET V. CARNEY BRIDGE & DEMOLITION
 
         PAGE  11
 
         
 
         
 
              That costs of this action are assessed against defendant 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              Signed and filed this 24th day of October, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                         DEBORAH A. DUBIK
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. Ned A. Stockdale
 
         Attorney at Law
 
         108 N. 7th Street
 
         Estherville, IA 51334
 
         
 
         Carney & Hancock
 
         3281 5th Ave S
 
         Fort Dodge, IA 50501
 
         CERTIFIED & REGULAR MAIL
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                               1803; 4100; 1802
 
                                               Filed October 24, 1988
 
                                               Deborah A. Dubik
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LEONARD SWEET,
 
         
 
              Claimant,                          File No. 850439
 
         
 
         vs.
 
                                              A R B I T R A T I O N
 
         CARNEY BRIDGE AND
 
         DEMOLITION, INC.,                       D E C I S I O N
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
         1803
 
         
 
              Claimant, a truck driver, sustained an injury which arose 
 
         out of and in the course of his employment when a load of 
 
         railroad ties fell on him.  Claimant found to have sustained a 
 
         fracture of the seventh thoracic vertebra and was treated 
 
         conservatively.  Claimant was released to return to work with 
 
         restrictions that precluded him from engaging in his regular 
 
         occupation.  Claimant, age 51 with a tenth grade education, found 
 
         to have sustained a permanent partial disability of 45% for 
 
         industrial purposes.
 
         
 
         4100
 
         
 
              Claimant failed to establish he was an odd-lot employee.
 
         
 
         1802
 
         
 
              Claimant sustained his injury on August 15, 1987 and reached 
 
         maximum medical recovery May 16, 1988.  However, during the 
 
         interim period claimant returned to work at various times which 
 
         failed to particularly identify which times he worked and which 
 
         times he did not.  Therefore, the only definite time which 
 
         claimant could identify he could not work as a result of his 
 
         injury was from August 15, 1987 through September 1, 1987.  
 
         Healing period benefits awarded for this period of time.
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LEONARD SWEET,                                 File No. 850439
 
         
 
              Claimant,                                  R E V I E W -
 
         
 
         vs.                                           R E O P E N I N G
 
         
 
         CARNEY BRIDGE AND DEMOLITION,                  D E C I S I O N
 
         INC.,
 
                                                           F I L E D
 
              Employer,
 
              Self-Insured,                               MAY 11 1990
 
              Defendant.
 
                                                      INDUSTRIAL SERVICES
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in review-reopening upon the petition 
 
         of defendant filed May 26, 1989.  Claimant suffered an injury 
 
         arising out of and in the course of his employment on August 15, 
 
         1987, when a load of railroad ties fell over him.  After he filed 
 
         a petition seeking arbitration, a hearing was held on June 7, 
 
         1988, and a decision was filed on October 24 of that year.  The 
 
         arbitration decision found that claimant was not an odd-lot 
 
         employee, although he had sustained a fracture of the seventh 
 
         thoracic vertebra, and that he had sustained a permanent partial 
 
         disability of 45 percent for industrial purposes.  Defendant did 
 
         not participate in the arbitration proceeding or present 
 
         evidence, because the record had been closed to further evidence 
 
         or activity by defendant by order of December 16, 1987.  
 
         Thereafter, defendant filed an appeal to the industrial 
 
         commissioner, but in a ruling of November 29, 1988, the 
 
         commissioner found the appeal to be untimely and the deputy's 
 
         proposed decision became the final decision of the agency by 
 
         operation of law.  The notice of appeal was dismissed.
 
         
 
              Hearing on the petition for review-reopening was thereafter 
 
         held in Storm Lake, Iowa, on April,10, 1990.  The additional 
 
         record consisted of defendant's exhibits A through D, inclusive, 
 
         and the testimony of claimant and Don Carney.
 
         
 
                                      ISSUES
 
         
 
              The sole issues presented for determination are whether 
 
         claimant has experienced a change of condition since the prior 
 
         arbitration hearing and, if so, the extent of his current 
 
         industrial disability.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              The arbitration decision of October 24, 1988, found that 
 
         claimant had insignificant employment following the work injury.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Prior to hearing, claimant had work restrictions of not 
 
         lifting more than 10-15 pounds, had difficulty sitting, standing 
 
         and bending, and had been advised to avoid anything that would 
 
         involve his upper body on a repetitive basis.  Claimant was found 
 
         to have been hampered in his earning capacity, although he had 
 
         not established that he was an odd-lot employee.  It was found 
 
         that claimant was still able to drive, but it was necessary for 
 
         him to frequently stop and stretch; claimant considered his 
 
         occupation to be that of truck driver, but explained that a 
 
         regular part of his driving responsibilities included the 
 
         necessity of loading and unloading, which he would be prohibited 
 
         from doing in the future unless the product hauled weighed less 
 
         than 15 pounds.
 
         
 
              Claimant's status has changed in some respects since the 
 
         hearing in the arbitration case.  Then, he was doing only 
 
         seasonal and part-time work and had no prospects for employment 
 
         when his current job terminated; claimant was not employed by 
 
         defendant at the time of that hearing.  Claimant had had to quit 
 
         all of the jobs he had taken and was physically unable to handle 
 
         truck driving.  Since the earlier hearing, claimant returned to 
 
         work with defendant in approximately July, 1988.  He has driven 
 
         truck and performed other duties at the sawmill, such as making 
 
         pallets, lifting boards and the like.  Claimant agreed that his 
 
         duties now are basically the same as had been the case before the 
 
         work injury and that he has proven able to tolerate that 
 
         employment and thinks he can continue to do so indefinitely.  
 
         Claimant has engaged in long-distance driving and has not found 
 
         it necessary to pull over to take frequent breaks by reason of 
 
         discomfort.  Claimant agreed he basically has had no problems 
 
         performing his duties as truck driver, even on an extended 
 
         two-week trip.
 
         
 
              Claimant has also shown himself able to work beyond the 
 
         physical restrictions imposed by Brian W. Nelson, M.D.  Claimant 
 
         has thrown 20-pound sets of chain over loads and agreed that 
 
         occasional lifting in excess of 15 pounds is not currently a 
 
         problem for him.  He has done lifting at defendant's sawmill, but 
 
         did not believe lifting was very substantial.  Claimant agreed 
 
         that he has not missed any work due to his injury since July, 
 
         1988, and has worked up to 96 hours in one week (even working 65 
 
         hours the next week).  Claimant has applied for work with other 
 
         transportation companies on at least three occasions, but has not 
 
         been hired (he attributes this failure to prospective employers' 
 
         reluctance to hire an individual with a history of back 
 
         problems). Claimant did note that the vehicle he currently drives 
 
         is equipped with an air-ride seat and suspension, both of which 
 
         substantially reduce bouncing around in the cab of the truck, but 
 
         are not commonly available in the industry.
 
         
 
              The videotape introduced into evidence shows claimant doing 
 
         some lifting, particularly of boards with another worker.  The 
 
         parties dispute the size of the boards, but the photographs 
 
         embodied in exhibits A and B appear to show claimant, with the 
 
         help of another worker, handling a board described by Don Carney 
 
         (defendant's Vice President) as 2 inches by 12 inches by 
 
         approximately 16-18 feet and weighing 50-60 pounds.  Claimant was 
 
         also videotaped carrying two wheel blocks, which appeared quite 
 
         heavy to this observer.  Claimant agreed that the videotape 
 
         fairly depicted that particular duty and some of his own job 
 
         responsibilities.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Don Carney established that claimant worked on a part-time 
 
         basis prior to his injury, but now works at least 40 hours per 
 
         week.  He usually works overtime and is earning $1.00 per hour 
 
         more, plus expenses when on the road.  He described claimant as a 
 
         good worker whose future job with this company is secure 
 
         (although the company is currently defending a lawsuit which 
 
         might prove ruinous if prosecuted successfully).
 
         
 
              Dr. Nelson, claimant's treating and board-certified 
 
         orthopaedic surgeon, testified by deposition taken September 14, 
 
         1989, and shed some light on the weight restrictions he had 
 
         earlier imposed on claimant.  Dr. Nelson is of the view that back 
 
         injury patients should not treat their problems with rest; that 
 
         it is very important for them to be as active as possible to 
 
         prevent atrophy, stiffness and muscle fibrosis.  He usually 
 
         advises patients that they may be having pain, but that the pain 
 
         is not doing permanent damage; that sometimes pain cannot be 
 
         relieved, but function can nonetheless be increased.  Asked 
 
         whether he contemplated that claimant would gradually be able to 
 
         lift more than his original 10-15 pound limitation, Dr. Nelson 
 
         indicated that after maximum medical improvement has been 
 
         reached, lifting restrictions are symptomatic restrictions.  "In 
 
         other words, if you lift 50 pounds, you're not going to do 
 
         yourself any damage, but it might hurt."  Dr. Nelson noted that 
 
         it is more dangerous to have someone do very little than too 
 
         much.  He felt it best to advise claimant to do as much as he 
 
         felt that he could, the more the better.  While other doctors 
 
         might give specific restrictions, Dr. Nelson wishes to stay away 
 
         from specific restrictions through a desire to encourage people 
 
         to be more active.  It is therefore found that the restrictions 
 
         originally imposed by Dr. Nelson were not meant to be specific; 
 
         that the restriction essentially was to begin at 10 or 15 pounds 
 
         and thereafter to stay active and increase the ability to lift as 
 
         much as possible.  Dr. Nelson noted that with the type of 
 
         compression fracture claimant suffered, it would not be 
 
         surprising if he had a chronic aching pain no matter what he did, 
 
         but that pain would tend to increase with an increase in 
 
         activity.
 
         
 
              Dr. Nelson did not believe that claimant's physical 
 
         impairment rating had improved.  With a 50 percent crush injury 
 
         to a thoracic vertebra, claimant had suffered a very, very 
 
         significant injury because it actually changed the anatomy and 
 
         shape of the entire back and how the back works.  Specifically, 
 
         to Dr. Nelson's knowledge, the condition of claimant's back had 
 
         not changed since his earlier deposition of April, 1988.  If 
 
         claimant was able to perform more work at the present time than 
 
         had been earlier the case, that did not necessarily mean his 
 
         impairment had diminished, although it was difficult for the 
 
         doctor to give an opinion as to how the impairment actually 
 
         affected claimant's day-to-day activities.  While claimant might 
 
         be doing better now, he might be doing worse later.  The fact 
 
         that claimant was continuing to be able to do his job as prior to 
 
         the injury indicated that claimant was himself unusual and speaks 
 
         well of his motivation.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Dr. Nelson had seen claimant only once recently, and that 
 
         essentially for evaluation of an unrelated problem.  Dr. Nelson 
 
         did not closely examine claimant's back prior to testifying.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Pursuant to Iowa Code section 86.1.4(2), in a proceeding to 
 
         reopen an award for payments, inquiry is to be made into whether 
 
         or not the condition of the employee warrants an end to, 
 
         diminishment of, or increase of compensation previously awarded.  
 
         A change in condition must be shown to justify changing the 
 
         original award. Henderson v. Iles, 250 Iowa 787, 96 N.W.2d 321 
 
         (1959).  It is not proper to merely redetermine the condition of 
 
         the employee as adjudicated by the former award.  Stice v. 
 
         Consol. Indus. Coal Co., 228 Iowa 1031, 291 N.W.2d 452 (1940).
 
         
 
              A mere difference of opinion of experts or competent 
 
         observers as to the degree of disability arising from the 
 
         original injury is insufficient to justify a different 
 
         determination on a petition for review-reopening; there must be 
 
         substantial evidence of a worsening of the condition not 
 
         contemplated at the time of the first award.  Bousfield v. 
 
         Sisters of Mercy, 249 Iowa 64, 86 N.W.2d 109 (1957).  Or, a 
 
         change in condition may be found where claimant has failed to 
 
         improve to the extent initially anticipated, Meyers v. Holiday 
 
         Inn of Cedar Falls, Iowa, 272 N.W.2d 24 (Iowa App. 1978).  
 
         Additionally, in cases not involving scheduled members, a change 
 
         in earning capacity subsequent to the original award which is 
 
         proximately caused by the original injury may constitute a change 
 
         in condition.  Blacksmith v. All-American, Inc., 290 N.W.2d 
 
         348.(Iowa 1980).
 
         
 
              The evidence in this case establishes that claimant has 
 
         experienced a change in condition since the earlier award.  At 
 
         the time of the arbitration hearing, claimant had not been 
 
         reemployed by defendant and had worked only a few temporary 
 
         seasonal jobs, having no prospects for continuing employment once 
 
         his current position came to an end.  Claimant had attempted to 
 
         return to work as a truck driver, but was unable to pursue this, 
 
         his regular occupation, because of the necessity to take frequent 
 
         breaks due to back pain.
 
         
 
              Claimant's situation is now much different.  Since returning 
 
         to work in July, 1988, he has missed no work whatsoever due to 
 
         aftereffects of his injury.  He has successfully resumed duties 
 
         as a long-distance driver without the necessity for frequent 
 
         breaks, including even an extended two-week road trip.  Claimant 
 
         has been reemployed by defendant on a full-time basis at a higher 
 
         rate of pay and not only has been able to tolerate this 
 
         employment, but believes that he can continue to do so 
 
         indefinitely.  Not only is claimant no longer limited to 
 
         part-time work, but he has worked as many as 96 hours in a single 
 
         week, and frequently works substantial overtime.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
              Dr. Nelson's deposition makes clear that the original 
 
         15-pound weight restriction was and is subject to change as 
 
         claimant's condition improves.  Claimant has shown himself to be 
 
         a motivated and hard worker, and now regularly lifts weights 
 
         beyond his original restriction without obvious problems.
 
         
 
              This combination of economic and noneconomic factors 
 
         establishes that claimant has experienced a change in condition 
 
         since the earlier award.  Therefore, it is appropriate to 
 
         consider his current industrial disability.
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963). 
 
         Barton v. Nevada Poultry, 253 Iowa 285, 110 N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  This 
 
         is so as impairment and disability are not synonymous.  Degree of 
 
         industrial disability can in fact be much different than the 
 
         degree of impairment because in the first instance reference is 
 
         to loss of earning capacity and in the latter to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted. Loss of earnings caused by a job transfer 
 
         for reasons related to the injury is also relevant.  These are 
 
         matters which the finder of fact considers collectively in 
 
         arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 
         motivation - five percent; work experience - thirty percent, etc. 
 
         Neither does a rating of functional impairment directly correlate 
 
         to a degree of industrial disability to the body as a whole.  In 
 
         other words, there are no formulae which can be applied and then 
 
         added up to determine the degree of industrial disability.  It 
 
         therefore becomes necessary for the deputy or commissioner to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, 
 
         February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, 
 
         March 26, 1985).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Even though claimant is now working without problems in what 
 
         appears to be a stable position, there can be no guarantee that 
 
         this employer will remain in business or that claimant will be 
 
         retained.  In this job, claimant is allowed to make his own 
 
         decision as to what work he can perform and he is not required to 
 
         do anything he feels unable to do.  Claimant is provided with an 
 
         air-ride seat and suspension in his truck tractor, which is not 
 
         the case with all potential trucking employers.  Even though 
 
         claimant is currently suffering fewer symptoms, he still has a 
 
         very substantial physical impairment as set forth by Dr. Nelson. 
 
         He is now age 52, almost two years after the arbitration 
 
         decision. Claimant still has less than a tenth grade education 
 
         and a work history largely limited to over-the-road driving; it 
 
         can scarcely be denied that claimant is a less desirable 
 
         potential employee to prospective employers by reason of his 
 
         thoracic compression fracture.
 
         
 
              Claimant still has substantial industrial disability, but 
 
         the undersigned is convinced that his industrial disability is 
 
         now less than was the case at the time of the earlier award. 
 
         Considering all these factors, it is determined that claimant now 
 
         has suffered a permanent partial disability of 30 percent of the 
 
         body as a whole, or 150 weeks of benefits.
 
         
 
              There is no change in the healing period determination as 
 
         made in the previous decision.  Defendant shall be entitled to 
 
         credit for all benefits paid to claimant pursuant to the 
 
         arbitration decision.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Defendant is to pay healing period benefits and disputed 
 
         medical expenses pursuant to the arbitration decision of October 
 
         24, 1988.
 
         
 
              Defendant shall pay unto claimant one hundred fifty (150) 
 
         weeks of permanent partial disability at the stipulated rate of 
 
         one hundred twenty-seven and 54/100 dollars ($127.54) per week 
 
         commencing September 2, 1987.
 
         
 
              Defendant shall receive full credit for all disability 
 
         benefits previously paid.
 
         
 
              Costs of this action shall be assessed to defendant pursuant 
 
         to Division of Industrial Services Rule 343-4.33.
 
         
 
              Defendant shall file claim activity reports as requested by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
              Signed and filed this 11th day of May, 1990.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         
 
         
 
         
 
                                            DAVID RASEY
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Ned A. Stockdale
 
         Attorney at Law
 
         108 North 7th Street
 
         Estherville, Iowa  51334
 
         
 
         Mr. Peter J. Leehey
 
         Attorney at Law
 
         503 Snell Building
 
         P.O. Box 1680
 
         Fort Dodge, Iowa  50501
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
                                            
 
 
 
 
 
 
 
 
 
 
 
                                            5-1803
 
                                            Filed May 11, 1990
 
                                            DAVID RASEY
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LEONARD SWEET,
 
         
 
              Claimant,                               File No. 850439
 
         
 
         vs.                                           R E V I E W -
 
         
 
         CARNEY BRIDGE AND DEMOLITION,               R E O P E N I N G
 
         INC.,
 
                                                      D E C I S I O N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         5-1803
 
         
 
              Permanent disability reduced in review-reopening due to 
 
         claimant's change in condition, physically and economically.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         RONALD PIPER, JR.,                          File No. 850448
 
         
 
              Claimant,                           A R B I T R A T I O N
 
         
 
         vs.                                         D E C I S I O N
 
         
 
         CITY OF DES MOINES, IOWA,                      F I L E D
 
         
 
              Employer,                                JUN 22 1989
 
              Self-insured,
 
              Defendant.                       IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by Ronald Piper, 
 
         Jr., claimant, against the City of Des Moines, self-insured 
 
         employer, defendant, for workers' compensation benefits as a 
 
         result of an alleged injury on June 10, 1987.  On November 3, 
 
         1988, a hearing was held on claimant's petition and the matter 
 
         was considered fully submitted at the close of this hearing.
 
         
 
              The parties have submitted a prehearing report of contested 
 
         issues and stipulations which was approved and accepted as a part 
 
         of the record of this case at the time of hearing.  Oral testimony 
 
         was received during the hearing from claimant and the following 
 
         witnesses:  Gregory Davis, Deborah Piper and Michael Peterson.  
 
         The exhibits received into the evidence at the hearing are listed 
 
         in the prehearing report.  According to the prehearing report, the 
 
         parties have stipulated to the following matters:
 
         
 
              1.  On June 10, 1987, claimant received an injury which 
 
         arose out of and in the course of employment with the City of Des 
 
         Moines.
 
         
 
              2.  Claimant's total entitlement to temporary total 
 
         disability or healing period benefits is 35 days, all of which 
 
         have been paid.
 
         
 
              3.  If the injury is found to have caused permanent 
 
         disability, the type of disability is an industrial disability to 
 
         the body as a whole.
 
         
 
              4.  If permanent disability benefits are awarded, they 
 
         should begin as of January 26, 1988.
 
         
 
              5.  Claimant's rate of weekly compensation in the event of 
 
         an award of weekly benefits from this proceeding shall be 
 
         $242.65.
 
         
 
                                                
 
                                                         
 
              6.  All requested medical benefits have been or will be paid 
 
         by defendant.
 
         
 
              At hearing the undersigned took under advisement an 
 
         objection to the consideration of any issue of disability which 
 
         may have been caused by an alleged work injury on December 7, 
 
         1988, which had not been plead in this proceeding.  The objection 
 
         as to consideration of any new claim for disability for such an 
 
         injury date is sustained but evidence concerning this injury will 
 
         be considered to the extent that it pertains to the claim of a 
 
         work injury on June 10, 1987.
 
         
 
                                     ISSUES
 
         
 
              The parties submitted the following issues for determination 
 
         in this proceeding:
 
         
 
               I.  Whether there is a causal relationship between the work 
 
         injury and the claimed permanent disability; and,
 
         
 
              II.  The extent of claimant's entitlement to weekly benefits 
 
         for permanent disability.
 
         
 
                             STATEMENT OF FACTS
 
         
 
              The following is a brief statement highlighting some of the 
 
         more pertinent evidence presented.  Whether or not specifically 
 
         referred to in this statement, all of the evidence received at 
 
         the hearing was independently reviewed and considered in arriving 
 
         at this decision.  Any conclusions about the evidence received 
 
         contained in the following statement should be viewed as 
 
         preliminary findings of fact.
 
         
 
              Claimant testified that he has worked for the City of Des 
 
         Moines since May 1979, and continues in this employment at the 
 
         present time.  Claimant stated that during his Des Moines 
 
         employment he was first assigned to janitorial work.  In 1980 he 
 
         was transferred to street maintenance and in March 1985, he began 
 
         street excavation work, the work he is currently performing. 
 
         Claimant has received all regular pay raises and has not lost 
 
         earnings as a result of the claimed work injury other than for the 
 
         time lost during the recovery for which he has already been 
 
         compensated.  One of claimant's fellow employees, Gregory Davis, 
 
         testified that claimant is an outstanding worker.  Claimant's 
 
         annual performance evaluations have been satisfactory except for a 
 
         few occasions early in his employment.  The only area of needed 
 
         improvement in these evaluations was absenteeism.  The reasons for 
 
         these absences were not discussed by claimant at hearing.  
 
         Claimant had an absenteeism problem before the work injury 
 
         according to these performance evaluations.  At the time of the 
 
         initial hire by the city, claimant passed a physical examination.  
 
         Claimant said that his work requires a considerable amount of 
 
         heavy lifting of road materials and debris including heavy chunks 
 
         of broken concrete pavement.
 
         
 
                                                
 
                                                         
 
              The facts surrounding the work injury on June 10, 1987, are 
 
         not in dispute.  Claimant testified that while lifting a heavy 
 
         cement saw, he heard something "pop" in his lower back and pain 
 
         ensued.  Claimant initially sought treatment from the city 
 
         doctor, J. Blessman, M.D., who took claimant off work and 
 
         prescribed physical therapy and medication for "back strain."  
 
         When claimant failed to improve, Dr. Blessman referred claimant 
 
         to William R. Boulden, M.D., a board certified orthopedic 
 
         surgeon.  After x-rays and a CAT scan, Dr. Boulden diagnosed 
 
         grade I spondylolisthesis (hereinafter referred to as spondy) at 
 
         the L5-S1 level of claimant's spine.  Dr. Boulden also diagnosed 
 
         spinal stenosis and a bulging disc at the L4-5 level.  These 
 
         conditions, Dr. Boulden stated, preexisted the injury of June 10, 
 
         1987.  Claimant was treated by Dr. Boulden with anti-inflammatory 
 
         medication and a home exercise program.  Claimant was returned to 
 
         light duty on July 10, 1987.  After claimant indicated 
 
         improvement, he was released by Dr. Boulden to full duty on July 
 
         27, 1987.  Claimant returned to Dr. Boulden on October 15, 1987, 
 
         with complaints of back pain, usually at night.  He stated at 
 
         that time that he had gone back to regular duty and was 
 
         tolerating it.  Anti-inflammatory medication and ice messages was 
 
         prescribed at that time.  On December 1, 1987, claimant returned 
 
         with increasing symptoms requiring his absence from work for a 
 
         couple of days. Additional medication was prescribed.
 
         
 
              On December 7, 1987, claimant said that he reinjured his back 
 
         after failing from a truck and landed on his buttocks.  Dr. 
 
         Boulden reported that claimant complained at that time of 
 
         lingering low back pain but had returned to work.  Dr. Boulden 
 
         diagnosed an aggravation of the underlying spondy condition and 
 
         recommended light duty, back exercises and anti-inflammatory 
 
         medication.  After his pain worsened in January 1988, claimant was 
 
         given epidural steroid injections.  These injections relieved the 
 
         leg pain but claimant still had leg numbness and low back 
 
         discomfort.  Dr. Boulden continued to recommend home exercises.  
 
         On January 21, 1988, Dr. Boulden opined to claimant's attorney 
 
         that claimant has an overall 20 percent impairment, 10 percent 
 
         attributable to prior existing conditions and the remaining 10 
 
         percent was the result of the work injury.  Which work injury to 
 
         which the doctor was referring was not made clear by the doctor.  
 
         On January 25, 1988, claimant reported back to Dr. Boulden that he 
 
         was tolerating things well but still had occasional leg pain.  
 
         Claimant said that the pain "isn't that bad."  Claimant was 
 
         released then to full duty and was to return to Dr. Boulden or Dr. 
 
         Blessman if he had problems. Claimant returned next to Dr. Boulden 
 
         on August 29, 1988, stating that the use of the anti-inflammatory 
 
         medication was bothering his stomach and requested a change of 
 
         prescription.  Claimant again was instructed as to the need of 
 
         continued home exercises and the need to perform sound body 
 
         mechanics in his job.  Claimant has not been seen by Dr. Boulden 
 
         since that time.
 
         
 
              In July 1988, after an apparent conference with the assistant 
 
         city attorney, Dr. Boulden retreated from his January 1988 
 
         assessment of impairment and stated that claimant had not 
 
                                                
 
                                                         
 
         sustained any type of permanent impairment from either of the two 
 
         work injuries, July 1988 or December 1988.  Dr. Boulden explained 
 
         his change of opinion in his deposition on the basis that 
 
         claimant's symptomatology, which he found in January 1988, had 
 
         alleviated itself subsequently and that claimant had returned to 
 
         full duty without apparent problems.  Dr. Boulden felt that after 
 
         each of the two injuries in June and December of 1987, claimant 
 
         returned to the same state he was before the June 1987 incident 
 
         given is prior existing spondy and spinal stenosis conditions.  
 
         Dr. Boulden stated that these prior existing conditions are a 
 
         cause of permanent partial impairment.  He stated that the rating 
 
         would be 10 percent under American Academy of Orthopedic Surgeon 
 
         Guidelines if claimant was not experiencing continued symptoms but 
 
         the rating would be 20 percent with a continuation of symptoms.  
 
         Dr. Boulden did not attribute any of this impairment to claimant's 
 
         work for the City of Des Moines.  Dr. Boulden stated that claimant 
 
         had significant back and leg problems before June of 1987, which 
 
         he felt was to be expected from the spondy condition.
 
         
 
              Claimant's family physician, Dennis F. Rolek, D.O., reports 
 
         that claimant suffered a 15 percent permanent partial impairment 
 
         under AMA Guidelines as a result of the work related injury in 
 
         1987.  Which injury to which the doctor was referring was not 
 
         clear in his report.  A review of Dr. Rolek's records in evidence 
 
         indicates that claimant has a substantial prior health history 
 
 
 
                             
 
                                                         
 
         involving his neck, upper or cervical back and low back.  
 
         Claimant was first found to have first degree spondy condition in 
 
         an x-ray of January of 1980.  This was called second degree 
 
         spondy in an x-ray report of October 1981.  In January 1980, 
 
         claimant fell at work onto his buttocks injuring his back with 
 
         occasional episodes of pain upon bending.  In March 1980, 
 
         claimant fell injuring his ankle.  In October 1981, claimant fell 
 
         while operating a jackhammer and injured his low back and was off 
 
         work until early November.  In June 1984, claimant complained of 
 
         neck pain after lifting at work.  In September 1984, claimant was 
 
         struck by a vehicle while paving a road and suffered neck and 
 
         shoulder pain. Claimant was off work at that time for a few 
 
         weeks.  In October 1984, claimant received another work injury 
 
         involving neck and low back pain.  Claimant was placed on light 
 
         duty at that time for one month.  In January 1985, claimant had 
 
         neck pain and headaches.  In March 1985, claimant complained of 
 
         neck and arm pain.  In April 1985, Dr. Rolek diagnosed an 
 
         internal derangement of the left shoulder, cephalalgia 
 
         (traumatic), possible seizure disorder, some cervical strait and 
 
         possible thoracic outlet syndrome.  The doctor rated claimant as 
 
         having a 20 percent permanent partial impairment at that time due 
 
         to these conditions.  In July 1986, claimant fell at a local 
 
         grocery store and reported an injury to his tailbone, left ankle 
 
         and shoulder.  Claimant later complained of lower lumbar pain.  
 
         In AuguSt 1986, claimant complained of neck and lower lumbar back 
 
         pain with a positive straight leg raising test. Claimant was 
 
         treated in the emergency room of a local hospital where claimant 
 
         attributed low back and leg pain to.the recent fall at the 
 
         grocery store.  Claimant was referred to Dr. Clemens, a general 
 
         surgeon, for evaluation of thoracic outlet syndrome in 1986.  Dr. 
 
         Clemens felt at that time that claimant was not suffering from 
 
         this condition.  In September 1986, Dr. Rolek diagnosed thoracic 
 
         outlet syndrome himself and a herniated cervical disc.  Claimant 
 
         refused a myelogram test in October 1986, and he was placed on 
 
         light duty for one month.  In January 1987, claimant complained 
 
         of left arm pain and abdominal pain.  In March 1987, claimant was 
 
         diagnosed as suffering from cervical strain after lifting a 
 
         concrete saw at work.  Claimant was off work at that time for 
 
         approximately 13 days.
 
         
 
              Claimant testified that he did not return to the same 
 
         physical state as existed before the injury in June 1987 as 
 
         asserted by Dr. Boulden.  He states that although he returned to 
 
         full duty, he, unlike before, continuously felt "pressure in his 
 
         back" and continually took medication to ease the pain.  Claimant 
 
         states that unlike before, he had to always "watch what he did" 
 
         and "not bend too quickly" or lift heavy objections without 
 
         careful attention to what he was doing.  He stated that he cannot 
 
         lift heavy objects without pain.  He states that he cannot operate 
 
         a saw or cement drills without pain but does so when ordered to do 
 
         so out of fear of losing his job.  He states that he "never got no 
 
         different" after the December 1987 injury and returned to the same 
 
         condition before the June 1987 injury within a few weeks.  
 
         Claimant states that he can no longer go boating, play "rough 
 
         house" with his kids, or work on small engines as before June 
 
                                                
 
                                                         
 
         1987.  He stated that his fellow employees now break up the 
 
         concrete into smaller pieces to assist him.  Claimant's wife 
 
         agreed in her testimony that claimant's condition worsened after 
 
         the June 1987 injury.  A fellow employee, Davis, testified that he 
 
         observed claimant in pain while lifting which did not occur before 
 
         the June 1987 injury.  He also said that this did not occur after 
 
         the 1986 fall at the grocery store.  This employee states that he 
 
         breaks up the concrete into smaller pieces on his own, not upon 
 
         the request of claimant, in order to assist not only claimant but 
 
         himself and others.
 
         
 
              Claimant is 28 years of age and has only an eleventh grade 
 
         education.  Claimant's employment before working for Des Moines, 
 
         was custodial work, labor work in a chemical plant, service 
 
         station work and ticket taker.  Almost all of claimant's past 
 
         employment has been in manual labor.  Claimant worked as a 
 
         temporary truck driver for a short time with the City of Des 
 
         Moines.  Claimant testified that he has unsuccessfully applied 
 
         for other more suitable jobs with the city, but has not obtained 
 
         any. Michael Peterson, the safety and training director for the 
 
         City of Des Moines testified that claimant has many promotional 
 
         jobs available to him at higher pay which require less physical 
 
         work but that he did not know the likelihood of claimant 
 
         obtaining any of these jobs.  All of the jobs are filled 
 
         competitively after testing.  If a person achieves the top 10 
 
         from testing, on-the-job performance ratings weigh heavily on the 
 
         final selection.  He admitted that claimant has a history of 
 
         heavy use of sick leave in the past.
 
         
 
              Claimant's appearance and demeanor at the hearing while 
 
         testifying and those of his witnesses indicated that they were 
 
         testifying in a candid and truthful manner.
 
         
 
                       APPLICABLE LAW AND ANALYSIS
 
         
 
               I.  The claimant has the burden of proving by a 
 
         preponderance of the evidence that the work injury is a cause of 
 
         the claimed disability.  A disability may be either temporary or 
 
         permanent.  In the case of a claim for temporary disability, the 
 
         claimant must establish that the work injury was a cause of 
 
         absence from work and lost earnings during a period of recovery 
 
         from the injury.  Generally, a claim of permanent disability 
 
         invokes an initial determination of whether the work injury was a 
 
         cause of permanent physical impairment or permanent limitation in 
 
         work activity.  However, in some instances, such as a job 
 
         transfer caused by a work injury, permanent disability benefits 
 
         can be awarded without a showing of a causal connection to a 
 
         physical change of condition.  Blacksmith v. All-American, Inc., 
 
         290 N.W.2d 348, 354 (Iowa 1980); McSpadden v. Big Ben Coal Co., 
 
         288 N.W.2d 181 (Iowa 1980).
 
         
 
              The question of causal connection is essentially within the 
 
         domain of expert medical opinion.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).  The opinion of 
 
         experts need not be couched in definite, positive or unequivocal 
 
                                                
 
                                                         
 
         language and the expert opinion may be accepted or rejected, in 
 
         whole or in part, by the trier of fact.  Sondag v. Ferris 
 
         Hardware, 220 N.W.2d 903 (Iowa 1974).  The weight to be given to 
 
         such an opinion is for the finder of fact, and that may be 
 
         affected by the completeness of the premise given the expert and 
 
         other surrounding circumstances.  Bodish v. Fischer, Inc., 257 
 
         Iowa 516, 133 N.W.2d 867 (1965).
 
         
 
              Furthermore, if the available expert testimony is 
 
         insufficient alone to support a finding of causal.connection, 
 
         such testimony may be coupled with nonexpert testimony to show 
 
         causation and be sufficient to sustain an award.  Giere v. Asse 
 
         Haugen Homes, Inc., 259 Iowa 1065, 146 N.W.2d 911, 915 (1966). 
 
         Such evidence does not, however, compel an award as a matter of 
 
         law.  Anderson v. Oscar Mayer & Co., 217 N.W.2d 531, 536 (Iowa 
 
         1974).  To establish compensability, the injury need only be a 
 
         significant factor, not be the only factor causing the claimed 
 
         disability.  Blacksmith, 290 N.W.2d 348, 354.  In the case of a 
 
         preexisting condition, an employee is not entitled to recover for 
 
         the results of a preexisting injury or disease but can recover 
 
         for an aggravation thereof which resulted in the disability found 
 
         to exist.  Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 
 
         N.W.2d 251 (1963).
 
         
 
              In the case sub judice, the evidence rather clearly 
 
         establishes that claimant has a significant permanent impairment 
 
         due to prior existing spondylolisthesis and spinal stenosis and 
 
         that claimant suffered an aggravation of these conditions on June 
 
         10, 1987.  The fighting issue in this case is the causal 
 
         connection between this work injury and permanent impairment.
 
         
 
              At first glance, it would appear that claimant should not 
 
         prevail.  The only physician to support claimant's position in 
 
         this case is his family physician, Dr. Rolek.  Dr. Rolek's 
 
         qualifications in orthopedic matters are no match for Dr. 
 
         Boulden, a board certified orthopedic surgeon, who does not 
 
         support claimant's position.  However, after observation of their 
 
         demeanor while testifying, the undersigned believes claimant, his 
 
         wife and the fellow employee.  According to their testimony, 
 
         something significant did happen on June 10, 1987, which did not 
 
         happen before or after.  Therefore, a closer look at Dr. 
 
         Boulden's testimony was made and it was concluded that his 
 
         opinion with reference to the causal connection between the work 
 
         injury and permanent impairment must be rejected.  Dr. Boulden 
 
         changed his opinion regarding permanency on the basis of four 
 
         assumed facts. He assumed that claimant was able to return to 
 
         work without additional symptoms.  He assumed that claimant's job 
 
         was not modified to accommodate for his return to work.  He 
 
         assumed that claimant did not worsen to a point that surgery was 
 
         necessary and he felt that claimant had experienced similar 
 
         aggravations in the past.
 
         
 
              First, Dr. Boulden changed his opinion concerning permanency 
 
         in a letter dated July 25, 1988.  In that letter he stated that he 
 
         had recently received correspondence from and had a conference 
 
                                                
 
                                                         
 
         with defendants' attorney.  At that time, Dr. Boulden had seen 
 
         claimant only once since issuing the January 21, 1988 opinion on 
 
         January 25. In his deposition, he explained that his change of 
 
         opinion on permanency was based upon claimant's improved symptoms. 
 
         This changed opinion was therefore issued after he had not seen 
 
         claimant for approximately five months.  What information Dr. 
 
         Boulden was provided by defense counsel prior to the July 1985 
 
         change of opinion is not a part of the record.  Dr. Boulden did 
 
         tell claimant in January 1985 to return to Dr. Blessman or himself 
 
         if problems developed.  Dr. Boulden is apparently operating on the 
 
         assumption that claimant's failure to return to him or Dr. 
 
         Blessman was due to a lack of symptoms.  Claimant credibly 
 
         testified that this was not the case.  Claimant said that he 
 
         continues to work despite his pain because he had to feed his 
 
         family and no alternative work was offered.  He said that he was 
 
         told that he would be replaced if he could not perform the work. 
 
         Dr. Boulden further testified that when he saw claimant in August 
 
         of 1988, claimant reported that he was doing fairly well.  
 
         However, claimant returned because he needed a different 
 
         anti-inflammatory medication due to stomach problems. Obviously, 
 
         claimant was regularly using.medication and was experiencing 
 
         continuing symptoms at that time.
 
         
 
              Second, Dr. Boulden is wrong in his assumption that 
 
         claimant's job was not modified.  Claimant and his fellow workers 
 
         testified without contradiction that they modified the job to 
 
         minimize lifting.  Claimant testified that he modified the way he 
 
         performed the job by following the advice of Dr. Boulden and his 
 
         physical therapist with reference to body mechanics.  Claimant 
 
         testified credibly that he has modified his entire life-style 
 
         around his weak back.
 
         
 
              Third, with reference to claimant's past medical history, it 
 
 
 
                       
 
                                                         
 
         is clear that claimant has a long history of upper back problems. 
 
         However, his history of low back problems is limited to four 
 
         instances after the diagnosis of spondy in 1980.  After each of 
 
         these instances there was no continuing treatment and no 
 
         continuing use of medications.  Claimant credibly testified that 
 
         he fully recovered from these injuries and flare-ups without 
 
         lingering pain and his testimony is uncontroverted.  Claimant's 
 
         fellow worker noticed no change in claimant's condition following 
 
         recovery from the grocery store fall in 1986.  This testimony 
 
         cannot be ignored.
 
         
 
              Finally, admittedly, surgery is strong evidence of permanent 
 
         impairment.  However, it is quite unusual in the experience of 
 
         this agency and in the experience of this deputy commissioner for 
 
         a physician to take the position that surgery is necessary before 
 
         a rating of impairment can be made.
 
         
 
              In the last analysis, the undersigned recognizes Dr. 
 
         Boulden's expertise but cannot accept the proposition that 
 
         claimant has not experienced permanent disability when it is 
 
         clear that he regularly experiences pain while lifting in his 
 
         job; he continuously uses medication to remain employed; and, his 
 
         job has been actually modified by claimant and others to 
 
         accommodate for symptoms.  Therefore, although Dr. Boulden has 
 
         super qualifications, his opinions are only as good as the facts 
 
         he was presented with.  As those facts are,not correct, neither 
 
         is Dr. Boulden's opinion with reference to the impact of the June 
 
         10, 1987 injury.
 
         
 
              According to Dr. Boulden, claimant has a preexisting 10 
 
         percent permanent partial impairment due to his spondy condition. 
 
         He added in his deposition testimony that if claimant was 
 
         suffering a continuation of symptoms, this impairment rating 
 
         would increase by an additional 10 percent.  Given such 
 
         testimony, which is clearly within the specialized expertise of 
 
         Dr. Boulden, it will be found that claimant has suffered an 
 
         additional 10 percent permanent partial impairment and the June 
 
         10, 1987 injury precipitated these continuing symptoms which have 
 
         remain unchanged since that time.  According to the credible 
 
         testimony of claimant, symptoms were unchanged by the December 
 
         1987 injury.
 
         
 
              II.  Claimant must establish by a preponderance of the 
 
         evidence the extent of weekly benefits for permanent disability 
 
         to which claimant is entitled.  As the claimant has shown that 
 
         the work injury was a cause of a permanent physical impairment or 
 
         limitation upon activity involving the body as a whole, the 
 
         degree of permanent disability must be measured pursuant to Iowa 
 
         Code section 85.34(2)(u).  However, unlike scheduled member 
 
         disabilities, the degree of disability under this provision is 
 
         not measured solely by the extent of a functional impairment or 
 
         loss of use of a body member.  A disability to the body as a 
 
         whole or an "industrial disability" is a loss of earning capacity 
 
         resulting from the work injury.  Diederich v. Tri-City Railway 
 
         Co., 219 Iowa 587, 593, 258 N.W. 899 (1935).  A physical 
 
                                                
 
                                                         
 
         impairment or restriction on work activity may or may not result 
 
         in such a loss of earning capacity.  The extent to which a work 
 
         injury and a resulting medical condition have resulted in an 
 
         industrial disability is determined from examination of several 
 
         factors. These factors include the employee's medical condition 
 
         prior to the injury, immediately after the injury and presently; 
 
         the situs of the injury, its severity and the length of healing 
 
         period; the work experience of the employee prior to the injury, 
 
         after the injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         Olson v. Goodyear Service Stores, 255 Iowa 1112, 1121, 125 
 
         N.W.2d 251, 257 (1963).  See Peterson v. Truck Haven Cafe, Inc., 
 
         (Appeal Decision, February 28, 1985).
 
         
 
              Claimant's medical condition before the work injury was not 
 
         excellent and he had at least a 10 percent permanent partial 
 
         functional impairment before June 10, 1987 due to spondy.  At 
 
         least one doctor indicated that he had a 20 percent permanent 
 
         partial impairment due to his upper back and neck problems. 
 
         However, the effect of these prior impairments upon claimant's 
 
         livelihood and ability to earn a living was limited to brief 
 
         periods of absences from work when flare-ups occurred. 
 
         Consequently, claimant had significant prior permanent partial 
 
         industrial disability before June 10, 1987, but this disability 
 
         was mild.
 
         
 
              Prior to June 10, 1987, claimant was fully able to perform 
 
         physical tasks involving heavy lifting, repetitive lifting, 
 
         bending, twisting and stooping despite problems with his upper 
 
         and lower back.  It was only after the June 10, 1987 injury that 
 
         the problems became chronic and constant which required continued 
 
         use of medication and significant job modification.
 
         
 
              Claimant's physicians have not as yet restricted claimant's 
 
         work activities.  Obviously, claimant prefers not to have those 
 
         restrictions imposed as he would probably lose his job.  
 
         Therefore, the absence of such restrictions is not an appropriate 
 
         indicator of claimant's disability.
 
         
 
              Claimant's medical condition to date has not prevented him 
 
         from returning to his former work or to any other manual labor 
 
         work, the work for which he is best suited given his work history 
 
         and education.  This fact significantly reduces the amount of 
 
         this award.  Should this condition change and claimant not be 
 
         able to continue to work in his current job, this agency is 
 
         available to review the matter at a later date.
 
         
 
              Apart from his lost earnings during his healing period which 
 
         has been compensated, claimant has not suffered a significant 
 
         permanent loss in actual earnings as a result of his disability 
 
                                                
 
                                                         
 
         due to his ability to remain on his job.  However, a showing that 
 
         claimant had no loss of actual earnings does not preclude an 
 
         award of industrial disability.  See Michael. v. Harrison County, 
 
         Thirty-fourth Biennial Reports Iowa Industrial Commissioner 218, 
 
         220 (Appeal Decision 1979).
 
         
 
              Claimant is 28 years of age and such youth is favorable to 
 
         returning.  See Walton v. B & H Tank Corp., II Iowa Industrial 
 
         Commissioner Report 426 (Appeal Decision 1981).  However, his 
 
         lack of education deters from his vocational rehabilitation 
 
         potential.
 
         
 
              Claimant has shown considerable motivation to remain 
 
         employed in the face of his disability.  Such motivation, 
 
         however, should not prevent a recovery of an adequate disability 
 
         award.  Claimant is advised that he should attempt vocational 
 
         rehabilitation if alternative employment with the City of Des 
 
         Moines is not possible.
 
         
 
              After examination of all the factors, it is found as a 
 
         matter of fact that claimant has, overall, a 30 percent loss in 
 
         his earning capacity as a result of his present physical 
 
         limitations and conditions.  However, 10 percent of this 
 
         disability preexisted the work injury of June 10, 1987.  That 
 
         injury was a cause of an additional 20 percent permanent partial 
 
         disability.  Based upon such a finding, claimant is entitled as a 
 
         matter of law to 100 weeks of permanent partial disability 
 
         benefits under Iowa Code section 85.34(2)(u) which is 20 percent 
 
         of 500 weeks, the maximum allowable number of weeks for an injury 
 
         to the body as a whole in that subsection.
 
         
 
                            FINDINGS OF FACT
 
         
 
              1.  Claimant, his wife and Gregory Davis were believable and 
 
         credible witnesses from observations while testifying during 
 
         hearing.
 
         
 
              2.  On June 10, 1987, while lifting a concrete saw, claimant 
 
         suffered an injury to the low back which arose out of and in the 
 
         course of employment with the City of Des Moines.  This injury 
 
         aggravated a preexisting low back condition of spondylolisthesis 
 
         and spinal stenosis.
 
         
 
              3.  The work injury of June 10, 1987, was a cause of a 10 
 
         percent permanent partial impairment to the body as a whole and 
 
         of permanent restrictions upon claimant's physical activity 
 
         consisting of lifting with only use of proper body mechanics and 
 
         a reduced amount of heavy lifting and repetitive bending and 
 
         twisting overall.  Although claimant had back pain episodes on 
 
         several occasions before June 10, 1987, subsequent to the 
 
         diagnosis of spondylolisthesis in 1980, these episodes were 
 
         temporary in duration.  It was not until the incident of June 10, 
 
         1987, that claimant experienced continuous symptoms which 
 
         required the continuous use of anti-inflammatory medication and 
 
         lifestyle modifications.  It was only after the June 10, 1987 
 
                                                
 
                                                         
 
         injury that claimant's job had to be modified by claimant and his 
 
         fellow employees to ease claimant's pain.  To date, claimant has 
 
         not sought or received surgical intervention to reduce his pain.  
 
         A work injury of December 7, 1987, consisting of a fall, resulted 
 
         in significant low back and leg pain but claimant recovered from 
 
         this injury and returned to the same condition that existed prior 
 
         to December 7, 1987.
 
         
 
              4.  The work injury of June 10, 1987, and the resulting 
 
         permanent partial impairment was a cause of a 20 percent loss of 
 
         earning capacity.  Claimant had a preexisting permanent partial 
 
         disability or loss of earning capacity of 10 percent as a result 
 
         of a prior existing low back condition and significant impairment 
 
         from his upper back, neck and shoulder conditions stemming from 
 
         problems beginning in 1984.  This prior disability resulted in 
 
         episodic bouts of pain which required brief absences from work. 
 
         After June 10, 1987, claimant's pain and use of medication became 
 
         continuous.  Claimant had to make job modifications.  Claimant 
 
         continues to work today despite his pain due to the need to earn 
 
         a living.  Claimant is fearful of losing his job due to his 
 
         disability and does not complain to fellow employees or to 
 
         management of his pain while working.  Claimant is 28 years of 
 
         age and is relatively young but only has an eleventh grade 
 
         education. At the present time at least claimant is able to 
 
         continue his employment with the City of Des Moines without a 
 
         loss of pay.
 
         
 
                             CONCLUSION OF LAW
 
         
 
              Claimant has established under law entitlement to weekly 
 
         benefits for a 20 percent permanent partial industrial 
 
         disability.
 
         
 
                  
 
                                                         
 
                                  ORDER
 
         
 
              1.  Defendants shall pay to claimant one hundred (100) weeks 
 
         of permanent partial disability benefits at the rate of two 
 
         hundred forty-two and 65/100 ($242.65) per week from January 26, 
 
         1988.
 
         
 
              2.  Defendants shall pay accrued weekly benefits in a lump 
 
         sum and shall receive credit against this award for all benefits 
 
         previously paid.
 
         
 
              3.  Defendants shall pay interest on weekly benefits awarded 
 
         herein as set forth in Iowa Code section 85.30.
 
         
 
              4.  Defendants shall pay the costs of this action pursuant 
 
         to Division of Industrial Services Rule 343-4.33.
 
         
 
              5.  Defendants shall file activity reports on the payment of 
 
         this award as requested by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 22nd day of June, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                            LARRY P. WALSHIRE
 
                                            DEPUTY INDUSTRIAL 
 
                                            COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Robert E. McKinney
 
         Attorney at Law
 
         480 6th St.
 
         P. 0. Box 209
 
         Waukee, Iowa  50263
 
         
 
         Mr. Steven C. Lussier
 
         Attorney at Law
 
         Legal Dept. - City Hall
 
         E. 1st & Locust
 
         Des Moines, Iowa  50307
 
 
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 51803; 2505
 
                                                 Filed June 22, 1989
 
                                                 LARRY P. WALSHIRE
 
         
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         RONALD PIPER, JR.,
 
         
 
              Claimant,
 
                                                   File No. 850448
 
         VS.
 
                                                 A R B I T R A T I 0 N
 
         CITY OF DES MOINES, IOWA,
 
                                                    D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
         51803 - Nonprecedential
 
         
 
              Causal connection and extent of permanent disability 
 
              issues.
 
         
 
         2505
 
         
 
              Opinion of board certified orthopedic surgeon was rejected 
 
         due to surgeon's incorrect factual assumptions.
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
         before the iowa industrial commissioner
 
         ____________________________________________________________
 
                   :
 
         JUDITH A. WICKS,    :
 
                   :
 
              Claimant, :
 
                   :
 
         vs.       :
 
                   :      File No. 850470
 
         LETICA CORPORATION, :
 
                   :        A P P E A L
 
              Employer, :
 
                   :      D E C I S I O N
 
         and       :
 
                   :
 
         COMMERCE & INDUSTRY      :
 
         INSURANCE COMPANY,  :
 
                   :
 
              Insurance Carrier,  :
 
              Defendants.    :
 
         ___________________________________________________________
 
         The record, including the transcript of the hearing before the 
 
         deputy and all exhibits admitted into the record, has been 
 
         reviewed de novo on appeal.  The decision of the deputy filed 
 
         June 5, 1991, is affirmed and is adopted as the final agency 
 
         action in this case. 
 
         Claimant shall pay the costs of the appeal, including the 
 
         preparation of the hearing transcript.
 
         Signed and filed this ____ day of September, 1991.
 
         
 
         
 
         
 
         
 
                   ________________________________
 
                            BYRON K. ORTON
 
                        INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. David Newell
 
         Attorney at Law
 
         323 E. 2nd Street
 
         PO Box 175
 
         Muscatine, Iowa 52761
 
         
 
         Mr. Richard G. Blane, II
 
         Mr. William D. Scherle
 
         Attorneys at Law
 
         8th Floor, Fleming Building
 
         Des Moines, Iowa 50309
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      9998
 
                      Filed September 26, 1991
 
                      BYRON K. ORTON
 
                      LPW
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                      :
 
            JUDITH A. WICKS,    :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 850470
 
            LETICA CORPORATION, :
 
                      :        A P P E A L
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            COMMERCE & INDUSTRY :
 
            INSURANCE COMPANY,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ____________________________________________________________
 
            _____
 
            
 
            9998
 
            
 
                 Summary affirmance of deputy's decision filed June 5, 
 
            1991.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            JUDITH A. WICKS,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  850470
 
            LETICA CORPORATION,           :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            COMMERCE AND INDUSTRY INS. CO.:
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by Judith 
 
            A. Wicks, claimant, against Letica Corporation, employer 
 
            (hereinafter referred to as Letica), and Commerce and 
 
            Industry Insurance Company, defendants, for workers' 
 
            compensation benefits as a result of an alleged injury on 
 
            April 9, 1987.  On April 8, 1991, a hearing was held on 
 
            claimant's petition and the matter was considered fully 
 
            submitted at the close of this hearing.
 
            
 
                 The parties have submitted a prehearing report of 
 
            contested issues and stipulations which was approved and 
 
            accepted as a part of the record of this case at the time of 
 
            hearing.  The oral testimony and written exhibits received 
 
            during the hearing are set forth in the hearing transcript.
 
            
 
                 According to the prehearing report, the parties have 
 
            stipulated to the following matters:
 
            
 
                 1.  An employee-employer relationship existed between  
 
            claimant and Letica at the time of the injury;
 
            
 
                 2.  If defendants are held liable for the alleged 
 
            injury, claimant is entitled to temporary total disability 
 
            or healing period benefits from April 9, 1987 through July 
 
            20, 1988;
 
            
 
                 3.  If the injury is found to have caused permanent 
 
            disability, the type of disability is a scheduled member 
 
            disability to the right and left arms;
 
            
 
                 4.  If permanent partial disability benefits are 
 
            awarded, they shall begin as of July 21, 1988;
 
            
 
                 5.  Claimant's weekly workers' compensation rate is 
 
            $106.82;
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 6.  All requested medical benefits have been or will be 
 
            paid by defendants; and
 
            
 
                 7.  Defendants voluntarily paid 72 weeks of 
 
            compensation at the rate of $106.82 per week prior to 
 
            hearing.
 
            
 
                                      issue
 
            
 
                 The parties submitted the following issues for 
 
            determination in this proceeding:
 
            
 
                 I.  Whether claimant received an injury arising out of 
 
            and in the course of employment; and
 
            
 
                 II.  The extent of claimant's entitlement to permanent 
 
            partial disability benefits.
 
            
 
                                 findings of fact
 
            
 
                 Having heard the testimony and considered all the 
 
            evidence, the deputy industrial commissioner finds as 
 
            follows:
 
            
 
                 Claimant worked for Letica on the night shift for seven 
 
            days from April 1, 1987 through April 8, 1987, a total of 54 
 
            hours.  Claimant was off work on a day off on April 6, 1987.  
 
            During this period of employment, claimant was assembling 
 
            plastic buckets by taking them from a mold machine and 
 
            installing a metal handle.  This job required the repetitive 
 
            use of claimant's hands, especially her right hand and 
 
            thumb, to push the end of the handle into the plastic 
 
            receptacle for handles on the bucket.  An experienced 
 
            operator only takes a few seconds to perform the job 
 
            according to the video tape submitted in the evidence.  
 
            
 
                 Claimant left her job at Letica on April 9, 1988, to 
 
            seek medical treatment due to bilateral hand and wrist pain.  
 
            She was terminated from the job when she reported back for 
 
            work with a wrist cast following treatment.  During the time 
 
            she was employed by Letica, claimant was also employed 
 
            part-time during the day with a dry cleaning firm.  Claimant 
 
            had worked at this job for many years and was assigned to 
 
            pressing clothes.  This job also involved the repetitive use 
 
            of hands and arms.  
 
            
 
                 On or about April 9, 1987, claimant injured her right 
 
            and left wrists and arms while performing her job at Letica.  
 
            This injury was diagnosed as bilateral carpal tunnel 
 
            syndrome as a result of repetitive work at Letica by William 
 
            Catalona, M.D., an orthopedic surgeon, who had treated 
 
            claimant  for a variety of problems since 1977.  Dr. 
 
            Catalona eventually performed two corrective carpal tunnel 
 
            release surgeries: one surgery on the right in July 1987 and 
 
            another on the left in October 1987.  
 
            
 
                 In their denial of the claim, the defense relies upon 
 
            the opinions of William Blair, M.D., an orthopedic surgeon 
 
            and professor of medicine at the University of Iowa 
 
            Hospitals and Clinics.  After review of his opinions, the 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            undersigned feels that the views of Dr. Blair do not 
 
            controvert the views of Dr. Catalona.  In his deposition 
 
            testimony, Dr. Blair opined that claimant's carpal tunnel 
 
            syndrome was a combination of a multiple number of factors, 
 
            such as her age, predisposition to such an injury, as well 
 
            as the activities of daily life and the activities at both 
 
            her work at Letica and her work at the dry cleaners.  
 
            
 
                 A view from another orthopedic surgeon, Dennis Miller, 
 
            M.D., in June 1987, that claimant clearly suffered from 
 
            carpal tunnel syndrome due to her work at Letica had to be 
 
            rejected as he was apparently unaware that claimant had 
 
            prior right and left arm and wrist problems before April 9, 
 
            1987.  Actually, claimant had a 10-year history of left and 
 
            right shoulder, arm and hand pain prior to the injury which 
 
            was treated by Dr. Catalona.
 
            
 
                 At the present time, claimant suffers continued 
 
            symptoms despite surgery to both wrists and complains of 
 
            bilateral loss of grip strength, loss of sensation and 
 
            chronic pain.  Most physicians agree that these continuing 
 
            problems are permanent and all agree that claimant should 
 
            restrict the use of her hands in the future to avoid 
 
            problems.  Impairment ratings by physicians in this case 
 
            vary greatly from 3 percent to over 50 percent for each 
 
            side.  However, the extent of permanent impairment is not 
 
            important to this decision as claimant failed to show that 
 
            her current symptoms and the permanent partial impairment 
 
            were the result of the work injury of April 9, 1987.  
 
            
 
                 In addition to the prior hand and arm problems dating 
 
            back to 1977, claimant suffered two significant injuries to 
 
            her hands subsequent to the work injury in this case.  In 
 
            October 1987, only a few days after her second carpal tunnel 
 
            release surgery, she fell on a sidewalk on outstretched 
 
            hands incurring a great deal of bilateral hand and wrist 
 
            pain.  In 1989, she slipped on a wet river bank while 
 
            fishing and suffered a significant injury to the tendons of 
 
            her left wrist.  Also, following the onset of pain while 
 
            working at the dry cleaning job in September 1989, claimant 
 
            was diagnosed as suffering from left de Quervain's 
 
            tenosynovitis of the left arm and this condition was 
 
            surgically treated by Leo Kulick, M.D., another orthopedic 
 
            surgeon.  
 
            
 
                 Four physicians have rendered opinions in this case as 
 
            to the causal connection of claimant's permanent partial 
 
            impairment to the injury.  The views of Dr. Miller and Dr. 
 
            Blair are discussed above.  In November 1989, claimant 
 
            received an evaluation from a retired general surgeon, F. 
 
            Dale Wilson, M.D.  According to Dr. Wilson, all of the 
 
            permanent partial impairment suffered by claimant in both 
 
            arms is attributable to the work injury of April 9, 1987.  
 
            He felt that the falls and the September 1989 injury at the 
 
            dry cleaners were not significant enough to cause impairment 
 
            or the need for surgery.  
 
            
 
                 The undersigned gave considerable weight to the views 
 
            of Dr. Catalona.  Dr. Catalona had been treating claimant 
 
            since 1977.  Among the doctors involved this case, he was  
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            the most familiar with claimant's history from a hands-on 
 
            experience.  He was also the primary treating physician for 
 
            the work injury, in that he performed both of the release 
 
            surgeries in this case.  Although it is apparent from his 
 
            progress notes that he felt that claimant suffered a carpal 
 
            tunnel syndrome injury from her work at Letica, he stated in 
 
            his office note of January 6, 1989, that it was impossible 
 
            to say one way or another whether claimant's symptoms are 
 
            related to her work injury or to her fall in October 1987.  
 
            Given this view and the lack of a consensus view from the 
 
            other evaluating physicians, claimant failed to show by a 
 
            preponderance of the evidence a causal connection of her 
 
            current symptoms and permanent partial impairment to the 
 
            work injury of April 9, 1987.
 
            
 
                 As the parties stipulated, with reference to the extent 
 
            of claimant's entitlement to temporary total disability 
 
            benefits, no findings as to these benefits need be made.
 
            
 
                                conclusions of law
 
            
 
                 I.  Claimant has the burden of proving by a 
 
            preponderance of the evidence that claimant received an 
 
            injury which arose out of and in the course of employment.  
 
            The words "out of" refer to the cause or source of the 
 
            injury.  The words "in the course of" refer to the time and 
 
            place and circumstances of the injury.  See Cedar Rapids 
 
            Community Sch. v. Cady, 278 N.W.2d 298 (Iowa 1979); Crowe v. 
 
            DeSoto Consol. Sch. Dist., 246 Iowa 402, 68 N.W.2d 63 
 
            (1955).  An employer takes an employee subject to any active 
 
            or dormant health impairments, and a work connected injury 
 
            which more than slightly aggravates the condition is 
 
            considered to be a personal injury.  Ziegler v. United 
 
            States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591 (1960) 
 
            and cases cited therein.
 
            
 
                 It is not necessary that claimant prove her disability 
 
            results from a sudden unexpected traumatic event.  It is 
 
            sufficient to show that the disability developed gradually 
 
            and progressively from work activity over a period of time.  
 
            McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 
 
            1985).  The McKeever court also held that the date of injury 
 
            in gradual injury cases is the time when pain prevents the 
 
            employee from continuing to work.  In the case sub judice, 
 
            the preponderance of the medical opinions supported a 
 
            finding of a gradual or cumulative trauma work injury.  
 
            However, the fighting issue in this case, which is causal 
 
            connection to permanent partial impairment.
 
            
 
                 II.  The claimant has the burden of proving by a 
 
            preponderance of the evidence that the work injury is a 
 
            cause of the claimed disability.  A disability may be either 
 
            temporary or permanent.  In the case of a claim for 
 
            temporary disability, the claimant must establish that the 
 
            work injury was a cause of absence from work and lost 
 
            earnings during a period of recovery from the injury.  
 
            Generally, a claim of permanent disability invokes an 
 
            initial determination of whether the work injury was a cause 
 
            of permanent physical impairment or permanent limitation in 
 
            work activity.  However, in some instances, such as a job 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            transfer caused by a work injury, permanent disability 
 
            benefits can be awarded without a showing of a causal 
 
            connection to a physical change of condition.  Blacksmith v. 
 
            All-American, Inc., 290 N.W.2d 348, 354 (Iowa 1980); 
 
            McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980).
 
            
 
                 The question of causal connection is essentially within 
 
            the domain of expert medical opinion.  Bradshaw v. Iowa 
 
            Methodist Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).  
 
            The opinion of experts need not be couched in definite, 
 
            positive or unequivocal language and the expert opinion may 
 
            be accepted or rejected, in whole or in part, by the trier 
 
            of fact.  Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 
 
            1974).  The weight to be given to such an opinion is for the 
 
            finder of fact, and that may be affected by the completeness 
 
            of the premise given the expert and other surrounding 
 
            circumstances.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 
            N.W.2d 867 (1965).
 
            Furthermore, if the available expert testimony is 
 
            insufficient alone to support a finding of causal 
 
            connection, such testimony may be coupled with nonexpert 
 
            testimony to show causation and be sufficient to sustain an 
 
            award.  Giere v. Asse Haugen Homes, Inc., 259 Iowa 1065, 146 
 
            N.W.2d 911, 915 (1966).  Such evidence does not, however, 
 
            compel an award as a matter of law.  Anderson v. Oscar Mayer 
 
            & Co., 217 N.W.2d 531, 536 (Iowa 1974).  To establish 
 
            compensability, the injury need only be a significant 
 
            factor, not be the only factor causing the claimed 
 
            disability.  Blacksmith, 290 N.W.2d 348, 354.  In the case
 
            
 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
            of a preexisting condition, an employee is not entitled to 
 
            recover for the results of a preexisting injury or disease 
 
            but can recover for an aggravation thereof which resulted in 
 
            the disability found to exist.  Olson v. Goodyear Service 
 
            Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963).
 
            
 
                 In the case sub judice, claimant contended that she 
 
            suffered disability as a result of a work injury due to 
 
            permanent impairment.  First, the evidence rather clearly 
 
            established that she does suffer, to some extent, a 
 
            permanent partial impairment due to continuing or lingering 
 
            problems with her wrists, hands and arms.  However, the 
 
            evidence failed to show a requisite causal connection 
 
            between the work injury of April 9, 1987, and this permanent 
 
            partial impairment.
 
            
 
                 Claimant is entitled to temporary total disability 
 
            benefits for an injury whether or not the injury caused 
 
            permanent impairment of permanent disability.  Iowa Code 
 
            section 85.33(1).  It was stipulated in the prehearing 
 
            report as to the extent of this entitlement to temporary 
 
            total disability benefits.  Also, according to the 
 
            prehearing report, it was stipulated that claimant has been 
 
            paid weekly benefits in excess of her entitlement to these 
 
            benefits.  Therefore, claimant's petition for additional 
 
            benefits will be dismissed with prejudice.  Although 
 
            claimant did not prevail in this proceeding, her claim was 
 
            arguable and she will be awarded costs.  
 
            
 
                                      order
 
            
 
                 1.  Claimant's claim for additional weekly disability 
 
            benefits is denied and her petition filed herein for 
 
            additional benefits is dismissed with prejudice.
 
            
 
                 2.  Defendants shall pay the costs of this action 
 
            pursuant to rule 343 IAC 4.33, including reimbursement to 
 
            claimant for any filing fee paid in this matter.  
 
            
 
                 Signed and filed this ____ day of June, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          LARRY P. WALSHIRE
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. David Newell
 
            Attorney at Law
 
            323 E 2nd St. 
 
            PO Box 175
 
            Muscatine, Iowa  52761
 
            
 
            Mr. Richard G. Blane, II
 
            Mr. William D. Scherle
 
            Attorneys at Law
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            8th Floor, Fleming Bldg.
 
            Des Moines, Iowa  50309
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                      51803
 
                      Filed June  , 1991
 
                      Larry P. Walshire
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            JUDITH A. WICKS,    :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No.  850470
 
            LETICA CORPORATION, :
 
                      :    A R B I T R A T I O N
 
                 Employer, :
 
                      :       D E C I S I O N
 
            and       :
 
                      :
 
            COMMERCE AND INDUSTRY INS. CO.:
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            5-1803
 
            
 
            Nonprecedential, extent of permanent disability benefits.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                                          :
 
            MICHAEL G. HAIN,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 850475
 
            GRAIN PROCESSING CORPORATION, :
 
                                          :        A P P E A L
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            CIGNA INSURANCE,              :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            _____
 
            STATEMENT OF THE CASE
 
            Claimant appeals from an arbitration decision denying 
 
            permanent partial disability benefits as the result of an 
 
            alleged injury on April 11, 1987.  The record on appeal 
 
            consists of the transcript of the arbitration proceeding; 
 
            claimant's exhibits 1 through 4 and 6 through 11; and 
 
            defendants' exhibits A through G.   The record also contains 
 
            the deposition of Earl Y. Bickel, M.D., taken January 9, 
 
            1991.  Both parties filed briefs on appeal.  Claimant filed 
 
            a reply brief.
 
            ISSUES
 
            Claimant states the following issue on appeal:
 
            
 
                 I.  Whether the deputy erred in excluding 
 
                 claimant's exhibit 5 from evidence.
 
            
 
                 II.  Whether the deputy erred in finding 
 
                 claimant's disability was not compensable and not 
 
                 related to the April 11, 1987 accident.
 
            
 
                 III.  Whether the deputy erred in allowing the 
 
                 testimony of Nee Leau about the contents of a 
 
                 document that was excluded because it was not 
 
                 served in discovery.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The findings of fact contained in the proposed agency 
 
            decision filed March 26, 1991  are adopted as final agency 
 
            action.
 
            CONCLUSIONS OF LAW
 
            The conclusions of law contained in the proposed agency 
 
            decision filed March 26, 1991 are adopted as final agency 
 
            action, with the following additional analysis:
 
            The exclusion of claimant's exhibit 5 and the admission of 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            the testimony of Nee Leau were proper.  However, even if the 
 
            testimony of Nee Leau was excluded, the conclusions of law 
 
            and the denial of further benefits would remain the same.  
 
            WHEREFORE, the decision of the deputy is affirmed.
 
            order
 
            THEREFORE, it is ordered:
 
            That claimant take nothing from this proceeding as he has 
 
            previously been paid all weekly compensation and all 
 
            benefits under section 85.27 of The Code to which he is 
 
            entitled.
 
            That claimant shall pay the costs of this matter including 
 
            the transcription of the hearing.  
 
            Signed and filed this ____ day of February, 1992.
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                               BYRON K. ORTON
 
                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Jerry Zimmerman
 
            Attorney at Law
 
            P.O. Box 74210
 
            Cedar Rapids, Iowa 52407
 
            
 
            Mr. John M. Bickel
 
            Attorney at Law
 
            P.O. Box 2107
 
            Cedar Rapids, Iowa 52406-2107