5-1803
 
                                          Filed July 20, 1990
 
                                          Clair R. Cramer
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            CHARLES VAN BLARICUM,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 852132
 
            SUPER VALU STORES, INC.,      :
 
                                          :        A P P E A L
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INSURANCE CO., :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            5-1803
 
            The greater weight of the evidence supports the deputy 
 
            industrial commissioner's findings that claimant is entitled 
 
            to 15 percent permanent partial disability as a result of 
 
            claimant's April 1, 1987 work injury.
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CHARLES VAN BLARICUM,
 
          
 
               Claimant,
 
                                           File No. 852132
 
          VS.
 
          
 
          SUPER VALU STORES, INC.,       A R B I T R A T I 0 N
 
          
 
               Employer,                    D E C I S I 0 N
 
          
 
          and
 
          
 
          LIBERTY MUTUAL INSURANCE CO.,
 
          
 
               Insurance Carrier,
 
               Defendants.
 
          
 
          
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by the claimant, 
 
         Charles Van Blaricum, against Super Valu Stores, Inc., employer, 
 
         and Liberty Mutual Insurance Co., insurance carrier, defendants 
 
         to recover benefits as a result of an injury sustained on April 
 
         1, 1987.  This matter came on for hearing before the deputy 
 
         industrial commissioner in Des Moines, Iowa, on April 5, 1989.  
 
         The record consists of the testimony of claimant and Wayne Senne; 
 
         joint exhibits 1 through 9; and defendants' exhibit A.
 
         
 
                                      ISSUES
 
         
 
              The issues to be decided in this matter are:
 
         
 
              1. The nature and extent of claimant's permanent disability; 
 
         and
 
         
 
              2. Whether claimant is entitled $69.06 in medical benefits 
 
         pursuant to section 85.27.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              Claimant testified that he was injured at work on April 1, 
 
         1987, when a chair on which he was sitting collapsed, throwing 
 
         him onto the floor injuring his elbow and back.  Claimant 
 
         indicated that the collapse of the chair was caused by a screw 
 
         breaking which held the seat.
 
         
 
              Claimant began working in the grocery business in 1946 
 
         working up from stockman to assistant manager at Thriftway
 
         
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 2
 
         
 
         
 
         and Safeway stores.  Claimant worked for the Beaverdale Super 
 
         Valu until 1962, at which time claimant came to work for 
 
         defendant employer in the warehouse.  Claimant worked for 
 
         defendant employer to and including April 24, 1987.  At the time 
 
         of claimant's April 1, 1987 injury, he held a position of order 
 
         clerk at the Super Valu warehouse.  Claimant stated that this job 
 
         involved taking orders as they came in from the computer room; 
 
         breaking larger piles down into smaller piles; putting these 
 
         orders into a bursting machine, which required stooping to within 
 
         approximately six to eight inches off the floor and resulted in a 
 
         separation of the computer printouts of order tickets into three 
 
         sections; stapling the tickets; and putting the tickets into the 
 
         appropriate customer pigeonhole.  Claimant stated that his shift 
 
         was from 4:00 a.m. to 2:00 p.m., and that when he arrived on his 
 
         shift, there was usually a two foot tall stack of tickets 
 
         weighing up to 75 pounds waiting for him to process.  Claimant 
 
         emphasized that he would lift the entire pile and run it through 
 
         the bursting machine.  Claimant also indicated that he wore a 
 
         phone headset so he could have his arms free to continue with his 
 
         order processing and taking oral phone orders.  Claimant 
 
         testified that his desk order job involved a lot of sitting; 
 
         getting up; looking for a tub to put the orders in; twisting; and 
 
         reaching, sometimes above his ahead.  Claimant emphasized that 
 
         the pace was intensive and one had to be mentally alert, 
 
         otherwise, orders could be messed up, mistakes made, and orders 
 
         not getting to the warehouse so that they could be filled and 
 
         delivered.  Claimant contended that from 1970 to the April 1, 
 
         1987 injury, he kept pace and did a good job, but after he fell 
 
         out of the chair on April 1, 1987, it became harder for him to 
 
         get up and down from the chair and do the filing due to the aches 
 
         and pain.  Claimant acknowledged that on April 1, 1987 he did not 
 
         think he was hurt in the chair accident and continued working.
 
         
 
              Claimant received his first medical help for his April 1, 
 
         1987 accident on April 15, 1987.  Claimant then returned to work 
 
         through April 24, 1987, after which date he has not worked.  
 
         Claimant described certain medical problems that have occurred 
 
         since the April 1, 1987 injury.  Claimant indicated that he had 
 
         back surgery on May 28, 1987 and an ulnar nerve surgery in 
 
         September 1987.  Claimant testified he wears daily a hard plastic 
 
         back brace that fits around his middle section.  Claimant 
 
         indicated that without wearing this brace prescribed 
 
         approximately two weeks after his second surgery, he feels like 
 
         his back is coming apart.  Claimant said that he cannot walk too 
 
         long without it.
 
         
 
              Claimant indicated that his medical condition was okay prior 
 
         to his April 1, 1987 injury.  Claimant admitted that he had back 
 
         surgery in 1961 and a second surgery in 1980, after which a Dr. 
 
         Jones put a 25 pound lifting restriction on him.  Claimant 
 
         contends he did not honor the restriction as his back seemed to 
 
         strengthen.  Claimant emphasized that he has not
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 3
 
         
 
         
 
         filed or received any workers' compensation or personal injury 
 
         benefits for these injuries.  Claimant could not recall, even 
 
         though reminded, that he had a third surgery involving removal of 
 
         an extruded lumbar disc at L-5, S-l on the left approximately in 
 
         May 1982.  Claimant acknowledged that he was treated for a heart 
 
         and prostrate problem between January 24, 1987 to March 17, 1987, 
 
         and that Dr. Kohles placed a 25 pound weight restriction due to 
 
         the prostrate surgery.
 
         
 
              Claimant testified that prior to April 1, 1987, he had plans 
 
         to work for four more years so that he could retire with 30 years 
 
         service and qualify for a full pension at age 66 in 1991.  
 
         Claimant contends that he did not voluntarily retire on April 3, 
 
         1988, but because of his back problems was advised by Robert A. 
 
         Hayne, M.D., to retire.  Claimant indicated that prior to his 
 
         retirement, Jack Wetsch, comptroller for the warehouse, told him 
 
         that claimant could not medically do the job he held on April 1, 
 
         1987, but that the employer would try to find claimant a job.  
 
         Claimant said that Wetsch later indicated a job may be available 
 
         in general accounting, but wasn't specific.  Claimant contends 
 
         that he would have to use a calculator, a CRT, typewriter, and an 
 
         adding machine and had no skills for the use of these.  Claimant 
 
         indicated that he was a one finger calculator and typewriter 
 
         operator.  Claimant acknowledged that he worked at a credit desk 
 
         type job sometime in the past while working for defendant 
 
         employer.  Claimant contends that this job would violate his 40 
 
         pound weight, two hours standing and sitting, and bending and 
 
         twisting restrictions.
 
         
 
              Claimant testified that on March 8, 1988, he and Mr. Wetsch 
 
         had a conversation in which claimant indicated that Wetsch told 
 
         him claimant's former order desk job was now filled.  Claimant 
 
         indicated he walked out of the employer's place of business and 
 
         decided to retire.  Claimant acknowledged that he never went back 
 
         to defendant employer to ask for a job after this March 1988 
 
         date.
 
         
 
              On June 8, 1987, Robert A. Hayne, M.D., wrote:
 
              
 
              It would appear that there is a relationship between the 
 
              onset of his symptoms that required the surgery and the 
 
              accident at work on the lst of April of this year.  The 
 
              findings at the time of surgery were one of an acutely 
 
              herniated disc and this would be compatible with his 
 
              history.
 
         
 
         (Joint Exhibit 1, page 10)
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
              On November 18, 1987, Dr. Hayne wrote:
 
              
 
              The permanent disability is 10% of body total attributed to 
 
              symptomatology that required a lumbar laminectomy
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 4
 
         
 
         
 
              in May of 1987.  He has an additional 10-15% of the left 
 
              upper extremity as a whole.
 
              
 
                 Insofar as his low back and 1eft ulnar nerve, Mr. Van 
 
              Blaricum could return at this time to light duty work.  A 
 
              conversation with Mr. Van Blaricum would leave me to believe 
 
              that he plans to take an early retirement.
 
         
 
         (Jt. Ex. 1, p. 5)
 
         
 
              On November 25, 1985, Dr. Hayne wrote:
 
              
 
                 It has come to my attention that Mr. Charles Van Blaricum 
 
              has had three previous operative procedures on his low-back 
 
              region.  He states that his work is one that requires him to 
 
              do heavy lifting.  Prolonged sitting of any type also 
 
              aggravates his pain.  In view of his past history of having 
 
              had recurrent low-back problems, his age, and his heart 
 
              problems, I would recommend that he take an early 
 
              retirement.
 
         
 
         (Jt. Ex. 1, p. 4)
 
         
 
              On December 18, 1987, Dr. Hayne wrote: "This 10% rating is 
 
         over and above any previous ratings for pre-existing low-back 
 
         problems." (Jt. Ex. 1, p. 3)  On February 10, 1988, Dr. Hayne 
 
         wrote:
 
         
 
                 I have evidently misunderstood information relayed to me 
 
              concerning Mr. Van Blaricum's cardiac problems.  Dr. 
 
              Cunningham and Dr. Kwatra had released him to return to work 
 
              prior to his April 1, 1987 injury.  He is therefore released 
 
              to return to light-duty type of work.  His work should not 
 
              require him to lift weights over 40 pounds.  Lifting within 
 
              this limitation should not be repetitive.  He should not sit 
 
              or stand longer than 2 hours without being able to move 
 
              about.  It would also be advisable that if he would obtain 
 
              work that requires minimal stooping, bending and twisting.
 
         
 
         (Jt. Ex. 1, p. 2)
 
         
 
              On October 31, 1988, Dr. Hayne wrote:
 
         
 
                 I saw Charles Van Blaricum in my office on October 14th 
 
              and I will enclose copies of the office record of that 
 
              examination.  I do not feel that there has been an increase 
 
              in his permanent impairment.  I feel insofar as his back and 
 
              neck problems, he's able to work and I will enclose a copy 
 
              of a letter written to your company on February 10th.  I 
 
              feel
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 5
 
         
 
         
 
              that the same restrictions apply.
 
         
 
         (Jt. Ex. 1, p. 1)
 
         
 
              On April 14, 1988, Kevin J. Cunningham, M.D., wrote:
 
              
 
                 This [sic] has had problems with chronic low back pain 
 
              intermittently for some time.  He sustained trauma in April 
 
              1987 and has had subsequent problems with low back pain and 
 
              intermittent sciatica.  He underwent a lumbar laminectomy in 
 
              May 1987.  Despite this, the patient has had intermittent 
 
              low back pain.
 
              
 
                 The patient has remained disabled due to intermittent low 
 
              back pain since April 1987.
 
         
 
         (Jt. Ex. 1, p. 18)
 
         
 
              Iowa Methodist Medical Center notes on the date of 
 
         claimant's surgery of May 28, 1987, reflect the following:
 
         
 
              PREOPERATIVE DIAGNOSIS: Herniated intervertebral disc at the 
 
              2nd lumbar interspace.
 
              
 
              POSTOPERATIVE DIAGNOSIS: Herniated intervertebral disc at 
 
              the 2nd lumbar interspace.
 
              
 
              OPERATION PROPOSED:  Lumbar laminectomy.
 
              
 
                  ....
 
              
 
                 It was necessary to remove the major portion of the 
 
              second lumbar laminal arch for exposure.  Upon retracting 
 
              the third lumbar nerve root medially, there was a 
 
              spontaneous extrusion of nucleus pulposus, the latter having 
 
              extruded through a laceration in the posterior aspect of the 
 
              annulus fibrosus on the intervertebral disc between the 
 
              second and third lumbar segments.  Many loose fragments of 
 
              nucleus pulposus were removed here, some of which impinged 
 
              severely against the third lumbar nerve root.
 
              
 
                 ....
 
              
 
              FINAL DIAGNOSIS: Diabetes mellitus with herniated disc at 
 
              the 2nd lumbar interspace bilateral.  The patient is 
 
              effected with hypothroidism also.
 
         
 
         (Jt. Ex. 1, p. 52)
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Wayne Senne, an accountant at the Super Valu stores 
 
         warehouse, testified that he was claimant's boss for five to six 
 
         years up to claimant's retirement in April 1987.  Senne described
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 6
 
         
 
         
 
         claimant's order desk job as a clerical paper job, putting the 
 
         right paper in the right pigeonhole, with telephoning involved.  
 
         Senne emphasized that he has done this same job many times when 
 
         someone was ill or not there, and that.he lifted the stacks of 
 
         paper and did all the tasks that claimant performed.  Senne 
 
         testified that the two foot stacks of paper would weigh from 25 
 
         to 40 pounds.  Senne acknowledged that claimant must do lifting 
 
         on the job, that it is not a repetitive task, that the cycle of 
 
         the tasks are repeated several times a day, and that the cycles 
 
         vary during the day.  Senne indicated that defendant employer 
 
         hired a part-time individual to do claimant's job hoping claimant 
 
         would return to work.  Senne indicated that in January 1988, he 
 
         then hired this part-time worker to a permanent status taking 
 
         over claimant's job.  Senne stated that he had made arrangements 
 
         for claimant to come back to work as he understood claimant was 
 
         released to return to work.
 
         
 
              Around February 20, 1989, Senne determined claimant could 
 
         not do the order desk job with his restrictions, but indicated 
 
         that he would have a job for claimant.  The claimant was to show 
 
         up on March 7, 1988 to work.  Senne testified that claimant 
 
         showed up on Monday, March 7, 1988, and talked with Jack Wetsch, 
 
         but claimant did not in fact return to work.  Senne emphasized 
 
         that there was a credit desk job, which is a clerical office job, 
 
         available for claimant, but claimant indicated that he could not 
 
         handle this job.  Senne emphasized that claimant had used an 
 
         adding machine and calculator before and did okay.  He indicated 
 
         that a work week would be 40 hours and that the wages and 
 
         benefits would be the same.  Senne understood that claimant's 
 
         restrictions were no lifting over 40 pounds, no repetitive 
 
         action, no standing over two hours, and no bending and twisting.  
 
         Senne emphasized that there was no reason claimant could not do 
 
         the credit desk job.  Senne acknowledged that claimant was a good 
 
         hard worker.
 
         
 
                                 LAW AND ANALYSIS
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 1, 1987 is causally related 
 
         to the disability on which he now bases his claim.  Bodish v. 
 
         Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965). Lindahl v. 
 
         L.O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A possibility is 
 
         insufficient; a probability is necessary. Burt v. John Deere 
 
         Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
         question of causal connection is essentially within the domain of 
 
         expert testimony.  Bradshaw v. Iowa Methodist Hospital, 251 Iowa 
 
         375, 101 N.W.2d 167 (1960).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However,
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 7
 
         
 
         
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of. the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone Co.
 
         , 261 Iowa 352, 154 N.W.2d l28 (1967).
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2nd 756, ___ 
 
         (1956).  If the claimant had a preexisting condition or 
 
         disability that is aggravated, accelerated, worsened or lighted 
 
         up so that it results in disability, claimant is entitled to 
 
         recover.  Nicks v Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 
 
         812, ____ (1962).
 
         
 
              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); 
 
         Yeager v. Firestone Tire & Rubber Co., 253 Iowa 369, 112 N.W.2d 
 
         299 (1961); Ziegler v. United States Gypsum Co., 252 Iowa 613, 
 
         106 N.W.2d 591 (1960).   See also Barz v. Oler, 257 Iowa 508, 133 
 
         N.W.2d 704 (1965); Almquist v. Shenandoah Nurseries, 218 Iowa 
 
         724, 254 N.W. 35 (1934).
 
         
 
              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."
 
         
 
              Dr. Hayne opined that claimant has a 10 percent impairment 
 
         of his lower back as a result of his May 1987 surgery, which 
 
         resulted from claimant's April 1, 1987 injury.  Dr. Hayne opined 
 
         that this 10 percent rating is over and above any previous rating 
 
         for preexisting low back problems.  The greater weight of medical 
 
         evidence shows that claimant's current disability is causally 
 
         connected to his injury of April 1, 1987.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Although there is reference in the reports as to an elbow 
 
         injury that occurred on the April 1, 1987 date, it is not an 
 
         issue in this matter.
 
         
 
              The parties stipulated that all healing period benefits have 
 
         been paid and is not an issue in this matter.
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 8
 
         
 
         
 
              Claimant was 62 years old at the time of his injury.  The 
 
         claimant had prior back surgeries in 1961, 1980 and 1982 and had 
 
         a 25 pound weight restriction as a result of the 1980 surgery.  
 
         Claimant indicated that he did not honor the 25 pound weight 
 
         restriction and was able and, in fact, did lift items in excess 
 
         of that weight limit without any apparent problems.  Although 
 
         claimant had prior back surgeries, the greater weight of medical 
 
         evidence indicates that claimant was not having any problems from 
 
         these prior surgeries on the date of his April 1, 1987 injury.  
 
         The medical evidence also indicate that whatever preexisting 
 
         condition claimant may have had, there was no aggravation of the 
 
         same and the 10 percent impairment opined by Dr. Hayne was solely 
 
         as a result of the April 1, 1987 injury.
 
         
 
              Evidence also indicates that from January to March 1987, 
 
         claimant was having some medical problems involving his prostrate 
 
         gland and, also, what was thought to be heart problems.  It was 
 
         later determined through an angiogram that claimant did not have 
 
         the suspected heart problem.
 
         
 
              Although claimant had an impairment to his back as a result 
 
         of the April 1, 1987 injury, claimant was released to go back to 
 
         work by Dr. Hayne at least by February, 1988 with a restriction 
 
         of light duty work which should not require claimant to lift over 
 
         40 pounds, no repetitive lifting within this limit, that this 
 
         lifting should not be repetitive, and should not sit or stand 
 
         longer than two hours without being able to move about.  The 
 
         doctor also advised that claimant's work should require minimal 
 
         stooping, bending and twisting.  Actually, in November 1987, Dr. 
 
         Hayne indicated that "insofar as his low back and left ulnar 
 
         nerve, Mr. Van Blaricum could return at this time to light duty 
 
         work.  A conversation with Mr. Van Blaricum would lead me to 
 
         believe that he plans to take an early retirement." It is 
 
         understandable that with the medical condition claimant was 
 
         experiencing, his age, and with the retirement benefits to which 
 
         he was entitled after approximately 26 years at Super Valu, 
 
         claimant would entertain the thought of early retirement.
 
         
 
              To determine, the extent of industrial disability, we must 
 
         consider age, education, prior work experience, employer's 
 
         willingness to re-employ claimant, claimant's motivation to work, 
 
         and functional limitations or restrictions.  The extent of 
 
         industrial disability can be affected by the employer's refusal 
 
         or unwillingness to re-employ claimant.  On the other hand, the 
 
         willingness of the employer to offer claimant a return of his 
 
         same job, similar job, or a job where there would be no actual 
 
         reduction of wages or benefits should and does affect industrial 
 
         disability and the issue as to whether there is a reduction of 
 
         earning capacity.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              In November 1987, claimant indicated to Dr. Hayne that he 
 
         was thinking about retirement.  The evidence indicates that
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 9
 
         
 
         
 
         the employer was holding his order desk job open and had hired a 
 
         part-time worker to do claimant's job until it appeared that 
 
         claimant was not able due to restrictions or was not going to 
 
         return to that job.  In January 1988, defendant employer then 
 
         filled claimant's former job.  The evidence shows that claimant 
 
         had available a credit desk job which he had done in the past, 
 
         and if that job was not available, defendant employer made it 
 
         known that there would be a job of some kind available for 
 
         claimant that he was able to do at the same pay and same 
 
         benefits.
 
         
 
              It appears claimant's objection to any of these other jobs 
 
         different than his former order desk job was because they 
 
         necessitated a use of a calculator and a typewriter.  Claimant 
 
         had managed to use these machines before and although he was a 
 
         one finger user, it had not been a problem with his employment in 
 
         the past.  The evidence indicates that the employer expected 
 
         claimant to return to work on or around March 7, 1988, but 
 
         claimant appeared with his wife at the defendant employer's place 
 
         of business and indicated he was going to retire.  At this time, 
 
         upon retirement, of course, no job was then available.  Claimant 
 
         related all the benefits he was entitled to as a result of his 
 
         retirement, which officially took place on April 3, 1988.  These 
 
         benefits included his entitlement to social security retirement, 
 
         profit sharing retirement, ESOP plan benefits in connection with 
 
         his employment, a 401K plan, and a military pension.
 
         
 
              Claimant acknowledged that no one at Super Valu told him to 
 
         retire.  At exhibit 5, page 96, there is a letter from claimant 
 
         to his supervisor, Jack Wetsch.  It was drafted at his attorney's 
 
         office and is obviously a self-serving letter prepared in 
 
         anticipation of litigation.  The undersigned concludes that 
 
         claimant intended to retire, and even though he does have an 
 
         impairment, claimant could have had a return to his former job or 
 
         at least attempted to perform that job, or taken a job that would 
 
         have fit within his restrictions with no loss of income or 
 
         benefits.  Claimant testified that he had a 25 pound restriction 
 
         from a prior 1982 surgery and did not honor the same, and if he 
 
         had had the same motivation in 1987 or 1988 and did not desire to 
 
         retire, he could have at least attempted to return to work to see 
 
         if he was able to do the job.  Claimant's actions have 
 
         voluntarily affected the extent of reduction of his earning 
 
         capacity.  Claimant has a 10 percent impairment to the body as a 
 
         whole as a result of his April 1987 injury and has a 15 percent 
 
         industrial disability.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Defendants contend that the $51 balance of Dr. Sean 
 
         Cunningham and the $18.06 unpaid mileage, totaling $69.06, was 
 
         not authorized under 85.27 and should not be paid.  Dr. 
 
         Cunningham was claimant's family doctor, to whom he originally 
 
         went, not knowing at the time as to whether his medical situation 
 
         was the result of his April 1, 1987 injury, after which time 
 
         claimant was referred to a specialist, Dr. Hayne.  Defendants are 
 
         responsible for
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 10
 
         
 
         
 
         the $69.06.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, it is found:
 
         
 
              1. Claimant received a low back injury at work on April 1, 
 
         1987 when he fell from a defective chair.
 
         
 
              2. Claimant's disability is a result of his injury of April 
 
         1, 1987.
 
         
 
              3. All healing period benefits to which claimant is entitled 
 
         have been paid and is not an issue herein.
 
         
 
              4. Claimant was told he could return to a light duty job 
 
         with defendant employer on November 18, 1987.  On February 10, 
 
         1988, claimant was released to return to light duty work with 
 
         restrictions of no lifting over 40 pounds; no repetitive lifting 
 
         within this restriction; no standing or sitting longer than two 
 
         hours without being able to move about; and minimal stooping, 
 
         bending and twisting.
 
         
 
              5. Claimant voluntarily chose retirement on March 7, 1988, 
 
         effective April 3, 1988.
 
         
 
              6. Claimant did not return to employment with defendant 
 
         employer to a job available to him within his medical 
 
         restrictions.
 
         
 
              7. Claimant has a 10 percent impairment to his body as a 
 
         whole due to his low back injury at L2-L3 which resulted in a 
 
         lumbar laminectomy on May 28, 1987.
 
         
 
              8. Claimant has a 15 percent reduction in earning capacity.
 
         
 
              9. Defendants are to pay the $51 bill of Dr. Cunningham and 
 
         $18.06 mileage reimbursement, totaling $69.06.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
                                CONCLUSIONS OF LAW
 
         
 
              THEREFORE, it is concluded:
 
         
 
              Claimant's injury of April 1, 1987 arose out of and in the 
 
         course of his employment.
 
         
 
              Claimant's disability is causally connected to his low back 
 
         injury on April 1, 1987.
 
         
 
              Claimant has been paid all healing period benefits to which 
 
         he may be entitled as stipulated by the parties.
 
         
 
              Claimant was told he could return to a light duty job with 
 
         defendant employer on November 18, 1987, and on February
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 11
 
         
 
         10, 1988, claimant was released to return to work with 
 
         restrictions of no lifting over 40 pounds; no repetitive lifting 
 
         within this limitation; no standing or sitting longer than two 
 
         hours without being able to move about; and. minimal stooping, 
 
         bending and twisting.
 
         
 
              Claimant voluntarily chose retirement on March 7, 1988, 
 
         effective April 3, 1988.
 
         
 
              Claimant did not return to employment with defendant 
 
         employer to a job available within his medical restrictions.
 
         
 
              Claimant has a 10 percent impairment to his body as a whole 
 
         due to his low back injury, which resulted in a lumbar 
 
         laminectomy on May 28, 1987 at the L2-L3 area.
 
         
 
              Claimant has a 15 percent industrial disability.
 
         
 
              Defendants are to pay the $51 medical bill of Dr. Cunningham 
 
         and the $18.06 mileage reimbursement, totaling $69.06.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              Defendants are to pay unto claimant seventy-five (75) weeks 
 
         of permanent partial disability benefits at the stipulated rate 
 
         of two hundred fifty-six and 49/100 dollars ($256.49), commencing 
 
         November 19, 1987.
 
         
 
              Defendants shall be given credit for benefits previously 
 
         paid.
 
         
 
              Defendants are to pay or reimburse claimant for the 
 
         fifty-one dollar ($51.00) medical bill of Dr. Cunningham and the 
 
         eighteen and 06/100 dollars ($18.06) for mileage.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Defendants shall pay interest on benefits awarded herein as 
 
         set forth in Iowa Code section 85.30.
 
         
 
              Defendants shall pay the costs of this action pursuant to 
 
         Division of Industrial Rule 343-4.33.
 
         
 
              Defendants shall file an activity report upon payment of 
 
         this award as required by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1.
 
         
 
              Signed and filed this 18th day of May, 1989.
 
         
 
         
 
         
 
         
 
                                         BERNARD J. 0'MALLEY
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         VAN BLARICUM V. SUPER VALU STORES, INC.
 
         Page 12
 
         
 
         
 
         Copies to:
 
         
 
         Mr. Channing L. Dutton
 
         Attorney at Law
 
         West Towers Office
 
         1200 35th,  Ste 500
 
         West Des Moines, IA 50265
 
         
 
         Mr. W. C. Hoffmann
 
         Mr. Richard G. Book
 
         Attorney at Law
 
         500 Liberty Bldg
 
         Des Moines, IA 50309
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                                         51803
 
                                         Filed May 18, 1989
 
                                         Bernard J. O'Malley
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CHARLES VAN BLARICOM,
 
          
 
               Claimant,
 
                                         File No. 852132
 
          VS.
 
          
 
          SUPER VALU STORES, INC.,       A R B I T R A T I 0 N
 
          
 
               Employer,                   D E C I S I 0 N
 
          
 
          and
 
          
 
          LIBERTY MUTUAL INSURANCE CO.,
 
          
 
               Insurance Carrier,
 
               Defendants.
 
         
 
         
 
         51803
 
         
 
              Claimant awarded 15 percent industrial disability for low 
 
         back injury resulting from fall off employer's defective chair.
 
         
 
              Claimant's industrial disability affected by his decision to 
 
         retire and his refusal to take a job offered by employer which 
 
         would not violate his medical work restrictions.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            DARCY PUTNEY a/k/a DARCY      :
 
            SLYTER,                       :
 
                                          :
 
                 Claimant,                :      File Nos.  852166
 
                                          :                 880474
 
            vs.                           :
 
                                          :  A R B I T R A T I O N
 
            IBP, INC.,                    :
 
                                          :      D E C I S I O N
 
                 Employer,                :    
 
                 Self-Insured,            :      
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                                   introduction
 
            
 
                 This is a proceeding in arbitration brought by Darcy 
 
            Putney a/k/a Darcy Slyter, claimant, against IBP, Inc., 
 
            employer and self-insured defendant, and Second Injury Fund 
 
            of Iowa, for benefits as the result of an injury to her left 
 
            hand, wrist and arm that occurred on April 30, 1987, and an 
 
            alleged injury to her right hand, wrist and arm that 
 
            occurred on June 15, 1987.  The decision finds that there 
 
            was only one injury and that it occurred on May 9, 1987.  A 
 
            hearing was held in Storm Lake, Iowa, on May 18, 1990, and 
 
            the case was fully submitted at the close of the hearing.  
 
            Claimant was represented by Steve Hamilton.  Defendant 
 
            employer was represented by Marlon Mormann.  Defendant 
 
            Second Injury Fund of Iowa was represented by Robert D. 
 
            Wilson.  The record consists of the testimony of Darcy 
 
            Slyter, claimant; joint exhibits 1 through 15 and defendant 
 
            employer's exhibits C, J, K, and L.  Claimant presented a 
 
            brief claimant's statement of disputes at the time of the 
 
            hearing and defendant employer presented a brief employer's 
 
            description of disputes at the time of the hearing.  The 
 
            deputy ordered a transcript of the hearing.  All three 
 
            attorneys submitted excellent posthearing briefs.
 
            
 
                                preliminary matter
 
            
 
                 At the hearing, claimant contended that she was 
 
            entitled to reimbursement for an Iowa Code section 85.39 
 
            examination performed by Richard P. Murphy, M.D. (transcript 
 
            page 7).  Defendant employer objected to a determination of 
 
            claimant's entitlement to Dr. Murphy's bill in the amount of 
 
            $330 (exhibit 9) for the reason that this issue was not 
 
            designated as a hearing issue on the hearing assignment 
 
            order (tr. pp. 7 & 8).  The deputy sustained the objection 
 
            and ruled that hearing deputies determine only issues which 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            are designated as hearing issues on the hearing assignment 
 
            order (tr. p. 11).  Presswood v. Iowa Beef Processors, file 
 
            number 735442 (Appeal Decision 1986).
 
            
 
                 Defendant employer objected to joint exhibits 1 and 2 
 
            which are reports of injury to the extent that they be 
 
            considered only for purposes of notice.  Neither claimant 
 
            nor defendant Second Injury Fund of Iowa opposed defendant 
 
            employer's objection.  The deputy sustained the objection 
 
            for the reason that Iowa Code section 86.11 says that a 
 
            first report of injury is not admissible into evidence 
 
            except for the purpose of proving notice (tr. pp. 15-17).
 
            
 
                                      issues
 
            
 
                 The parties submitted the following issues for 
 
            determination at the time of the hearing:
 
            
 
                 Whether the injury of April 30, 1987, was the cause of 
 
            permanent disability;
 
            
 
                 Whether claimant is entitled to permanent partial 
 
            disability benefits for this injury, and if so, the extent 
 
            of benefits to which she is entitled, to include, a 
 
            determination of whether the injury was to the arm or to the 
 
            hand;
 
            
 
                 Whether claimant sustained an injury on June 15, 1987, 
 
            which arose out of and in the course of employment with 
 
            employer;
 
            
 
                 Whether this injury was the cause of permanent 
 
            disability;
 
            
 
                 Whether claimant is entitled to permanent partial 
 
            disability benefits for this injury, and if so, the extent 
 
            of benefits to which claimant is entitled, to include, 
 
            whether the injury was to the arm or to the hand;
 
            
 
                 Whether claimant gave proper notice of the June 15, 
 
            1987, injury pursuant to Iowa Code section 85.23 was 
 
            asserted as an affirmative defense by employer; and
 
            
 
                 Whether the Second Injury Fund of Iowa is liable for 
 
            any benefits, and if so, the extent of benefits for which it 
 
            is liable.
 
            
 
                                 findings of fact
 
            
 
                              injury-April 30, 1987
 
            
 
                 It is determined that claimant did not sustain a injury 
 
            which arose out of and in the course of employment on April 
 
            30, 1987.  This date is simply one of the dates on which 
 
            claimant reported pain to her left thumb (ex. 3, p. 9).  It 
 
            is further determined that claimant did not sustain an 
 
            injury arising out of and in the course of employment on 
 
            April 30, 1987, even though defendant employer used this 
 
            date to process a claim (file number 852166) and to pay 
 
            claimant various workers' compensation disability benefits 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            for difficulties she encountered to her left upper extremity 
 
            (defendant's ex. L).
 
            
 
                               injury-june 15, 1987
 
            
 
                 It is determined that claimant did not sustain an 
 
            injury which arose out of and in the course of employment on 
 
            June 15, 1987.  Defendant employer's absentee calendar for 
 
            the year 1987 shows that claimant was not even at work on 
 
            this date (jt. ex. 13, p. 3).  Furthermore, defendant 
 
            employer's nurse's notes do not record any activity or a new 
 
            injury to claimant for the date June 15, 1987 (ex. 3, p. 
 
            11).
 
            
 
                               injury-June 5, 1987
 
            
 
                 It is determined that claimant did not sustain an 
 
            injury which arose out of and in the course of employment 
 
            with employer on June 5, 1987.  Defendant employer's 
 
            absentee calendar for  1987 shows that claimant was not at 
 
            work on that date and had not been to work for several days 
 
            prior to that (ex. 13, p. 3).  Furthermore, the nurse's 
 
            notes of defendant employer do not record any new injury or 
 
            condition for the date June 5, 1987 (jt. ex. 3, p. 11).  It 
 
            is further determined that no injury occurred to claimant on 
 
            June 5, 1987, even though this date was chosen to process a 
 
            claim (file number 880474) and to pay claimant permanent 
 
            partial disability for an injury to her right thumb and 
 
            right arm (def. exs. J & K).
 
            
 
                                injury-May 9, 1987
 
            
 
                 It is determined that claimant sustained a cumulative 
 
            injury which arose out of an in the course of her employment 
 
            on May 9, 1987, which is the date, because of pain or 
 
            physical inability, claimant could no longer work.  McKeever 
 
            Custom Cabinets v. Smith, 379 N.W.2d 368, 374 (Iowa 1985).  
 
            Employer's nurse's notes show that claimant was taken off 
 
            work on May 9, 1987 (ex. 3, p. 10).  Employer's absentee 
 
            calendar for 1987 shows that claimant was taken off work on 
 
            May 9, 1987 (ex. 13, p. 3).  
 
            
 
                 It is further determined that claimant sustained a loss 
 
            to both arms caused by a single accident within the context 
 
            of Iowa Code section 85.34(2)(s).
 
            
 
                 Claimant started to work for employer on November 15, 
 
            1985 (tr. p. 30; ex 3., p. 1).  Claimant denied any kind of 
 
            a disabling condition to her hands and arms prior to her 
 
            employment with employer.  She stated she could do anything 
 
            and everything with her hands and arms (tr. p. 31).  There 
 
            was no evidence to demonstrate that claimant did have any 
 
            prior problems with her hands and arms before her employment 
 
            with employer.  On the contrary, a medical history 
 
            questionnaire completed by claimant at the time of her 
 
            employment with employer and a physical examination 
 
            performed by employer disclosed no hand and arm problems 
 
            (ex. 4).  Claimant testified that at the time of her 
 
            preemployment physical examination the nurse told her that 
 
            she had more grip in her hands than most men that they hired 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            (tr. p. 28).  The physical examination disclosed that the 
 
            dynometer examination scored claimant with 80 on the left 
 
            and 78 on the right (ex. 4, p. 4).
 
            
 
                 Claimant testified that she worked six days a week and 
 
            between eight and ten hours a day for employer (tr. pp. 35 & 
 
            89).  Her first job was cleaning chine bones with a wizard 
 
            knife.  The chine bone is the spine and partial rib bones.  
 
            Her job was to clean the scrap meat off of the bone.  She 
 
            pulled the chine bone down with her left hand and cut the 
 
            meat off with her dominant right hand with a wizard knife 
 
            which is constantly vibrating.  She estimated that she 
 
            processed 758 hogs per hour and that she made two or three 
 
            cuts per bone on each animal (tr. pp. 30-36).  She said 
 
            employer trained her to do all of the jobs on the line with 
 
            the exception of four of them (tr. p. 36).  All of these 
 
            jobs required very repetitive use of the hands (tr. p. 38).  
 
            
 
                 After cleaning chine bones, claimant then trimmed butts 
 
            with a six inch straight knife.  Again, she held the meat 
 
            with her nondominant left hand and cut it with a six inch 
 
            straight knife in her dominant right hand (tr. p. 36).  In 
 
            performing most of the jobs on the line, she pulled chine 
 
            bones, cut ham ends off of the loin, boned ham ends, boned 
 
            blades, pulled ribs and riblets, trimmed ham ends, hacked 
 
            ribs, pulled knuckles on the ham line, pulled light and dark 
 
            butts, and ran the membrane skinner (tr. pp. 36-39).  In 
 
            operating the membrane skinner she held a piece of meat 
 
            weighing approximately eight to 14 pounds in her hands and 
 
            bounced it up and down on an air blade to clean the membrane 
 
            and fat off of the meat (tr. p. 39).  
 
            
 
                 Claimant testified that she had a number of 
 
            difficulties with both upper extremities and that prior to 
 
            her surgeries she was having hot wax treatments almost every 
 
            day (tr. pp. 48-54).  The nurse's notes show that she had a 
 
            hot wax treatment for a swollen right hand on June 10, 1986.  
 
            She had numbness in the right hand radiating into her arm on 
 
            July 3, 1986, which was splinted.  Her right wrist was sore 
 
            again on September 10, 1986, from using a large wizard 
 
            knife, and it was wrapped and supported.  This occurred 
 
            again to the right hand on September 19, 1986.  On September 
 
            26, 1986, she had sharp pain in the right hand and elbow.  
 
            On September 30, 1986, she had increased burning and pulling 
 
            in the right arm while pulling ribs.  October 1, 1986, she 
 
            had right wrist pain radiating to the right elbow.  She had 
 
            continued problems on October 7, 1986.  She was off at the 
 
            end of 1987 for approximately two months for gallbladder 
 
            problems.  
 
            
 
                 On March 11, 1987, she reported a popping sensation in 
 
            her left wrist.  On April 30, 1987, she reported 
 
            intermittent pain in her left thumb performing the job of 
 
            rolling knuckles.  She was scheduled to see B. VanderKooi, 
 
            M.D., on May 1, 1987.  On May 5, 1987, she had pain in the 
 
            left wrist and on May 6, 1987, she had pain in the right 
 
            forearm (ex. 3, pp. 5-11).
 
            
 
                 Dr. VanderKooi saw claimant on May 1, 1987 and May 9, 
 
            1987, and found that claimant had bilateral problems at that 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            time which he described as tendonitis.  In response to the 
 
            question, "Was the injury or disease caused, aggravated or 
 
            accelerated by the patient's alleged employment activity?"  
 
            Dr. VanderKooi checked "yes."  He recommended a job change 
 
            as part of her treatment (exs. 5 & 6).  W.E. Erps, M.D., 
 
            reported on May 9, 1987, that claimant had a nerve deficit 
 
            in both wrists, positive Phalen's and Tinel's in both wrists 
 
            (ex. 7).  
 
            
 
                 Claimant saw Ronald S. Bergman, D.O., an orthopedic 
 
            surgeon, on May 22, 1987, and he diagnosed bilateral upper 
 
            extremity problems and fitted her with bilateral cock-up 
 
            splints (ex. 8, p. 10).  He diagnosed right carpal tunnel, 
 
            ulnar tunnel, cubital tunnel, and trigger finger on the 
 
            right and carpal tunnel and ulnar tunnel on the left.  He 
 
            noted that she ran a wizard and straight knife for the past 
 
            18 months (ex. 8, pp. 1 & 10).  
 
            
 
                 On June 12, 1987, Dr. Bergman performed a right carpal 
 
            tunnel release with a CO2 laser (ex. 8, pp. 4 & 11).  On 
 
            June 22, 1987, he performed left carpal tunnel release with 
 
            CO2 laser and a left ulnar tunnel release (ex. 8, pp. 4 & 
 
            12).  On September 16, 1987, he performed a right cubital 
 
            tunnel release and a right trigger finger release (ex. 8, 
 
            pp. 4, 13 & 14).  On April 27, 1988, Dr. Bergman wrote, "Ms. 
 
            Putney has been treated surgically for work related injuries 
 
            sustained while being employed at IBP, Inc. in Storm Lake, 
 
            Iowa." (ex. 8, p. 8).
 
            
 
                 A.J. Wolbrink, M.D., examined claimant on July 22, 
 
            1988, and issued impairment ratings (ex. 10, pp. 1-3).  In a 
 
            subsequent letter on March 21, 1990, Dr. Wolbrink stated 
 
            that it was the aggravation from her work situation which 
 
            caused the symptoms which have resulted in the permanent 
 
            impairment ratings which he gave (ex. 10, p. 5).  
 
            
 
                 Ivan Schloff, M.D., examined claimant on January 10, 
 
            1990.  He said that his restriction of no repeated lifting 
 
            over 25 pounds was half due to her neck, which was not work 
 
            related, and half due to her hands and right elbow which he 
 
            said was apparently work related.  He added that the 
 
            restriction of no repetitive activity with her hands is all 
 
            work related (ex. 11, p. 7).  
 
            
 
                 The fact that the right and left upper extremity 
 
            symptoms developed within a few months of each other is 
 
            sufficient to constitute "a single accident" within the 
 
            context of Iowa Code section 85.34(2)(s).  Torgerson v. 
 
            Webster City Custom Meats, file number 863533 (filed August 
 
            12, 1991) (on appeal).  Jones v. Lamoni Products, file 
 
            number 800310 (filed May 29, 1991) (on appeal).  
 
            
 
                 The language of Deputy Walleser interpreting the 
 
            statute in the Jones case is adopted for this decision and 
 
            reads as follows:
 
            
 
                 The ultimate goal of statutory construction is to 
 
                 determine and effectuate the intent of the 
 
                 legislature.  Iowa Beef Processors, Inc. v. 
 
                 Miller, 312 N.W.2d 530, 532 (Iowa 1981).  One 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
                 must look to the object to be accomplished, the 
 
                 mischiefs to be remedied, or the purpose to be 
 
                 served, and place on the statute a reasonable or 
 
                 liberal construction which will best effect, 
 
                 rather than defeat, the legislature's purpose.  
 
                 City of Mason City v. Pub. Employment Relations 
 
                 Bd., 316 N.W.2d 851, 854 (Iowa 1982).  All parts 
 
                 of the statute are to be considered together 
 
                 without attributing undue importance to any single 
 
                 or isolated portion.  Iowa Beef Processors, Inc., 
 
                 supra.  Strained, impractical or absurd results 
 
                 are to be avoided in favor of a sensible, logical 
 
                 construction.  Ida County Courier & Reminder v. 
 
                 Attorney General, 316 N.W.2d 846, 851 (Iowa 1982).  
 
                 The policy is to liberally construe workers' 
 
                 compensation statues in favor of the worker.  
 
                 Caterpillar Tractor Co. v. Shook, 313 N.W.2d 503, 
 
                 506 (Iowa 1981).  It is generally presumed that 
 
                 statutory words are used in their ordinary and 
 
                 usual sense with the meaning commonly attributed 
 
                 to them.  American Home Products Corp. v. Iowa 
 
                 State Bd. of Tax Review, 302 N.W.2d 140, 142 (Iowa 
 
                 1981).    
 
            
 
                    The Iowa Supreme Court has defined "injury" 
 
                 very broadly.  Almquist v. Shenandoah Nurseries, 
 
                 218 Iowa 724, 254 N.W. 35 (1934); Lawyer and 
 
                 Higgs, Iowa Workers' Compensation--Law and 
 
                 Practice, section 4-1, page 19.
 
            
 
                    An accident is not required.  Olson v. Goodyear 
 
                 Service Stores, 255 Iowa 1112, 1121 125 N.W.2d 251 
 
                 (1963).  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).  Cumulative 
 
                 injuries such as this one are recognized in Iowa 
 
                 in situations where the disability comes on 
 
                 gradually and the compensable injury occurs later.  
 
                 Repetitive activity has been determined to be a 
 
                 valid cause of an injury.  McKeever Custom 
 
                 Cabinets v. Smith, 379 N.W.2d 368 (Iowa 1985).
 
            
 
            (Torgerson v. Webster City Custom Meat, file number 863533 
 
            (August 12, 1991) (on appeal)
 
            
 
                 It is also determined that this case falls within the 
 
            facts of Himschoot v. Montezuma Manufacturing, file numbers 
 
            672778 and 738235 (Appeal Decision April 15, 1988), aff'd, 
 
            No. _______, (Iowa Ct. App. February 22, 1990) and Kebernik 
 
            v. Thatcher Plastic Packaging, file number 704973 (Arb. 
 
            Decn., December 22, 1988); which were also decided by this 
 
            deputy in which claimant reported bilateral symptoms on her 
 
            first visit to the doctor.  In this case, Dr. VanderKooi, 
 
            Dr. Erps, and Dr. Bergman all recorded bilateral symptoms on 
 
            claimant's first office visit.
 
            
 
                 Wherefore, it is determined that claimant sustained a 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            cumulative injury on May 9, 1987, which arose out of and in 
 
            the course of employment with employer under Iowa Code 
 
            section 85.34(2)(s).
 
            
 
                causal connection-entitlement-permanent disability
 
            
 
                 It is determined that the injury is the cause of 
 
            permanent disability, that the disability affects both arms, 
 
            that claimant has sustained a 19 percent impairment to the 
 
            body as a whole and is entitled to 95 weeks of permanent 
 
            partial disability benefits under Iowa Code section 
 
            85.34(2)(s).
 
            
 
                 Statements of causal connection of the injury to 
 
            claimant's disability are stated in the foregoing section 
 
            from Dr. VanderKooi, Dr. Bergman, Dr. Wolbrink, and Dr. 
 
            Schloff.
 
            
 
                 A summary of the impairment ratings or what porports to 
 
            be the impairment ratings is as follows:
 
            
 
                 Dr. Bergman determined that claimant sustained a 6 
 
            percent permanent partial disability of the right thumb and 
 
            a 1 percent permanent partial disability of the right upper 
 
            extremity contributed by the elbow.  He also found a 3 
 
            percent permanent partial disability of the left thumb, but 
 
            0 percent permanent partial disability of the left wrist and 
 
            upper extremity (ex. 8, pp. 6 & 17).
 
            
 
                 Dr. Schloff determined that claimant sustained a 5.5 
 
            percent permanent partial disability of the left upper 
 
            extremity and a 5.75 percent permanent partial disability of 
 
            the right upper extremity (ex. 11, p. 7).  
 
            
 
                 Dr. Wolbrink determined that claimant had a permanent 
 
            impairment of 3 percent of the left upper extremity due to 
 
            residual weakness and loss of sensation.  He said there was 
 
            a 28 percent impairment of the right upper extremity due to 
 
            the tendonitis and residual weakness and loss of motion of 
 
            the right wrist.  
 
            
 
                 Dr. Wolbrink further explained his impairment ratings 
 
            to defendant in a letter dated September 28, 1988, as 
 
            follows:
 
            
 
                    An itemization of the impairment ratings which 
 
                 I gave on the right upper extremity for Mrs. 
 
                 Slyter would be as follows:
 
            
 
                      5 percent impairment due to only 30o of 
 
                      dorsiflexion of the wrist.
 
            6 percent permanent impairment due to 
 
            only 30o palmar flexion of the wrist.
 
            17 percent permanent impairment due to 
 
            the weakness measured at a grip strength 
 
            of 17 kilograms.
 
            
 
                    These are added together for a total of 28 
 
                 percent permanent impairment of the upper 
 
                 extremity.
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            
 
                    This impairment rating is based upon the 
 
                 "Guides to the Evaluation of Permanent 
 
                 Impairment", American Medical Association, Second 
 
                 Edition.  There are many guides to impairment, but 
 
                 I feel that this has as objective a standard as is 
 
                 available at the present time.
 
            
 
            (defendant's exhibit C, page 1)
 
            
 
                 Defendant employer is not correct in its allegation 
 
            that Dr. Wolbrink should have combined these numbers rather 
 
            than add them.  These are all ratings to the upper 
 
            extremity.  Ratings to the upper extremity are added rather 
 
            than combined.  See, Guides to the Evaluation of Permanent 
 
            Impairment, second edition, pages 14, 17 and 24.  Dr. 
 
            Wolbrink gave his initial impairment rating on July 22, 1988 
 
            (ex. 10, p. 3) and explained it further for defendant 
 
            employer on September 28, 1988 (def. ex. C).  Both of these 
 
            dates precede the publication of the AMA Guides, third 
 
            edition, which had its first printing in November of 1988.
 
            
 
                 It is determined that claimant sustained an injury to 
 
            the right and left arm because both defendant's evaluating 
 
            physician, Dr. Schloff and claimant's evaluating physician, 
 
            Dr. Wolbrink, found that claimant had impaired both her 
 
            right and left upper extremities.  Only Dr. Bergman rated 
 
            the right and left thumb, however, with respect to the right 
 
            elbow, it should be noted that he rated the right upper 
 
            extremity.
 
            
 
                 Dr. Bergman's ratings are not accepted as the correct 
 
            ratings in this case because they are unrealistically low.  
 
            Even defendant's evaluator, who was hired for the express 
 
            purpose of evaluating claimant and making a rating for the 
 
            purposes of litigation, substantially exceeded Dr. Bergman's 
 
            rating.  
 
            
 
                 Dr. Schloff's ratings appear to be too low when 
 
            compared with the restrictions he imposed upon claimant and 
 
            in light in the amount of surgery and surgical scars he 
 
            found on her body and when through agency expertise this 
 
            case is compared to similar cases.  [Iowa Administrative 
 
            Procedure Act 17A.14(5)].  Claimant testified that she had 
 
            three separate surgeries and five total incisions (tr. p. 
 
            61).  
 
            
 
                 Dr. Schloff described the surgical incisions and scars:
 
            
 
                    On the left hand there is a midline incision on 
 
                 the palmar aspect of the hand approximately 2 
 
                 inches in length.  There is also a zigzag incision 
 
                 approximately 1 inch in length over the ulnar side 
 
                 of the volar aspect of the wrist.
 
            
 
                    In the right hand there is a scar approximately 
 
                 1 inch in length which is zigzag at the base of 
 
                 the right finger in the distal palmar crease.  
 
                 There is also a 2-inch scar on the volar aspect of 
 
                 the wrist in the midline.  Examination of the 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
                 right elbow reveals a scar on the medial side 
 
                 which is approximately 2-1/2 inches in length.
 
            
 
            (exhibit 11, page 5)
 
            
 
                 It should be noted that at the time of claimant's 
 
            preemployment physical examination, her dynometer test 
 
            scored 80 on the left and 78 on the right (ex. 4, p. 4).  At 
 
            the time of Dr. Schloff's examination on January 10, 1990, 
 
            he found that examination of her hands revealed a grip 
 
            strength with the dynometer on the right side measuring 38, 
 
            32 (ex. 11, p. 5).  Thus, it would appear that claimant had 
 
            lost more than half of her grip strength in at least the 
 
            right hand.
 
            
 
                 Dr. Schloff found:
 
            
 
                    In my opinion, this patient is capable of 
 
                 working with restrictions only.  She could not 
 
                 work at a job which would require repetitive 
 
                 activities with her hands or repeated lifting of 
 
                 over 25 pounds...
 
            
 
                    The condition of no repeated lifting of over 25 
 
                 pounds is half due to her neck, which is not 
 
                 work-related and half due to her hands and right 
 
                 elbow, which apparently is work-related.
 
            
 
                    The restriction of no repetitive activity with 
 
                 her hands is all work-related.
 
            
 
            (exhibit 11, pages 6 & 7)
 
            
 
                 Dr. Schloff added that both upper extremities have been 
 
            affected and he phrased his impairment ratings in terms of 
 
            the upper extremities.  He did not believe the ulnar nerve 
 
            findings in the right upper extremity were related to her 
 
            work activities.
 
            
 
                 Thus, Dr. Schloff's rather precise ratings, in which he 
 
            even used decimals, do not appear to be consistent with his 
 
            other findings, in particular, the restrictions he imposed 
 
            upon claimant.  Also, applying agency expertise they are 
 
            lower than impairment ratings by other orthopedic surgeons 
 
            in similar cases.
 
            
 
                 Furthermore, the ratings of Dr. Bergman and Dr. Schloff 
 
            are brought into question because they said each rating was 
 
            permanent partial disability, whereas, it is the physicians 
 
            job to rate permanent impairment and it is the realm of the 
 
            industrial commissioner to determine permanent partial 
 
            disability.  Guides to the Evaluation of Permanent 
 
            Impairment, third edition, chapter 1, "Concepts of 
 
            Impairment Evaluation" section 1.1 "Basic Considerations, 
 
            Impairment-Disability-Handicap".  
 
            
 
                 Furthermore, Dr. Wolbrink's rating seemed to be more 
 
            consistent with the other evidence of disability in this 
 
            case and other cases of this nature.  
 
            
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
                 Claimant testified that when she returned to work in 
 
            the later part of 1987, she was not able to perform her old 
 
            jobs without pain (tr. p. 63).  She could not perform them 
 
            with the high degree of frequency and speed that employer 
 
            wanted (tr. p. 64).  Claimant testified that she had a 
 
            discussion with the foreman and the personnel director and 
 
            they suggested that she quit the job.  She refused to quit 
 
            and said they would have to medically disqualify her (tr. p. 
 
            64).  The termination report shows that the termination was 
 
            voluntary because of occupational disability.  It adds that 
 
            the quality of work was marginal and the quantity of work 
 
            was unsatisfactory (ex. 13, p. 5).  An employee separation 
 
            form shows that claimant voluntarily quit due to illness or 
 
            injury.  The remarks state, "Work-related injury.  [N]o work 
 
            to meet her permanent restrictions.  [D]o not contest claim 
 
            per Dan Heffernan." (ex. 13, p. 6).  Another form entitled 
 
            "Qualification or Disqualification Record" is marked medical 
 
            disqualification with the comment, "Orders from Dr. Bergman 
 
            for Darcy to be off line work permanently." (ex. 13, p. 8).  
 
            
 
                 Claimant testified and a number of the doctors reported 
 
            that she reported to them that her arms go to sleep while 
 
            driving a car holding onto the steering wheel, that she 
 
            cannot pick things up at an odd angle and that she drops 
 
            things (tr. p. 76).
 
            
 
                 For these reasons, it is determined that Dr. Wolbrink's 
 
            report is not only the most medically correct report, but it 
 
            is also the most consistent with all of the other evidence 
 
            in the case.
 
            
 
                 Using either the second or third edition of the Guides 
 
            to the Evaluation of Permanent Impairment, published by the 
 
            American Medical Association, 28 percent of the right upper 
 
            extremity converts to 17 percent of the body as a whole and 
 
            3 percent of the left upper extremity converts to 2 percent 
 
            of the body as a whole.  Seventeen percent and 2 percent 
 
            combine to 19 percent of the body as a whole.
 
            
 
                 Wherefore, it is determined that claimant has sustained 
 
            a 19 percent permanent impairment to the body as a whole and 
 
            pursuant to Iowa Code section 85.34(2)(s) and when this 
 
            percentage is applied to 500 weeks, it calculates out that 
 
            claimant is entitled to 95 weeks of permanent partial 
 
            disability benefits.
 
            
 
                                      notice
 
            
 
                 Since it is determined that claimant did not sustain an 
 
            injury on June 15, 1987, the notice issue is moot.
 
            
 
                       LIABILITY of the second injury fund
 
            
 
                 Since it has been determined that claimant sustained 
 
            only one cumulative injury under Iowa Code section 
 
            85.34(2)(s), then claimant has not sustained a second 
 
            permanent injury to another scheduled member which would 
 
            entitle her to benefits under Iowa Code section 85.64.
 
            
 
                 The Second Injury Fund attacked claimant's credibility, 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            but since there is no award of benefits against the Second 
 
            Injury Fund and since ths decision was primarily determined 
 
            by the ratings of the doctors based on their physical 
 
            findings, then claimant's credibility has had practically no 
 
            effect on the decision in this case.
 
            
 
                 Defendant Second Injury Fund established that claimant 
 
            did not disclose her injuries on subsequent employment 
 
            applications after she moved to Minnesota.  It is not 
 
            uncommon, however, for otherwise honest employees who need 
 
            work and are truly seeking work to not disclose prior 
 
            injuries because of discrimination against previously 
 
            injured employees in the competitive labor market.  The 
 
            newly enacted American Disabilities Act may help to 
 
            counterbalance this situation.  Claimant told the truth at 
 
            the hearing and admitted that she did not disclose the prior 
 
            injuries and attempted to explain why.
 
            
 
                                conclusions of law
 
            
 
                 Wherefore, based upon the evidence presented and the 
 
            foregoing principles of law, the following conclusions of 
 
            law are made:
 
            
 
                 That claimant sustained a cumulative injury on May 9, 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            1987, to both arms in a single accident pursuant to Iowa 
 
            Code section 85.34(2)(s) which arose out of and in the 
 
            course of employment with employer.  Iowa Code section 
 
            85.3(1); McDowell v. Town of Clarksville, 241 N.W.2d 904 
 
            (Iowa 1976); Musselman v. Central Telephone Co., 261 Iowa 
 
            352, 154 N.W.2d 128 (1967).
 
            
 
                 That the injury was the cause of permanent disability.  
 
            Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 
 
            (1965); Lindahl v. L.O. Boggs Co., 236 Iowa 296 18 N.W.2d 
 
            607 (1945).
 
            
 
                 That claimant has sustained a 19 percent impairment to 
 
            the body as a whole and that claimant is entitled to 95 
 
            weeks of permanent partial disability benefits.  Iowa Code 
 
            section 85.34(2)(s).
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 That defendant pay to claimant ninety-five (95) weeks 
 
            of permanent partial disability benefits at the rate of one 
 
            hundred eighty-eight and 98/100 dollars ($188.98) per week 
 
            as stipulated to by the parties in the total amount of 
 
            seventeen thousand nine hundred fifty-three and 10/100 
 
            dollars ($17,953.10) commencing on February 23, 1988, as 
 
            stipulated to by the parties.  
 
            
 
                 That these benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue pursuant to Iowa Code section 
 
            85.30.
 
            
 
                 That defendant is entitled to a credit for three 
 
            hundred forty and 16/100 dollars ($340.16) previously paid 
 
            to claimant for the left thumb at the rate of one hundred 
 
            eighty-eight and 98/100 dollars ($188.98) per week and one 
 
            thousand one hundred forty-nine and 42/100 dollars 
 
            ($1,149.42) previously paid by defendant to claimant for the 
 
            right thumb and right arm at the rate of one hundred 
 
            eighty-eight and 43/100 dollars per week.
 
            
 
                 That the costs of this action, including the cost of 
 
            the attendance of the court reporter at hearing and the cost 
 
            of the  transcript, are charged to defendant employer 
 
            pursuant to rule 343 IAC 4.33 and Iowa Code section 
 
            86.19(1).
 
            
 
                 That defendant file claim activity reports as requested 
 
            by this agency pursuant to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of November, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            
 
            Copies to:
 
            
 
            Mr. Steve Hamilton
 
            Attorney at Law
 
            606 Ontario Street
 
            PO Box 188
 
            Storm Lake, IA  50588
 
            
 
            
 
            
 
            Ms. Marie Welsh
 
            Attorney at Law
 
            PO Box 515, Department #41
 
            Dakota City, NE  68731
 
            
 
            Mr. Robert D. Wilson
 
            Assistant Attorney General
 
            Hoover State Office Bldg.
 
            Des Moines, IA  50319
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                                          51106 51401 51402.20 51402.30 
 
                                          52209 53200 51803
 
                                          Filed November 7, 1991
 
                                          Walter R. McManus, Jr.
 
            
 
                           before the iowa industrial 
 
                                   commissioner
 
            ____________________________________________________________
 
                                          :
 
            DARCY PUTNEY a/k/a DARCY      :
 
            SLYTER,                       :
 
                                          :
 
                 Claimant,                :      File Nos.  852166
 
                                          :                 880474
 
            vs.                           :
 
                                          :  A R B I T R A T I O N
 
            IBP, INC.,                    :
 
                                          :      D E C I S I O N
 
                 Employer,                :    
 
                 Self-Insured,            :      
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            51106 51401 51402.20 51402.30 52209 
 
            Employer treated left extremity problems as one claim and 
 
            right extremity problems as another claim.  Deputy found one 
 
            injury, a cumulative injury, which occurred when claimant 
 
            was forced to quit work (McKeever) to both extremities under 
 
            Iowa Code section 85.34(2)(s).  
 
            When symptoms occurred in both extremities only a few months 
 
            apart, it was determined to be "a single accident" in the 
 
            context of Iowa Code section 85.34(2)(s).
 
            The injury was further determined to be "a single accident" 
 
            in the context of Iowa Code section 85.34(2)(s) because 
 
            three of the treating physicians all reported bilateral 
 
            symptoms at the time of the first office call.
 
            
 
            53200
 
            Because of the single accident determination there was no 
 
            second permanent injury to another member and, therefore, 
 
            there was no liability to the Second Injury Fund of Iowa.
 
            The injury was determined to be an injury to both arms 
 
            rather than both hands based on the terms used by two of the 
 
            three rating doctors.
 
            
 
            
 
            51803
 
            Ratings of the treating physician and defendant's evaluator 
 
            were determined to be too low based upon other physical 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            evidence in the case and agency expertise.  Claimant's 
 
            evaluator ratings were used to award 95 weeks of permanent 
 
            partial disability based upon a 19 percent 
 
            functional/physical impairment to both arms.
 
            Defendant's evaluators used the term permanent partial 
 
            disability to express their ratings, whereas, claimant's 
 
            evaluator correctly found permanent impairment.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            BERTHA WOODRUFF,              :
 
                                          :
 
                 Claimant,                :      File Nos. 862183/852177
 
                                          :                864966/923653
 
            vs.                           :                923654
 
                                          :
 
            SEARS, ROEBUCK & CO.,         :       A R B I T R A T I O N
 
                                          :
 
                 Employer,                :         D E C I S I O N
 
                                          :
 
            and                           :
 
                                          :
 
            ALLSTATE INSURANCE COMPANY,   :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                 
 
            
 
                                   introduction
 
            
 
                 This is a proceeding in arbitration brought by Bertha 
 
            Woodruff against Sears, Roebuck & Company, employer, and 
 
            Allstate Insurance Company, insurance carrier, as 
 
            defendants.  Claimant seek to recover benefits under the 
 
            Iowa Workers' Compensation Act as the result of alleged 
 
            injuries occurring on five dates:  March 17, 1987 (agency 
 
            file number 852177); July 15, 1987 (agency file number 
 
            864966); July 23, 1987 (agency file number 862183); January 
 
            21, 1988 (agency file number 923653); and, August 1, 1989 
 
            (agency file number 923654).  This matter came on for 
 
            hearing before the undersigned deputy industrial 
 
            commissioner on July 10, 1991.  The case was considered 
 
            fully submitted at the close of the hearing, although leave 
 
            was granted to allow the parties to file briefs.
 
            
 
                 The record in this case consists of the testimony of 
 
            the claimant, Donald Woodruff, Fergus James Burns, and Troy 
 
            Fee; and, joint exhibits a-n, p and q.
 
            
 
                                      issues
 
            
 
                 Claimant filed five petitions, and all cases were 
 
            consolidated.  Pursuant to the prehearing report submitted 
 
            and approved at the hearing, and in conjunction with the 
 
            hearing assignment order, the following issues were 
 
            presented for resolution:
 
            
 
                 1.  Whether there is a causal relationship between the 
 
            alleged injuries and claimant's current disability;
 
            
 
                 2.  Whether claimant is entitled to temporary 
 
            disability or healing period benefits, or permanent partial 
 
            or total disability benefits;
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 3.  Whether claimant is entitled to medical benefits 
 
            pursuant to Iowa Code section 85.27; and,
 
            
 
                 4.  Whether defendants are entitled to credit as 
 
            governed by Iowa Code section 85.38(2).
 
            
 
                 Additionally, with respect to agency file number 923653 
 
            and agency file number 923654, defendants deny that claimant 
 
            sustained an injury which arose out of and in the course of 
 
            her employment.
 
            
 
                                 findings of fact
 
            
 
                 The undersigned deputy, having heard the testimony and 
 
            having reviewed all of the evidence received, finds the 
 
            following facts:
 
            
 
                 Claimant was born on March 30, 1934.  She quit school 
 
            in the tenth grade, and has not acquired a GED.  Claimant 
 
            holds no special degrees or certificates.
 
            
 
                 In the 1950's, claimant worked as a waitress in various 
 
            restaurants.  She also worked in a candy factory and 
 
            manufacturing plant on assembly lines.  From 1956 through 
 
            1981, claimant was a full-time mother and homemaker.
 
            
 
                 She returned to the work force outside of the home in 
 
            the fall of 1981.  At that time, she worked as a hostess 
 
            five days a week for approximately six months at the Rib 
 
            Joint Restaurant.
 
            
 
                 In the fall of 1982, claimant began to work for 
 
            defendant Sears on a part-time basis.  Although her hours 
 
            sometimes varied, she usually worked five days per week, 
 
            five hours per day.  She was hired as a 
 
            clerk/cashier/greeter in the automotive department, a 
 
            position she held until August of 1989.
 
            
 
                 Her job duties included greeting customers, writing 
 
            orders and providing car keys to service departments.  
 
            Additionally, her position required claimant to occasionally 
 
            lift shocks, mufflers, struts and oil, which weighed between 
 
            five and eight pounds.  She would also lift supplies and 
 
            packages that were sold to customers.  She worked behind a 
 
            counter, with some of her work being performed at a desk.  
 
            Claimant stated that she stood most of the time while 
 
            working, and she was able to perform all of the required job 
 
            duties, with no physical problems that interfered with her 
 
            daily routine.
 
            
 
                 On March 17, 1987, as claimant walking across the floor 
 
            to the restroom, she slipped, and felt pain in her low back 
 
            and right leg.  She continued to work, and told her 
 
            supervisor about the incident.  She was sent to Charter 
 
            Community Hospital and was treated by V. Wall, M.D.  She was 
 
            released to return to work on March 20, 1987, and returned 
 
            to the same employment without any significant difficulty.
 
            
 
                 The next incident occurred on July 15, 1987, and 
 
            claimant described that on this date she slipped on a 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            plastic tie located on the floor, and as she caught herself 
 
            felt pain in her low back again.  She continued to work 
 
            throughout the day.  She filled out an accident report, and 
 
            was sent to Donna Drees, M.D.  She was taken off of work 
 
            until July 21, 1987, and was given Flexeril and Clinoril.  
 
            (Joint Exhibit m, page 2).
 
            
 
                 The next injury alleged by claimant is that of July 23, 
 
            1987.  Claimant testified that on this date, she tripped 
 
            over a telephone cord and fell to the ground.  Again, she 
 
            completed an incident report and received treatment from the 
 
            Charter Community Hospital Emergency Room.  The physician on 
 
            duty diagnosed a lumbosacral strain, and apparently claimant 
 
            was taken off of work for the next six months.  During this 
 
            time, she received physical therapy three days per week at 
 
            Charter Community Hospital.  (Jt. Ex. m).  After six months 
 
            of treatment, claimant returned to her same position with 
 
            the defendant employer.
 
            
 
                 The next incident occurred on January 23, 1988.  
 
            Claimant stated that she was behind the counter and tripped 
 
            over an electrical cord connected to the cash register.  As 
 
            she started to fall forward, she was grabbed by a fellow 
 
            employee, Troy Fee, who prevented her from falling to the 
 
            floor.  Claimant stated that when the co-employee grabbed 
 
            her, he hurt her ribs, and the jolt hurt her mid and low 
 
            back.  She does not recall if she missed work due to this 
 
            incident.
 
            
 
                 Finally, on August 1, 1989, claimant described an 
 
            incident where she went to the credit area for a photocopy 
 
            of a piece of paper, and slipped on wet paint.  As she 
 
            slipped, she twisted and hit the door jam with her left 
 
            side.  Claimant stated she was sore all over from the 
 
            twisting motion, particularly in the neck, shoulder and arm 
 
            area.  Claimant has not returned to substantial employment 
 
            since this last incident.
 
            
 
              
 
            
 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            analysis and conclusions of law
 
            
 
                 March 17, 1987 - - Agency File Number 852177
 
            
 
                 July 15, 1987  - - Agency File Number 864966
 
            
 
                 July 23, 1987 - - Agency File Number 862183
 
            
 
                 The first issue to be addressed with respect to the 
 
            aforementioned file numbers is whether claimant is entitled 
 
            to permanent partial disability benefits.
 
            
 
                 For each of these files, defendants have admitted that 
 
            claimant received an injury which arose out of and in the 
 
            course of her employment, and they have admitted that 
 
            claimant is entitled to receive temporary disability 
 
            benefits during her period of recovery.  At issue, is 
 
            whether claimant has sustained any type of permanency with 
 
            respect to the first three injury dates.  As noted under the 
 
            facts section, claimant injured her back on each of these 
 
            three occasions.
 
            
 
                 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(1).
 
            
 
                 If claimant has sustained a permanent disability due to 
 
            the work-related accidents, she is entitled to healing 
 
            period benefits for time off of work, and permanent partial 
 
            disability benefits to compensate her for the disability.  
 
            See, Iowa Code sections 85.33, 85.34.
 
            
 
                 Claimant sought treatment with numerous medical 
 
            practitioner following the first three work-related 
 
            incidents.  From March 17, 1987 through July 23, 1987, 
 
            claimant was treated by Donna Drees, M.D. and Marshall 
 
            Flapan, M.D.  Dr. Flapan's notes indicate that he first 
 
            treated claimant on March 21, 1987 and noted discomfort on 
 
            straight leg raising exam and discomfort of the right 
 
            sacroiliac joint.  X-rays of the lumbosacral spine from 
 
            Charter Hospital were within normal limits.  He assessed a 
 
            low back sprain and contusion secondary to the work injury, 
 
            and prescribed Feldene.  He also continued physical therapy.
 
            
 
                 During June of 1987 and January of 1988, Dr. Flapan 
 
            continued to treat claimant.  Claimant underwent an MRI of 
 
            the lumbar spine which failed to demonstrate any evidence of 
 
            disc herniation or nerve root impingement.  She continued to 
 
            complain of pain and discomfort, but reported improvement 
 
            with outpatient physical therapy and the use of a TENS unit.  
 
            Dr. Flapan assessed degenerative disc disease without 
 
            neurological deficit.  He released claimant to return to 
 
            work on January 4, 1988.
 
            
 
                 It is noted that no where in the record is there 
 
            evidence of any permanent partial disability with respect to 
 
            any of the aforementioned three injury dates.  The only 
 
            specific reference to that effect is a letter from Dr. 
 
            Flapan to the insurance carrier which states the following:
 
            
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
                    Thank you for your letter of July 20, 1987, 
 
                 requesting further information on Bertha Woodruff.  
 
                 You should be in receipt of my office dictation 
 
                 outlining my findings on Bertha Woodruff.  When 
 
                 last seen on the 4th of June, she was released to 
 
                 return to work on the 8th of June.  She has not 
 
                 sustained any permanent impairment.
 
            
 
            (Jt. Ex. h, p. 4).
 
            
 
                 As a result, claimant has failed to sustain her burden 
 
            of proving by a preponderance of the evidence that she 
 
            sustained any permanent disability in agency files 852177, 
 
            864966, and 862183.
 
            
 
                 January 21, 1988 - - Agency File Number 923653
 
            
 
                 Claimant alleges a fourth work-related injury on 
 
            January 21, 1988.
 
            
 
                 The first issue to be addressed is whether claimant 
 
            received an injury which arose out of and in the course of 
 
            her employment on this date.
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that she received an injury on which arose 
 
            out of and in the course of her employment. McDowell v. Town 
 
            of Clarksville, 241 N.W.2d 904 (Iowa 1976); Musselman v. 
 
            Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967). 
 
            
 
                 The injury must both arise out of and be in the course 
 
            of the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 
 
            Iowa 402, 68 N.W.2d 63 and cases cited at pp. 405-406 of the 
 
            Iowa Report.  See also Sister Mary Benedict v. St. Mary's 
 
            Corp., 255 Iowa 847, 124 N.W.2d 548 (l963) and Hansen v. 
 
            State of Iowa, 249 Iowa 1147, 91 N.W.2d 555 (1958).
 
            
 
                 The words "out of" refer to the cause or source of the 
 
            injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63. 
 
            
 
                 The words "in the course of" refer to the time and 
 
            place and circumstances of the injury.  McClure v. Union 
 
            et al. Counties, 188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 
 
            402, 68 N.W.2d 63.
 
            
 
                 "An injury occurs in the course of the employment when 
 
            it is within the period of employment at a place the 
 
            employee may reasonably be, and while he is doing his work 
 
            or something incidental to it."  Cedar Rapids Comm. Sch. 
 
            Dist. v. Cady, 278 N.W.2d 298 (Iowa 1979), McClure, 188 
 
            N.W.2d 283; Musselman v. Central Telephone Co., 261 Iowa 
 
            352, 154 N.W.2d 128 (1967). 
 
            
 
                 As a greeter/cashier for Sears, claimant had a variety 
 
            of duties.  The evidence clearly indicates that claimant was 
 
            working the hours required by her employer.  Furthermore, 
 
            claimant was able to describe with clarity and specificity 
 
            how the injury occurred.  As a result, it is found that 
 
            claimant received an injury on January 21, 1988 which arose 
 
            out of and in the course of her employment with Sears.
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
                 The next issue to be addressed is whether there is a 
 
            causal relationship between claimant's injury and her 
 
            disability.
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of January 21, 
 
            1988 is causally related to the disability on which she now 
 
            bases her claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 
            N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 296, 18 
 
            N.W.2d 607 (1945).  A possibility is insufficient; a 
 
            probability is necessary.  Burt v. John Deere Waterloo 
 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
            question of causal connection is essentially within the 
 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
            Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). 
 
            
 
                 However, expert medical evidence must be considered 
 
            with all other evidence introduced bearing on the causal 
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id. at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
            Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
            
 
                 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. Aase 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 v. All-American, Inc., 290 N.W.2d 
 
            348, 354 (Iowa 1980).
 
            
 
                 While a claimant is not entitled to compensation for 
 
            the results of a preexisting injury or disease, the mere 
 
            existence at the time of a subsequent injury is not a 
 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
 
            preexisting condition or disability that is aggravated, 
 
            accelerated, worsened or lighted up so that it results in 
 
            disability, claimant is entitled to recover.  Nicks v. 
 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
 
            (1962).
 
            
 
                 Dr. Flapan again treated claimant after the January 21, 
 
            1988 incident.  His notes, dated January 26, 1988, indicate 
 
            that claimant did not display any objective findings during 
 
            his examination.  Again, he assessed claimant's condition of 
 
            that of degenerative disc disease without object neurologic 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            deficit.  He did not take claimant out of work, but renewed 
 
            a prescription for Tylenol III.  Claimant was to continue 
 
            physical therapy and was to return to Dr. Flapan in three 
 
            months.  During this time, she used a TENS unit.
 
            
 
                 In March and April of 1988, claimant returned to Dr. 
 
            Flapan.  Again, he did not report any objective findings, 
 
            and continued claimant on medication and exercises.  On 
 
            April 19, 1988, claimant was discharged from physical 
 
            therapy.
 
            
 
                 Finally, claimant returned once again to Dr. Flapan on 
 
            July 19, 1988.  His notes indicate that claimant complained 
 
            of some discomfort from time to time in her back and right 
 
            lower extremity.  He noted that she had not been working, 
 
            but discharged her from his care.
 
            
 
                 On July 28, 1987, in response to a letter a dated July 
 
            20, 1987, Dr. Flapan was of the opinion that claimant had 
 
            not sustained any permanent impairment, and released 
 
            claimant to return to work June 8, 1987.  (Jt. Ex. h, p. 6).
 
            
 
                 On August 15, 1988, Dr. Flapan rendered an opinion that 
 
            claimant had sustained a five percent permanent functional 
 
            impairment.  (Jt. Ex. h, p. 1).
 
            
 
                 The records note that claimant again sought treatment 
 
            from Dr. Flapan in December of 1988, when she was 
 
            complaining of discomfort in the low back and right lower 
 
            extremity.  At this point, Dr. Flapan again noted 
 
            degenerative disc disease with symptoms suggestive of right 
 
            S1 radiculitis.  He recommended an epidural steroid 
 
            injection, but claimant declined.  (Jt. Ex. h, p. 6).
 
            
 
                 Claimant sought an independent medical examination from 
 
            Jerome Bashara, M.D., on July 25, 1989.  He rendered an 
 
            opinion that claimant sustained a seven percent impairment 
 
            due to a work-related injury.  He did not clarify which 
 
            injury.  (Jt. Ex. j).
 
            
 
                 Although, Dr. Flapan's opinion does not causally relate 
 
            claimant's impairment to the injury she sustained, the 
 
            undersigned feels there is enough evidence in the record to 
 
            indicate that such causal relationship does in fact exist.
 
            
 
                 As claimant has sustained a permanent injury to her low 
 
            back, it is necessary to evaluate her 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, expe
 
            rience 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 disabil
 
            ity.  This is so as impairment and disability are not syn
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            onymous.  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 dis
 
            ability 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 dis
 
            ability.  See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985); Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, l985).
 
            
 
                 Claimant was 56 years of age at the time of the 
 
            hearing.  She completed the ninth grade in school, and has 
 
            not attained her GED.  Claimant began to work for Sears in 
 
            1982, but prior to that had been a full time mother and 
 
            housewife for more than 25 years.  Her other working 
 
            experience includes working on assembly lines in a candy 
 
            factory and manufacturing plant.  She has also worked as a 
 
            waitress.
 
            
 
                 Claimant's physical condition prior to the accident is 
 
            unremarkable.  Nothing in the records suggest that she ever 
 
            sought treatment for any type of back pain or problems.  Her 
 
            physical condition after the accident has been marginal, 
 
            although the records indicate that claimant has progressed 
 
            to a point where she functions in a normal capacity.  Her 
 
            healing period was somewhat extended, as she was off of work 
 
            for approximately six months before being released to return 
 
            to her same position with Sears.
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            
 
                 On an emotional and intellectual basis, claimant 
 
            appeared average.  Her motivation to aggressively undertake 
 
            physical therapy, as well as return to the work force is 
 
            questioned, but claimant did continue to return to her place 
 
            of employment and work whenever released by her treating 
 
            physician, Dr. Flapan.
 
            
 
                 Her actual earnings after the accident are the same as 
 
            her earnings prior to the accident.  The employer seemed 
 
            willing to accommodate claimant, and continued to employ her 
 
            despite Dr. Drees' advice "dump her as soon as possible".  
 
            (Jt. Ex. q).
 
            
 
                 After considering all of the factors that comprise an 
 
            industrial disability, and considering that claimant 
 
            returned to her normal employment after the January 21, 1988 
 
            injury, it is determined that claimant has sustained a five 
 
            percent industrial disability.
 
            
 
                 August 1, 1989 - - Agency File Number 923654
 
            
 
                 The first issue to be addressed with respect to the 
 
            August 1, 1989 injury date is whether claimant sustained an 
 
            injury which arose out of and in the course of her 
 
            employment.
 
            
 
                 Citations to the legal standard for claimant's burden 
 
            of proving her claim are relevant, but will not be 
 
            reiterated here.
 
            
 
                 Again, claimant described with specificity her job 
 
            duties at the time she was injured.  There appears to be no 
 
            valid dispute that claimant slipped on wet paint on the 
 
            floor and twisted as she went to catch herself.  She hit the 
 
            door jamb with her left side, and filed an incident report.  
 
            Claimant stated that she was sore all over from twisting, 
 
            but felt particularly intensive pain in her neck.
 
            
 
                 Claimant was treated at the Mercy Medical Clinic by 
 
            Kenneth Anderson, M.D., and Harold Eklund, M.D.  It was 
 
            recommended that she undergo physical therapy and claimant 
 
            was to undergo an MRI on August 21, 1989.  A diagnosis on 
 
            September 8, 1989, indicated a possible nerve root 
 
            impingement, and claimant was referred to a neurosurgeon for 
 
            a second opinion.  (Jt. Ex. b).
 
            
 
                 On June 21, 1990, claimant received a second opinion 
 
            from David Boarini, M.D.  He concurred with Dr. Koontz's 
 
            recommendation that claimant undergo surgery based on the 
 
            results of the CT scan, which revealed a C5-6 nerve root cut 
 
            off.  Additionally, Dr. Boarini agreed that claimant, at the 
 
            C6-7 level, was not normal.  He also pointed out that 
 
            claimant displayed a, "wide range of symptoms and some 
 
            obvious functional overlay."  Additionally, Dr. Boarini 
 
            opined that claimant's neck condition was caused by the 
 
            underlying degenerative disc disease, and not significantly 
 
            related to the slip she had in August of 1989.  (Jt. Ex. c, 
 
            p. 2).
 
            
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
                 Claimant also underwent a myelogram of the cervical 
 
            spine, which revealed a central disc bulge at the C6-7 
 
            level, a large left-sided HNP, which was amputating the C6 
 
            nerve root, and a mild central disc bulge at the C3-4 level.  
 
            There was evidence of disc degeneration.
 
            
 
                 As claimant did not display much improvement after 
 
            physical therapy and pool exercises were undertaken for an 
 
            extended period of time.  Claimant eventually underwent 
 
            surgery on August 31, 1990.  The surgery was in the form of 
 
            a cervical laminectomy at the C5-6 level, and a diskectomy 
 
            and fusion at the C6-7 level.  The surgery was performed by 
 
            Donald Koontz, M.D.
 
            
 
                 On March 4, 1991, Dr. Koontz rendered the following 
 
            opinion:
 
            
 
                 I think she is now able to return to work two days 
 
                 a week for four or five hours a day as we talked 
 
                 about before.  I think her restrictions will be as 
 
                 I outlined before which include no work above 
 
                 shoulder level, one time lift of 25 to 30 pounds 
 
                 with repetitive lifting of no more than 10 to 15 
 
                 pounds, the need to sit and stand intermittently 
 
                 while on the job and no repetitive bending, 
 
                 twisting or flexion/extension of the head and 
 
                 neck.  As you'll recall, she has some limitations 
 
                 related to her lower back as well.
 
            
 
                 I think she can begin her work on Tuesday March 
 
                 12th and hopefully will be able to work Tuesday 
 
                 and Thursday for at least 3 or 4 weeks prior to 
 
                 increasing her work time.  I think gradually 
 
                 she'll be able to work back into full time but she 
 
                 will need to continue her status at working 4 to 5 
 
                 hours a day as she did before.
 
            
 
            (Jt. Ex. g, pp. 3-4).
 
            
 
                 On February 18, 1991, Dr. Koontz rendered an opinion 
 
            that claimant had sustained a 16 percent permanent 
 
            impairment related to the neck injury.  (Jt. Ex. g, p. 1).
 
            
 
                 The undersigned finds that there is a causal 
 
            relationship between the twisting episode of August 1, 1989 
 
            and claimant's current permanent disability.
 
            
 
                 The next issue to be addressed is whether claimant is 
 
            entitled to healing period benefits during the recuperation 
 
            time.
 
            
 
                 Section 85.34(1) provides that healing period benefits 
 
            are payable to an injured worker who has suffered permanent 
 
            partial disability until (1) the worker has returned to 
 
            work; (2) the worker is medically capable of returning to 
 
            substantially similar employer; or (3) the worker has 
 
            achieved maximum medical recovery.  The healing period can 
 
            be considered the period during which there is a reasonable 
 
            expectation of improvement of the disabling condition.  See 
 
            Armstrong Tire & Rubber Co. v. Kubli, 312 N.W.2d 60 (Iowa 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            App. 1981).  Healing period benefits can be interrupted or 
 
            intermittent.  Teel v. McCord, 394 N.W.2d 405 (Iowa 1986).
 
            
 
                 As claimant has sustained a permanent injury, she is 
 
            entitled to healing period benefits during the time she was 
 
            off of work.
 
            
 
                 The undersigned finds that although claimant has been 
 
            treated by several physicians, Dr. Koontz is the treating 
 
            physician for this particular injury, not Dr. Eklund.  Dr. 
 
            Eklund referred claimant to Dr. Koontz, who treated her on a 
 
            sustained, regular basis.  He is the most familiar with her 
 
            case and medical progress.  As a result, claimant's healing 
 
            period ended on April 9, 1991, four weeks after claimant was 
 
            returned to work on a part-time basis.
 
            
 
                 The next issue to be addressed is claimant's 
 
            entitlement to permanent partial disability benefits, in the 
 
            form of an industrial disability, as claimant's has 
 
            sustained an injury to the body as a whole.
 
            
 
                 Citations to the law with respect to an industrial 
 
            disability are relevant here, but will not be reiterated.  
 
            The fact worth noting with respect to claimant's industrial 
 
            disability for this latest episode revolves around her 
 
            ability to return to that employment which she had prior to 
 
            the injury.  Although claimant does have permanent partial 
 
            disability, and permanent medical restrictions, the 
 
            description of the greeter/cashier position she held at the 
 
            time of the injury does not require claimant to work outside 
 
            of the restrictions imposed.  It is noted that at the 
 
            hearing, claimant testified that she could barely use a 
 
            stapler, yet this particular job function seems to lie 
 
            within the restrictions as set out by Dr. Koontz.
 
            
 
                 There is ample evidence in the record to support a 
 
            finding that claimant has sustained some industrial 
 
            disability.  She has permanent medical restrictions and 
 
            impairment, both of which may preclude her from fulfilling 
 
            some duties occasionally required by the greeter/cashier 
 
            position.
 
            
 
                 After considering all of the elements that comprise an 
 
            industrial disability, it is found that claimant has 
 
            sustained a 16 percent industrial disability or lack of 
 
            earning capacity.
 
            
 
                 There is also an issue as to defendants' responsibility 
 
            to reimburse mileage incurred by claimant in pursuit of 
 
            medical services.
 
            
 
                 Iowa Code section 85.27 provides, in relevant 
 
                 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 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
                 necessary transportation expenses incurred for 
 
                 such services.  The employer shall also furnish 
 
                 reasonable and necessary crutches, artificial 
 
                 members and appliances but shall not be required 
 
                 to furnish more than one set of permanent 
 
                 prosthetic devices.
 
            
 
                 Claimant is to be reimbursed for mileage expenses she 
 
            has incurred due to seeking medical services.
 
            
 
                                      order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That claimant takes nothing further for the injuries of 
 
            March 17, 1987; July 15, 1987; and, July 23, 1987.
 
            
 
                 That defendants shall pay unto claimant twenty-five 
 
            (25) weeks of permanent partial disability payments at the 
 
            rate of eight-five and 38/100 dollars ($85.38) per week 
 
            beginning January 22, 1988 for the injury of January 21, 
 
            1988.
 
            
 
                 That defendants shall pay unto claimant healing period 
 
            benefits beginning August 2, 1989 through April 8, 1991 at 
 
            the rate of ninety-three and 75/100 dollars ($93.75) per 
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            week for the August 1, 1989 injury.
 
            
 
                 That defendants shall pay unto claimant eighty (80) 
 
            weeks of permanent partial disability benefits at the rate 
 
            of ninety-three and 75/100 dollars ($93.75) per week 
 
            beginning April 9, 1991 for the injury of August 1, 1989.
 
            
 
                 That defendants shall pay the costs of reasonably 
 
            necessary transportation expenses claimant has incurred in 
 
            receiving medical services as defined by Iowa Code section 
 
            85.27.
 
            
 
                 That defendants shall pay the accrued weekly benefits 
 
            in a lump sum.
 
            
 
                 That defendants shall receive credit against benefits 
 
            previously paid.
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            
 
                 That defendants shall pay the costs of this action 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 That defendants shall file an activity report upon 
 
            payment of this award as required by this agency pursuant to 
 
            rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of September, 1991.
 
            
 
            
 
            
 
            
 
                                          
 
            ________________________________
 
                                          PATRICIA J. LANTZ
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr Robert E McKinney
 
            Attorney at Law
 
            480 6th Street
 
            PO Box 209
 
            Waukee Iowa 50263
 

 
            
 
            Page  14
 
            
 
            
 
            
 
            
 
            
 
            Mr Jeff M Margolin
 
            Attorney at Law
 
            Terrace Center Ste 111
 
            2700 Grand Avenue
 
            Des Moines Iowa 50312
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      5-1800
 
                      Filed September 27, 1991
 
                      PATRICIA J. LANTZ
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            BERTHA WOODRUFF,    :
 
                      :
 
                 Claimant, :    File Nos. 862183/852177
 
                      :              864966/923653
 
            vs.       :              923654
 
                      :
 
            SEARS, ROEBUCK & CO.,    :     A R B I T R A T I O N
 
                      :
 
                 Employer, :        D E C I S I O N
 
                      :
 
            and       :
 
                      :
 
            ALLSTATE INSURANCE COMPANY,   :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            5-1800
 
            Claimant in separate accidents, sustained five percent 
 
            impairment to her low back and 16 percent impairment to her 
 
            neck.  She was awarded the same for industrial purposes.  
 
            The evidence showed that, even though claimant had some 
 
            restrictions, her job did not require physical activities 
 
            which fell outside of the limitations.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            MARCELLA EATON,               :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 852585
 
            NEWELL GOOD SAMARITAN CENTER, :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INSURANCE      :
 
            COMPANY,                      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by Marcella 
 
            Eaton against Newell Good Samaritan Center, employer, and 
 
            Liberty Mutual Insurance Company, insurance carrier.  Ms. 
 
            Eaton bases her claim upon an alleged injury occurring on 
 
            April 18, 1987.  In accordance with the prehearing report 
 
            and hearing assignment order, the parties submit the 
 
            following issues for resolution:
 
            
 
                 1.  Whether claimant sustained an injury which arose 
 
            out of and in the course of her employment;
 
            
 
                 2.  Whether there is a causal relationship between the 
 
            alleged injury and a permanent disability; and,
 
            
 
                 3.  Whether claimant is entitled to permanent partial 
 
            disability benefits.
 
            
 
                 The case was heard and fully submitted at Storm Lake, 
 
            Iowa on March 25, 1991.  The record consists of testimony 
 
            from the claimant, Daniel Ranier, Martha Kragel and Pam 
 
            Bogue; and, joint exhibits 1-18.
 
            
 
                                 findings of fact
 
            
 
                 The undersigned deputy, having heard all of the 
 
            testimony and having reviewed all of the evidence received, 
 
            finds the following facts:
 
            
 
                 Claimant, Marcella Eaton, was born May 1, 1948.  She is 
 
            a high school graduate, attended Rochester Community College 
 
            for two years, and acquired an associate arts degree in 
 
            business, with a major in accounting. 
 
            
 
                 In 1979, claimant acquired an associate degree in 
 
            nursing, and began working for the Rochester Methodist 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            Hospital in Rochester, Minnesota.  She was a full-time 
 
            employee in the plastic surgery and EMT departments.  Her 
 
            primary duties included assisting with tracheotomies, 
 
            mastectomies, and assisting nose and ear problems.  This 
 
            position required little lifting, bending or stooping.
 
            
 
                 In 1983, claimant moved to Brooklyn Park, Minnesota and 
 
            began working at the Abbott-Northwestern Hospital in the 
 
            cardiac care unit.
 
            
 
                 In July of 1984, claimant began working at St. Marys 
 
            Hospital at the Mayo Clinic on the neurology floor.  This 
 
            position required her to perform a substantial amount of 
 
            lifting and bending, and claimant described that she cared 
 
            for comatose patients who required complete care, including 
 
            lifting the patient on and off of the bed.
 
            
 
                 In December of 1985, claimant moved to Albert City, 
 
            Iowa and secured employment in March of 1987 at the Newell 
 
            Good Samaritan Center in Newell, Iowa.  Claimant underwent a 
 
            pre-employment physical examination, which she passed.  Her 
 
            duties at the center included making rounds every two hours 
 
            to check on the residents; changing beds; helping patients 
 
            to the commode; and, administering treatments, prescriptions 
 
            and medications.
 
            
 
                 On April 18, 1987, claimant was in the process of 
 
            checking on the residents.  She and an aide, Martha Kragel, 
 
            were in the process of changing the sheets on a patient's 
 
            bed, when the patient became violent, and began kicking, 
 
            scratching, pinching and fighting with the claimant.  It was 
 
            established that this particular patient had a history of 
 
            becoming violent.  As claimant tried to hold down the 
 
            patient, she felt something "let go" in her lower back.  She 
 
            immediately felt pain, but thought she had pulled a muscle 
 
            and continued working.  At this time, claimant made no 
 
            official report of an injury occurring on the job.
 
            
 
                 Claimant continued to work until mid-May, when the pain 
 
            increased and she went to see a chiropractor, A. W. 
 
            Samuelson, D.C.  Dr. Samuelson took x-rays, applied ice 
 
            packs, and recommended that claimant quit the nursing 
 
            profession.  Claimant returned to Dr. Samuelson on three 
 
            subsequent occasions, and he indicated that claimant had an 
 
            unstable L-5 disc.  (Joint Exhibit 16, Pages 1-2)  Once 
 
            claimant treated with Dr. Samuelson, she told the employer 
 
            that she had been injured while working on April 18, 1987.  
 
            The employer directed claimant to David Van Gorp, M.D., for 
 
            treatment.  Claimant initially saw Dr. Van Gorp on May 29, 
 
            1987.  His notes indicate that claimant complained of sudden 
 
            pain in her back, with radiation of the pain to her legs, 
 
            left more than right.  She complained of numbness, tingling 
 
            and paresthesia of the legs.  He also noted leaking and 
 
            incontinence of urine.  (Jt. Ex. 4, p. 1)  Unfortunately, 
 
            page 2 of exhibit 4 is unreadable, but page 3 indicates that 
 
            Dr. Van Gorp's diagnosis was acute lumbar disc syndrome.  He 
 
            recommended a conservative trial in the Buena Vista County 
 
            Hospital, heat, bed rest, anti-inflammatories, traction and 
 
            physical therapy.
 
            
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
                 On June 8, 1987, Dr. Van Gorp noted that claimant had 
 
            not fully responded to the conservative treatment, and 
 
            ordered an epidural steroid flood.  Claimant was then 
 
            transferred to St. Marys Hospital in Rochester, Minnesota 
 
            for a neurological evaluation, and probable neurosurgery.  
 
            He recommended a myelogram.  Dr. Van Gorp also noted that 
 
            the x-rays taken by Dr. Samuelson showed a narrowed 
 
            intravertebral disc space at the L5-S1 level.  (Jt. Ex. 4, 
 
            p. 3)
 
            
 
                 Records from the Mayo Clinic are marked as joint 
 
            exhibit 5, pages 1-67.  Upon review, pages 1-30, and pages 
 
            32-42 are irrelevant to these proceedings.
 
            
 
                 Claimant was admitted to St. Marys Hospital at the Mayo 
 
            Clinic neurology department, on June 8, 1987.  These records 
 
            indicate that claimant hurt her back while working at the 
 
            Newell Good Samaritan Center on April 18, 1987.  Her 
 
            complaints at the time of admission were pain in the right 
 
            buttock and thigh.  A CT scan of the spine showed a possible 
 
            large, mid line protruding disc at the L5-S1 level.  (Jt. 
 
            Ex. 5, pp. 43-44)  A summary from the Mayo Clinic, found at 
 
            joint exhibit 5, pages 62-67 (pages 62-66 are duplicates), 
 
            indicates that claimant presented to the hospital with a 
 
            "mild bilateral L5 radiculopathy, which was confirmed on an 
 
            electromyographic examination."  The EMG suggested "ongoing 
 
            resolution of the nerve damage."  Furthermore, a myelogram 
 
            was performed which "demonstrated disc protrusion at the 
 
            lumbosacral level which appeared to be compressing the S1 
 
            nerve root on that [right] side but there was no evidence of 
 
            ongoing compression of the L-5 nerve roots."  The consensus 
 
            was that claimant's symptoms "were produced by a protruded 
 
            intervertebral disk which resolved with the period of bed 
 
            rest.  The mild abnormality of the lumbosacral disk was 
 
            considered to be unrelated to your problem in a subdramatic 
 
            period."  No surgical intervention was required.  (Jt. Ex. 
 
            5, pp. 62-63)  The letter was signed by Philip McManis, 
 
            M.B.,B.S., and was dated June 26, 1987.
 
            
 
                 On August 20, 1987, Dr. McManis restricted claimant's 
 
            lifting duties to not more than 25 pounds, and indicated 
 
            that she could resume light duty work activities, and 
 
            claimant was to avoid strenuous lifting and activities 
 
            involving repetitive stooping and bending.  (Jt. Ex. 5, p. 
 
            67)
 
            
 
                 On October 13, 1987, claimant was referred to Brian 
 
            Nelson, M.D., for an evaluation and subsequent opinion.  
 
            Under Dr. Nelson's care, claimant underwent a physical 
 
            therapy program from October 20, 1987 through February 8, 
 
            1988.  (Jt. Ex. 7, pp. 5-22)  The physical therapy notes 
 
            indicate that claimant showed good motivation in performing 
 
            the exercises, and she showed some improvement on selected 
 
            days, with no improvement on other days.  Of particular note 
 
            is the entry dated December 21, 1987, which states that 
 
            "[S]he is a little sore today and she states that she has 
 
            been doing some moving over the weekend which makes her more 
 
            fatigued but she is continuing to demonstrate nice 
 
            progress."  (Jt. Ex. 7, p. 17)  Physical therapy notes after 
 
            that date show that claimant again continued on a roller 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            coaster path of improvement. 
 
            
 
                 Dr. Nelson made periodic evaluations during claimant's 
 
            exercise program, including evaluations dated November 16, 
 
            1987; January 4, 1988; and, February 8, 1988.  Specifically, 
 
            Dr. Nelson's evaluation dated November 16, 1987 supplies the 
 
            following information:
 
            
 
                 Marcella has been at the BAck [sic] Clinic now for 
 
                 one month. . . . She felt that she was actually 
 
                 improving and doing pretty well until this weekend 
 
                 when she had a little bit of a setback and now she 
 
                 is having pain across the lower lumbosacral area 
 
                 radiating into both buttocks.
 
            
 
                 ....
 
            
 
                 ASSESSMENT:  Lumbar disc syndrome as yet 
 
                 unresponsive to conservative care.
 
            
 
            (Jt Ex. 7, p. 7)
 
            
 
                 Dr. Nelson's next assessment came on January 4, 1988:
 
            
 
                 Marcella returns today for a recheck.  Since I saw 
 
                 her last, she has had a setback.  She states that 
 
                 a few weeks ago she was doing pretty well but 
 
                 since that time she and her husband have moved.  
 
                 She tried to take it easy during the move but she 
 
                 may have exacerbated her problem.  She is having 
 
                 more trouble at the Clinic now and is not able to 
 
                 work-out as hard.  Her pain symptoms are about the 
 
                 same and in the same area.
 
            
 
                 ....
 
            
 
                 ASSESSMENT:  Patient had been responding fairly 
 
                 nicely to isokinetic rehab with tremendous 
 
                 increase in her numbers and decrease in her 
 
                 symptoms but she has relapsed over the past couple 
 
                 of weeks.  She is still has a long ways [sic] to 
 
                 go before she reaches normal values, so I want to 
 
                 keep her going on the rehab and check her back 
 
                 again in about a month.  If she has noticed no 
 
                 improvement in symptoms then, then I think she 
 
                 needs another CT scan to see if she has 
 
                 re-herniated her disc.
 
            
 
            (Jt. Ex. 7, p. 8)
 
            
 
                 Lastly, Dr. Nelson's evaluated claimant on February 8, 
 
            1988:
 
            
 
                 Marcella returns today and she really has not 
 
                 improved since I saw her last month.  She appears 
 
                 to have done something during her move which has 
 
                 exacerbated her pain.  She now has a new complaint 
 
                 which is pain down the right buttock and into the 
 
                 posterior lateral aspect of the right leg.  This 
 
                 is suggestive of a new herniation or maybe a 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
                 re-herniation of her previous disc.
 
            
 
            (Jt. Ex. 7, p. 9)
 
            
 
                 Dr. Nelson ordered a myelogram and CT scan, and 
 
            referred claimant to Quentin J. Durward, M.D., for surgery, 
 
            as a large defect was noted on the myelogram.  (Jt. Ex. 7, 
 
            p. 9)
 
            
 
                 Claimant was admitted to the Marian Health Center in 
 
            Sioux City, Iowa on February 22, 1988.   She presented with 
 
            severe right sciatica, with progressively worse right leg 
 
            pain.  A straight leg raising test on the right side proved 
 
            positive, and she had sensory loss in the S1 and L5 
 
            distribution, as well as a right absent ankle reflex.  A 
 
            right L5-S1 microsurgical diskectomy was performed on 
 
            February 22, 1988.  She was dismissed on February 26, 1988.  
 
            (Jt. Ex. 8, pp. 1-3)
 
            
 
                 Claimant returned to Dr. Durward for a follow-up 
 
            treatment on April 6, 1988.  She was to remain off of work 
 
            for six weeks, but was encouraged to increase her activity.  
 
            (Jt. Ex. 8, p. 4)
 
            
 
                 Claimant returned to Dr. Durward on May 18, 1988, where 
 
            he advised her that she had a permanent weight lifting 
 
            restriction of 25 pounds, and she was to avoid bending.  
 
            (Jt. Ex. 8, p. 5) 
 
            
 
                 On September 12, 1988, Dr. Durward formed the following 
 
            opinion:
 
            
 
                 It is my opinion that Marcella Eaton has suffered 
 
                 a permanent partial impairment of 8% according to 
 
                 the AMA Guidelines.  This includes a 5% rating 
 
                 because she has had a degenerated disc and disc 
 
                 surgery and another 3% for the permanent numbness 
 
                 she has.
 
            
 
                 The 25 pound weight restriction, in my opinion, is 
 
                 permanent.  I believe she has reached her maximum 
 
                 medical recovery on 5/18/88.
 
            
 
            (Jt. Ex. 8, p. 6)
 
            
 
                         analysis and conclusions of law
 
            
 
                 The first issue to be resolved is whether claimant 
 
            sustained an injury on April 18, 1987 which arose out of and 
 
            in the course of her employment with the Newell Good 
 
            Samaritan Center.
 
            
 
                 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(1).
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that she received an injury on April 18, 
 
            1987 which arose out of and in the course of her employment. 
 
            McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            1976); Musselman v. Central Telephone Co., 261 Iowa 352, 154 
 
            N.W.2d 128 (1967). 
 
            
 
                 The injury must both arise out of and be in the course 
 
            of the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 
 
            Iowa 402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 
 
            of the Iowa Report.  See also Sister Mary Benedict v. St. 
 
            Mary's Corp., 255 Iowa 847, 124 N.W.2d 548 (l963) and Hansen 
 
            v. State of Iowa, 249 Iowa 1147, 91 N.W.2d 555 (1958).
 
            
 
                 The words "out of" refer to the cause or source of the 
 
            injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63. 
 
            
 
                 The words "in the course of" refer to the time and 
 
            place and circumstances of the injury.  McClure v. Union 
 
            et al. Counties, 188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 
 
            402, 68 N.W.2d 63.
 
            
 
                 "An injury occurs in the course of the employment when 
 
            it is within the period of employment at a place the 
 
            employee may reasonably be, and while he is doing his work 
 
            or something incidental to it."  Cedar Rapids Comm. Sch. 
 
            Dist. v. Cady, 278 N.W.2d 298 (Iowa 1979), McClure, 188 
 
            N.W.2d 283; Musselman, 261 Iowa 352, 154 N.W.2d 128. 
 
            
 
                 Claimant's position with the center required her to 
 
            provide complete services to elderly patients, and required 
 
            her to perform heavy lifting and repetitive bending and 
 
            stooping.  Martha Kragel, the aide with whom claimant was 
 
            working on the alleged injury date testified at the hearing, 
 
            and stated that she does not recall that claimant sustained 
 
            an injury while performing rounds, especially while 
 
            assisting the particularly combative patient claimant 
 
            described.
 
            
 
                 The medical records, and the histories contained 
 
            therein, are consistent with claimant's rendition of how the 
 
            injury occurred.  In her testimony, claimant defined her 
 
            position as involving heavy lifting and this assessment is 
 
            supported by the nature of services provided by the Newell 
 
            Good Samaritan Center.  And, although there is some evidence 
 
            in the record which indicates claimant sought chiropractic 
 
            services for a low back pain in 1984, there is no indication 
 
            that she has sought extensive treatment to her back.
 
            
 
                 After considering all of the evidence, it is found that 
 
            claimant has proven by a preponderance of the evidence that 
 
            her injury arose out of and in the course of her employment.
 
            
 
                 The next issue to be addressed is whether there is a 
 
            causal relationship between the injury and claimant's 
 
            present disability.
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of April 18, 
 
            1987 is causally related to the disability on which she now 
 
            bases her claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 
            N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 296, 18 
 
            N.W.2d 607 (1945).  A possibility is insufficient; a 
 
            probability is necessary.  Burt v. John Deere Waterloo 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
            question of causal connection is essentially within the 
 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
            Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). 
 
            
 
                 However, expert medical evidence must be considered 
 
            with all other evidence introduced bearing on the causal 
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id. at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
            Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
            
 
                 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. Aase 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 v. All-American, Inc., 290 N.W.2d 
 
            348, 354 (Iowa 1980).
 
            
 
                 Claimant was initially treated by a chiropractor 
 
            following her injury.  Eventually, she was evaluated at the 
 
            Mayo Clinic in June of 1987.  As stated earlier, Dr. McManis 
 
            from the clinic indicated that claimant had sustained a disc 
 
            protrusion in her lumbar spine which had resolved.
 
            
 
                 Claimant began physical therapy under the guidance of 
 
            Dr. Nelson.  The records indicate that she was making some 
 
            improvements under December of 1987.
 
            
 
                 Defendants argue that claimant aggravated her condition 
 
            while moving in December of 1987.  The records indicate that 
 
            claimant herself blamed some weekend activities on a set 
 
            back she had which increased her pain over the lower 
 
            lumbosacral area which radiated into both buttocks.  (Jt. 
 
            Ex. 7, p. 7)  
 
            
 
                 It is not disputed that claimant and her family moved 
 
            residences in December of 1987.  The question becomes 
 
            whether claimant's activities during the move were a 
 
            intervening or supervening event which breaks the causal 
 
            chain between claimant's original injury, in April of 1987 
 
            and her current disability.
 
            
 
                 Daniel Regnier testified on behalf of claimant.  He 
 
            helped claimant and her family with the move in December of 
 
            1987.  He testified that he did not see the claimant lift 
 
            any heavy items, and that if she lifted anything at all it 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            was only smaller items.  He defined heavy lifting as the 
 
            furniture and appliances.  He indicated that other people 
 
            helping with the move were claimant's husband; claimant's 
 
            mother-in-law and father-in-law; Dan Walker; and, claimant's 
 
            daughters.
 
            
 
                 Claimant testified that in order to prepare for the 
 
            move, she did the packing and boxing of household items.  
 
            Claimant stated that after the April 18, 1987 incident at 
 
            work, she had never fully recovered from back pain, and was 
 
            still unable to work.  In fact, claimant was still off of 
 
            work during the December 1987 incident.
 
            
 
                 After reviewing all of the evidence, the undersigned 
 
            finds that it would be purely speculative to find that the 
 
            moving incident was of enough significance to break the 
 
            causal connection between claimant's injury at work and her 
 
            resulting disability.  As indicated, she had not been 
 
            released to return to work in the time frame in which she 
 
            was participating in physical therapy under Dr. Nelson's 
 
            reign.  Likewise, she had not been given any type of 
 
            restrictions related to any activities, she had not yet been 
 
            given an impairment rating, and she was still under a 
 
            healing period process.
 
            
 
                 The medical evidence indicates that Dr. Nelson 
 
            indicated that he was uncertain whether claimant was 
 
            reinjured during the move, during physical therapy, during 
 
            work, if she had a relapse or any other reason.  (Jt. Ex. 
 
            15, p. 12)  He did indicate that at the beginning of the 
 
            physical therapy program designed for claimant, he did not 
 
            believe that surgery would be necessary.  (Jt. Ex. 15, p. 
 
            13)  Dr. Nelson opined that it would be rare that claimant 
 
            would reinjure herself during physical therapy.  (Jt. Ex. 
 
            15, p. 15)
 
            
 
                 Dr. McManus, a physician with the Mayo Clinic in 
 
            Rochester, Minnesota, indicates that as a result of testing 
 
            performed at the clinic, claimant had a disc protrusion at 
 
            the L-4 and L-5 interspace which had resolved prior to the 
 
            myelogram.  He also indicated there had been a disc rupture 
 
            at the S-1, L-5 interspace which was asymptomatic.  (Jt. Ex. 
 
            17, p. 11)  He had released claimant to return to work in 
 
            the "near future" and had given claimant a 25 pound lifting 
 
            restriction.  (Jt. Ex. 17,    p. 13)
 
            
 
                 Dr. McManus had causally linked the rupture of the 
 
            lumbosacral disc to the injury of April 18, 1987.  (Jt. Ex. 
 
            17, p. 18; Jt. Ex. 5, p. 67)  Dr. McManus was unable to form 
 
            an opinion regarding the cause of the disc rupture at the 
 
            lumbosacral interspace.  (Jt. Ex. 17, p. 25)
 
            
 
                 After considering all of the evidence, it is found that 
 
            the testimony from Mr. Ragnier, claimant's testimony and the 
 
            uncertainty expressed by the doctors as to whether claimant 
 
            reinjured herself during the move, is sufficient to prove by 
 
            a preponderance of the evidence that claimant's injury was 
 
            the producing cause of her disability.
 
            
 
                 The next issue to be resolved is whether claimant 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            sustained a permanent partial disability.
 
            
 
                 Claimant's injury is to the back, and is defined as a 
 
            body as a whole injury.  Therefore, it is necessary to 
 
            analyze her 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, expe
 
            rience 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 disabil
 
            ity.  This is so as impairment and disability are not syn
 
            onymous.  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 dis
 
            ability 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 dis
 
            ability.  See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985); Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, l985).
 
            
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
                 Claimant was 39 years old at the time of her injury; an 
 
            age which places her in the peak years of her potential 
 
            earning capacity.  She holds an associate degree in nursing, 
 
            and has sought employment primarily in the nursing home 
 
            industry.
 
            
 
                 Claimant's medical condition prior to the injury was 
 
            unremarkable, although it has been acknowledged that she did 
 
            have some prior medical treatment to her spine prior to the 
 
            injury.  Immediately after the injury of April 18, 1987, 
 
            claimant had severe pain, and was under either a 
 
            chiropractor's or doctor's care for almost one year.  
 
            Eventually, she underwent surgery in the form of a 
 
            laminectomy.  Presently, claimant has an eight percent 
 
            functional impairment rating, and a 25 pound lifting 
 
            restriction.  She reached maximum medical recovery on May 
 
            18, 1988.
 
            
 
                 Claimant's work history has been focused in the nursing 
 
            home arena, although she has worked in several hospitals 
 
            prior to moving to Iowa in 1985.  Presently, claimant earns 
 
            more than $12.00 per hour, and works 45-50 hours per week.  
 
            She currently works as the Director of Nursing at the 
 
            Pocahontas Manor.  At the time of her injury, she was 
 
            earning $6.00 per hour, and working a 32 hour work week.  To 
 
            their credit, the defendant employer offered claimant a 
 
            position, but claimant was not interested in the job.  
 
            Claimant testified that she wants to return to an actual 
 
            nursing position, because she will be paid more.  
 
            
 
                 Claimant displayed good motivation to return to work.  
 
            At this juncture, she has sustained no loss of earnings.
 
            
 
                 After considering and evaluation all of the factors, it 
 
            is determined that claimant has sustained a 20 percent 
 
            industrial disability.  With the lifting restriction imposed 
 
            upon her by Dr. Durward, claimant will be unable to ever 
 
            return to a position as a nurse in a hospital.  However, she 
 
            has had limited work experience in a hospital, and has 
 
            focused primarily on taking care of elderly residents in 
 
            nursing homes.  The lifting restriction would also preclude 
 
            her from returning to this type of employment as well, and 
 
            she will be required to focus on jobs which require 
 
            administrative skills in the health care profession.
 
            
 
                 Claimant's current position appears secure, and it is 
 
            well-suited to her physical limitations.  It is recognized 
 
            that actual earnings are indicative of her capacity to earn 
 
            a living.
 
            
 
                                      order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay claimant permanent partial 
 
            disability benefits for one hundred (100) weeks at the rate 
 
            of one hundred ten and 19/100 dollars ($110.19) commencing 
 
            on May 18, 1988.
 
            
 
                 That defendants shall pay accrued amounts in a lump sum 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            and shall receive credit against the award for weekly 
 
            benefits previously paid.
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            
 
                 That due to the condition of the exhibits, each party 
 
            shall pay their own costs incurred.
 
            
 
                 That defendants shall file claim activity reports as 
 
            requested by the agency pursuant to rule 343 IAC 3.1(2).
 
            
 
                 Signed and filed this ____ day of July, 1991.
 
            
 
            
 
            
 
            
 
                                          
 
            ________________________________
 
                                          PATRICIA J. LANTZ
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr Steve Hamilton
 
            Attorney at Law
 
            606 Ontario 
 
            PO Box 188
 
            Storm Lake Iowa 50588
 
            
 
            Mr Peter J Leehey
 
            Attorney at Law
 
            801 Carver Building
 
            PO Box 1680
 
            Fort Dodge Iowa 50501
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      5-1803
 
                      Filed July 8, 1991
 
                      PATRICIA J. LANTZ
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            MARCELLA EATON,     :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 852585
 
            NEWELL GOOD SAMARITAN CENTER, :
 
                      :    A R B I T R A T I O N
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            LIBERTY MUTUAL INSURANCE :
 
            COMPANY,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            5-1803
 
            Claimant, 40 years old, associate degree in nursing, 
 
            sustained a compensable back injury.  She was given an eight 
 
            percent functional impairment rating, with no lifting of 
 
            more than 20 pounds. 
 
            The defendant employer offered suitable employment, which 
 
            she declined.  She secured an administrative position as 
 
            director of nursing in a healthcare facility.  At the time 
 
            of her injury, she was earning $6.00/hour; in her current 
 
            position, she earns $11.00/hour.
 
            Evaluation of all factors supported determination that 
 
            claimant suffered a 20 percent industrial disability.
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
          PETER K. HOLMES,
 
         
 
              Claimant,                  :
 
         
 
          VS.                            :            File No. 852700
 
         
 
         LANDMARK COMMUNITY PUBLISHING               A R B I T R A T I O 
 
         N
 
         CO.,
 
                                                         D E C I S I O N
 
              Employer,
 
         
 
          and
 
         
 
         MARYLAND CASUALTY COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration upon claimant's petition 
 
         filed October 8, 1987.  Claimant alleges that he injured a 
 
         cervical disc while employed with defendant Landmark Community 
 
         Publishing Company on April 13, 1987 and now seeks benefits under 
 
         the Iowa Workers, Compensation Act.  Landmark is insured by 
 
         Maryland Casualty Company.
 
         
 
              Hearing on the petition for arbitration was had in Council 
 
         Bluffs, Iowa, on June 28, 1989.  The record consisted of joint 
 
         exhibits A through M, inclusive, and the testimony of the 
 
         following witnesses: claimant, Iris Holmes, Joseph Ross, John 
 
         Schoen, Helen Anderson and Danny Edie.
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the prehearing report, the parties have 
 
         stipulated:   that an employment relationship existed between 
 
         claimant and employer at the time of the alleged injury; that if 
 
         claimant sustained permanent disability, it is an industrial 
 
         disability to the body as a whole; that the appropriate rate of 
 
         weekly compensation is  $165.09; that the fees charged for 
 
         medical services or supplies are fair and reasonable and incurred 
 
         for reasonable and necessary medical treatment; that defendants 
 
         are entitled to credit under Iowa Code section 85.38(2) in the 
 
         sum of $8,922.91.
 
         
 
         
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Page 2
 
         
 
         
 
              Issues presented for resolution include: whether claimant 
 
         sustained an injury on April 13, 1987, arising out of and in the 
 
         course of his employment; whether the injury caused temporary or 
 
         permanent disability and the extent thereof; whether claimant is 
 
         entitled to medical benefits under Iowa Code section 85.27; 
 
         taxation of costs.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              The deputy, having heard the testimony and considered all of 
 
         the evidence finds:
 
         
 
              Claimant was approximately 34 years of age at the time of 
 
         hearing and has completed the eleventh grade.  He has never 
 
         graduated from high school or obtained a General Equivalency 
 
         Diploma, but completed a course in business machinery repair at 
 
         Southwestern Community College and was still attending school at 
 
         the time of hearing.
 
         
 
              Claimant's work history includes restaurant work (ranging 
 
         from dishwasher to manager), farm work, warehouse work, 
 
         carpentry, substantial experience in the oil drilling industry, 
 
         truck driving, equipment operation and various work with regional 
 
         newspapers, particularly in printing.  Claimant has also been 
 
         self-employed, particularly in vacuum cleaner repair and odd 
 
         jobs.
 
         
 
              Prior to the work injury, claimant had at least a three-year 
 
         history of intermittent neck and shoulder pains.  He has received 
 
         treatment in the past, but x-rays found no cervical disc 
 
         injuries.  Claimant credibly testified that the subject work 
 
         injury occurred on Monday, April 13, 1987.  He was engaged in 
 
         positioning a heavy roll of paper on a press using a "cheater 
 
         pipe" to lower the roll and was being assisted by his supervisor, 
 
         Danny Edie.  The roll turned and fell, giving claimant a 
 
         substantial jolt.  Claimant felt a twinge in his neck and 
 
         originally attributed it to only a pulled muscle.  He offhandedly 
 
         commented on this to Edie, but Edie does not recall the 
 
         conversation.
 
         
 
              Claimant continued to work, although he did complain of 
 
         soreness to his wife, Iris Holmes, when he returned home that 
 
         evening.  Claimant continued to work the rest of the week, 
 
         although pain progressively increased.  On the following Sunday 
 
         morning, April 19, claimant awoke with severe pain and was seen 
 
         by his physician Harold Hanson, M.D., at the emergency room of 
 
         Montgomery County Memorial Hospital.
 
         
 
              Emergency room notes prepared by registered nurse Joyce 
 
         Figgins (who testified by deposition on October 13, 1988)
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 
         Page 3
 
         
 
         
 
         reflect that claimant had been bothered for one week: "Lifts wts 
 
         & started to hurt so stopped.  This am got up & couldn't move 
 
         head, neck & R shoulder."  Dr. Hanson's notes show that claimant 
 
         pushes 900-1,000 pound rolls of paper and questioned whether that 
 
         aggravated the shoulder, the problem having recurred off and on 
 
         for years.
 
         
 
              Dr. Hanson found claimant to have full range of motion of 
 
         the shoulder and neck, although pain and tenderness.  Claimant 
 
         had intact neurological sensation.  Dr. Hanson originally 
 
         diagnosed neck and shoulder pain with muscle spasm and treated 
 
         claimant with medication and physical therapy.
 
         
 
              After three days of physical therapy failed to relieve 
 
         claimant's symptoms, Dr. Hanson referred him to neurological 
 
         surgeon R. Schuyler Gooding, M.D. A myelogram disclosed that 
 
         claimant had suffered a disc herniation at C5-6 which was then 
 
         surgically treated with an anterior discectomy and interbody 
 
         fusion at that level on May 1, 1987.  Claimant was discharged on 
 
         May 8 with restrictions against any lifting or exercise and car 
 
         riding only when absolutely necessary.
 
         
 
              Dr. Gooding wrote on July 17, 1987 that claimant was still 
 
         convalescing, but had been markedly relieved of his discomfort.  
 
         In that letter, Dr. Gooding opined that claimant's injury was 
 
         much more likely to have occurred while doing heavy lifting at 
 
         work as claimant described than while lifting weights as a 
 
         hobbyist, since weight lifters lift with the neck in a neutral 
 
         posture and the heavy weights at work would likely place the neck 
 
         at an angled posture, which involved a greater risk of injury.
 
         
 
              Dr. Gooding also noted that he normally follows "these 
 
         people" for a minimum of six months following surgery and does 
 
         not permit them to return to any significant bending, lifting or 
 
         carrying before that date.  He felt that the normal impairment 
 
         rating of an individual with an injury of this type with 
 
         associated discectomy and fusion would be placed at 15 percent.  
 
         The record does not reflect that Dr. Gooding imposed permanent 
 
         physical restrictions.
 
         
 
              Claimant's testimony established that pain is now much 
 
         milder than prior to surgery.  However, any lifting does bother 
 
         him and activities such as mowing the lawn cause soreness.  
 
         Because of his pain, claimant does not believe he could perform 
 
         the same work as a pressman and could not return to his former 
 
         work in the oil fields.  Since the injury, claimant has mostly 
 
         occupied himself attending school.  He did work for one day as a 
 
         telemarketer, but found the posture painful to his neck and 
 
         failed to finish
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 
         Page 4
 
         
 
         
 
         the day.  He otherwise has been self-employed and has applied for 
 
         some jobs without success, failing even to get an interview.
 
         
 
              John Schoen is a former instructor of business machine 
 
         repair at Southwest Community College and taught claimant.  He 
 
         noted that claimant had lots of problems with his neck and back 
 
         while taking that course, even wearing a neck brace.  Claimant 
 
         was unable to lift at first (having a 25-pound weight limit) and 
 
         generally had trouble lifting.  He is of the view that lifting 
 
         problems interfere with his ability to perform this sort of work, 
 
         since lifting is generally required.
 
         
 
              Claimant finished his course in electronic business machine 
 
         repair in June or July, 1988.  He had excellent grades.  He is 
 
         now taking a two-year computer science course that should lead to 
 
         an associate of arts degree.  He began in fall, 1988 and seeks to 
 
         develop skills as a computer programmer.  claimant was doing well 
 
         in this course of study at the time of hearing.
 
         
 
              Defendants are of the view that claimant did not suffer a 
 
         work incident such as he described.  Danny Edie does not recall 
 
         claimant complaining of a twinge while loading a roll of paper 
 
         and noted that claimant did not allege he had sustained a work 
 
         injury even though he complained of pain and stated that he was 
 
         going to the doctor.  Helen Anderson noted that claimant 
 
         complained of a stiff neck on April 20, but did not allege a work 
 
         injury until April 30, at which time he had already been 
 
         furnished a health benefits claim form.  She further noted that 
 
         the employee handbook called for prompt written reports of all 
 
         claimed work injuries.
 
         
 
              Defendants also note that claimant has had neck problems in 
 
         the past, that he lifts weights as a hobbyist, and that in 
 
         particular he complained to one of Dr. Hanson's partners of sharp 
 
         shooting pain in the left arm going down to his hand and fingers 
 
         on January 14, 1987.  Claimant noted at that time that he gets a 
 
         lot of pain in the left side of his neck and muscles.
 
         
 
              On the other hand, Iris Holmes testified that claimant 
 
         complained of soreness when he returned from work on April 13.  
 
         Joseph Ross was a coworker who has himself lost work from a 
 
         muscle spasm and testified that claimant complained of the work 
 
         injury about a week after, following his visit to the doctor.  As 
 
         has been seen, Dr. Gooding was of the view that claimant's 
 
         herniated disc probably resulted from lifting at work.  Dr. 
 
         Hanson (who testified by deposition on October 19, 1988) did not 
 
         recall claimant complaining of any
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 
         Page 5
 
         
 
         
 
         specific incident or injury, but felt that if claimant had in 
 
         fact suffered a jolt a week before, given his complaints of 
 
         progressively increasing pain, there could be a causal 
 
         relationship.  He found nothing in his records that would 
 
         disagree with Dr. Gooding's opinion that the jolt caused the disc 
 
         herniation.
 
         
 
              There is nothing inherently unlikely about claimant's 
 
         version of events.  The evidence is consistent with a theory that 
 
         claimant sustained an injury on April 13, 1987, but failed to 
 
         immediately recognize that it was serious.  If he merely made an 
 
         offhand remark to Danny Edie, there is no particular reason for 
 
         Edie to have noted or remembered it.  It is found as fact that 
 
         claimant did sustain a work injury as he described on April 13, 
 
         1987.
 
         
 
              Joint exhibit B consists of numerous medical bills, all of 
 
         which appear to be causally related to the work injury, except 
 
         for a $50.00 charge from Dr. Gooding on July 22, 1987 for 
 
         preparation of a medical report.  This charge is more properly 
 
         assessed as court costs.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received an injury on April 13, 1987 which arose 
 
         out of and in the course of his employment.  McDowell v. Town of 
 
         Clarksville, 241 N.W.2d 904 (Iowa 1976); Musselman v. Central 
 
         Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              The injury must both arise out of and be in the course of 
 
         the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 
 
         402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 of the 
 
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
 
         255 Iowa 847, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 13, 1987 is causally 
 
         related to the disability on which he now bases his claim.  
 
         Bodish v. Fischer, Inc., '257 Iowa 516, 133 N.W.2d 867 (1965).  
 
         Lindahl v. L. O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The question of causal connection is essentially within 
 
         the domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).
 
         
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 
         Page 6
 
         
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone Co.
 
         , 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-61 
 
         (1956).  If the claimant had a preexisting condition or 
 
         disability that is aggravated, accelerated, worsened or lighted 
 
         up so that it results in disability, claimant is entitled to 
 
         recover.  Nicks v. Davenport Produce Co., 254 Iowa 130, 115 
 
         N.W.2d 812, 815 (1962).
 
         
 
              The fighting issue in this case is whether claimant actually 
 
         suffered a work incident as he describes on April 13, 1987, and 
 
         if so, whether his herniated cervical disc is causally related to 
 
         the incident or either his prior condition or some undisclosed 
 
         intervening cause, such as lifting weights.  In essence, 
 
         defendants directly attack claimant's credibility and that of his 
 
         wife, Iris Holmes.  Both were credible witnesses.  Claimant was 
 
         slow in recognizing the seriousness of his injury and slower yet 
 
         in making known to defendant that it was work related.  There is 
 
         certainly evidence to support the implication that claimant 
 
         manufactured this incident to wrongfully seek workers' 
 
         compensation benefits.  But, none of that evidence compels any 
 
         such conclusion.  It is held that claimant did sustain an injury 
 
         arising out of and in the course of his employment as he alleges.
 
         
 
              Dr. Gooding has opined as to the probability of a causal 
 
         relationship.  Dr. Hanson takes no issue with that conclusion.  
 
         There is no countervailing expert evidence.  Even though claimant 
 
         may have had a preexisting condition of some kind, no vertebral 
 
         defect had been diagnosed, even though claimant has had 
 
         symptomatology over the years.  But, even if some condition 
 
         preexisted the work injury, it has certainly been aggravated or 
 
         lighted up and is therefore compensable.  There is no indication 
 
         that claimant had
 
         
 
         
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Page 7
 
         
 
         
 
         preexisting industrial disability.  It is held that claimant has 
 
         established the necessary causal nexus between the work injury 
 
         and his current impairment.
 
         
 
              Under Iowa Code section 85.34(l), healing period is 
 
         compensable beginning on the date of injury and until the 
 
         employee has returned to work, it is medically indicated that 
 
         significant improvement from the injury is not anticipated, or 
 
         until the employee is medically capable of returning to 
 
         substantially similar employment, whichever first occurs.
 
         
 
              There is very sparse evidence in the record as to the extent 
 
         of claimant's healing period.  He did not return to work and does 
 
         not intend to.  The sole evidence as to the extent of healing 
 
         period is contained in Dr. Gooding's letter of June 17, 1987, 
 
         when claimant was still convalescent.  While Dr. Gooding would 
 
         "normally follow these people" for a minimum of six months 
 
         following surgery, it is unclear to what extent he followed this 
 
         person.  However, it appears that claimant's restrictions against 
 
         significant bending, lifting or carrying would extent to at least 
 
         that date, and Dr. Gooding believed that claimant if "normal" 
 
         would have a resultant 15 percent impairment to the body as a 
 
         whole.  It is held that the best evidence as to the extent of 
 
         healing period (since claimant had cervical fusion surgery, he 
 
         obviously had some healing period) is six months from the date of 
 
         surgery, or 26 weeks.  However, claimant.discontinued working 
 
         after April 24, when he worked 9.7 hours as shown on the time 
 
         card.  Therefore, claimant will also be awarded healing period 
 
         benefits from April 25 through May 1, 1987, the date of surgery.  
 
         This is an additional seven days.  Claimant shall be awarded 27 
 
         weeks of healing period benefits.
 
         
 
              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. .0lson 
 
         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
 
         
 
         
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         Page 8
 
         
 
         
 
         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).
 
         
 
              Dr. Gooding opined that persons recovering normally from 
 
         cervical fusion surgery at C5-6 would sustain a 15 percent 
 
         permanent impairment to the body as a whole.  While claimant was 
 
         not so rated individually, there is no indication in the record 
 
         that his 'recuperation was other than normal.  But, this does not 
 
         necessarily translate into industrial disability.  Claimant 
 
         was:31 at the time of his work injury and had only an eleventh 
 
         grade education.  While claimant has impressive subsequent 
 
         academic achievements, defendants did not finance or assist in 
 
         those achievements and are not entitled to credit.  However, 
 
         claimant obviously had the potential for educational success at 
 
         the time of his
 
         
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         HOLMES V. LANDMARK COMMUNITY PUBLISHING CO.
 
         Page 9
 
         
 
         
 
         work injury, so his previous lack of education is less disabling 
 
         than it might be in someone less capable.
 
         
 
              Even though claimant has an impairment, the record does not 
 
         reflect that he is currently subject to medically imposed 
 
         restrictions.  Self-imposed restrictions lack the imprimatur of 
 
         professional opinion and are notoriously subjective.  But 
 
         claimant no doubt suffers pain as he says, and by reason of that 
 
         pain is no doubt foreclosed from certain occupations which would 
 
         have formerly been suitable, such as heavy work in the oil fields 
 
         as a roustabout. it should also not be forgotten that claimant's 
 
         history of cervical fusion surgery is bound to make him a less 
 
         attractive potential employee in the eyes of at least some 
 
         prospective employers.  Note also that defendant employer has not 
 
         made an effort to keep claimant employed at a job within his 
 
         capabilities.
 
         
 
              Considering the record in general and these factors in 
 
         particular, it is held that claimant has sustained an industrial 
 
         disability of 15 percent of the body as a whole, or 75 weeks.  
 
         Commencement date of permanent disability benefits is October 30, 
 
         1987.  As the parties have stipulated to a benefit rate of 
 
         $165.09, claimant shall be allowed permanency benefits totalling 
 
         $12,381.75.
 
         
 
              Claimant shall also be awarded the medical expenses set 
 
         forth in joint exhibit B, except Dr. Gooding's July 22, 1987 
 
         charge of $50.00 for preparation of a medical report.  As 
 
         claimant has not been shown to have paid these expenses from his 
 
         own pocket, the suppliers shall be reimbursed directly.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Defendants are to pay claimant twenty-seven (27) weeks of 
 
         healing period benefits at the stipulated rate of one hundred 
 
         sixty-five and 09/100 dollars ($165.09) per week commencing April 
 
         25, 1987 and totalling four thousand four hundred fifty-seven and 
 
         43/100 dollars ($4,457.43).
 
         
 
              Defendants shall pay claimant seventy-five (75) weeks of 
 
         permanent partial disability at the stipulated rate of one 
 
         hundred sixty-five and 09/100 dollars ($165.09) per week 
 
         commencing October 30, 1987, and totalling twelve thousand three 
 
         hundred eighty-one and 75/100 dollars ($12,381.75).
 
         
 
              Defendants shall pay the medical bills set forth in joint 
 
         exhibit B with the exception of Dr. Gooding's medical report 
 
         charge of fifty dollars ($50.00).
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         HOLMES v. LANDMARK COMMUNITY PUBLISHING CO.
 
         Page 10
 
         
 
         
 
              As all weekly benefits have accrued, they shall be paid in a 
 
         lump sum together with statutory interest pursuant to Iowa Code 
 
         section 85.30.  Interest does not accrue on medical bills.
 
         
 
              Costs of this action shall be assessed to defendants 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              Defendants shall file claim activity reports as requested by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
              Signed and filed this 15th day of May, 1990.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                         DAVID RASEY
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. James C. Steffes
 
         Attorney at Law
 
         211 North Maple Street
 
         Creston, Iowa 50801
 
         
 
         Mr. Philip Willson
 
         Attorney at Law
 
         P.O. Box 249
 
         Council Bluffs, Iowa 51502
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                                         5-1402.30
 
                                         May 15, 1990
 
                                         DAVID RASEY
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
          PETER K. HOLMES,
 
         
 
                Claimant,
 
         
 
          VS. :
 
         
 
          LANDMARK COMMUNITY PUBLISHING               File No. 852700
 
          CO.,
 
                                                     A R B I T R A T I O 
 
         N
 
                Employer,
 
                                                          D E C I S I O N
 
          and
 
         
 
          MARYLAND CASUALTY COMPANY,
 
          
 
                Insurance Carrier,
 
                Defendants.
 
         
 
         
 
         
 
         5-1402.30
 
         
 
              Claimant established an injury arising out of and in the 
 
         course of employment, and was awarded 15 percent body as a whole 
 
         permanent disability.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         ROBERT SPARBEL,                            File No. 852922
 
         
 
              Claimant,                               DECISION ON
 
         
 
         VS.                                         SECOND INJURY
 
         
 
         SECOND INJURY FUND OF IOWA,                 FUND BENEFITS
 
         
 
              Defendant.                               F I L E D
 
         
 
                                                      JUN 29 1990
 
         
 
                                                  INDUSTRIAL SERVICES
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding for benefits under our Second Injury 
 
         Fund Act brought by the claimant Robert Sparbel against the 
 
         Second Injury Fund of Iowa to recover benefits on account of an 
 
         alleged first injury of June 3, 1984 and an alleged second injury 
 
         of March 24, 1987.  This matter came on for hearing before the 
 
         undersigned deputy industrial commissioner at Davenport, Iowa on 
 
         April 17, 1990.  The record in this proceeding consists of the 
 
         testimony of claimant as well as of joint exhibits 1 through 12 
 
         and 14 through 21.
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the prehearing report and the oral stipulations 
 
         of the parties at hearing, the parties stipulated that claimant's 
 
         rate of weekly compensation is $220.41 and that the commencement 
 
         date for any additional, permanent partial disability is May 17, 
 
         1988.
 
         
 
              Issues remaining to be decided are:
 
         
 
              1.  Whether claimant is entitled to benefits under our 
 
         Second Injury Fund Act;
 
         
 
              2.  Whether claimant did receive first and second injuries 
 
         arising out of and in the course of his employment;
 
         
 
              3.  Whether a causal relationship exists between claimant's 
 
         injury and claimed industrial disability as contemplated by the 
 
         Second Injury Fund Act; and,
 
         
 
              4.  The nature and extent of any entitlement to Second 
 
         Injury Fund benefits.
 
         
 
         Additionally, the Second Injury Fund asked for a proposed finding 
 
         on claimant's credibility.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                                 FINDINGS OF FACT
 
         
 
              The deputy having heard the testimony and considered the 
 
         evidence, finds:
 
         
 
              Claimant is 45 years old and has completed the tenth grade. 
 
         His hearing demeanor reflected that he has some difficulty 
 
         thinking abstractly.  He began work with Sivyer Steel Corporation 
 
         in February 1964 and worked there until March 25, 1988.  Claimant 
 
         has no schooling or training beyond high school and beyond that 
 
         received on the job.  Jobs at Sivyer Steel are paid on either a 
 
         day work or piece work basis.  On day work, an employee receives 
 
         a set per hour wage; on piece work, the employee is paid per a 
 
         production quota.  Sivyer was a union shop.  Employees bid for 
 
         higher paying jobs and for transfer and were subject to layoff by 
 
         seniority.  Claimant performed a variety of jobs during his 
 
         tenure at Sivyer including belt tripper, sand mixer, core room 
 
         mixer, mold maker, arc air welder, office janitor and carpenter 
 
         helper. Most jobs involved standing and some bending; some 
 
         required shoveling and the use of air hammers.
 
         
 
              As of September 6, 1984, claimant had been arc air welding 
 
         for approximately five years.  The arc air welder uses an 
 
         approximately one foot long holder to push metal off casting.  He 
 
         then uses a chip hammer to chip metal remnants from the casting. 
 
         The arc air welding holder is used three to five hours per day; 
 
         the chip hammer is used the balance of the day.
 
         
 
              As of September 1984, claimant had a loss of grip strength 
 
         in both hands.  Apparently [carpal tunnel] surgery was performed 
 
         on both wrists.  Claimant then returned to arc air welding.  He 
 
         had continued numbness and pain mostly in his left arm, although 
 
         it also was in his left elbow.  Richard R. Ripperger, M.D., who 
 
         had performed claimant's surgery, restricted claimant from 
 
         repetitive gripping motions or from the use of vibrating tools.  
 
         A November 23, 1987 report of Frank E. Miller, M.D., indicates 
 
         that claimant underwent carpal tunnel releases [apparently in 
 
         1985] and seemed to have a good result on the right side, but for 
 
         occasional hand numbness and path in the ulnar aspect of the left 
 
         forearm. Claimant subsequently underwent a left ulnar 
 
         transposition.  It did not seem to specifically improve his arm 
 
         symptoms, which have since mildly increased.  Claimant also had 
 
         numbness of the fifth finger of the left hand and numbness in the 
 
         fourth and fifth fingers of the right hand.  No EMG evidence of 
 
         radiculopathy or of any peripheral denervating process was found.  
 
         Nerve conduction studies were within normal limits.  There was no 
 
         indication of carpal tunnel entrapment or involvement of the 
 
         ulnar nerve at either the wrist or elbow.
 
         
 
              Claimant had been earning an average weekly wage of $520.00 
 
         as an arc air welder.  He then became an office janitor.  Office 
 
         janitor was a day work job and paid at an overall lower rate than 
 
         arc air welder.  Claimant subsequently bid for the job of pouring 
 
         floor chainer.  That job had an average weekly wage of $339.00.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              On March 24, 1987, claimant hit his left knee on a box.  Dr. 
 
         Ripperger performed arthroscopic surgery on June 9, 1987 and 
 
         found a degenerated medial meniscus with evidence of 
 
         chondromalacia.  Dr. Ripperger restricted claimant from ladder 
 
         climbing, squatting and prolonged standing.
 
         
 
              Claimant agreed that in October 1986 he had bumped his left 
 
         knee on a table at work.  He saw C. R. Fesenmeyer, M.D., for that 
 
         incident, but lost no time and had no surgery.  He did have 
 
         swelling and stiffness thereafter.
 
         
 
              Claimant sprained his left knee playing volleyball in 1977. 
 
         He did not have knee restrictions prior to March 24, 1987, 
 
         however.
 
         
 
              Dr. Ripperger has assigned claimant a three percent 
 
         impairment of the right upper extremity and a five percent 
 
         impairment of the left upper extremity, combining to a five 
 
         percent impairment of the whole person.  Dr. Ripperger has 
 
         assigned claimant a 15 percent impairment of the left lower 
 
         extremity corresponding to a 6 percent impairment of the whole 
 
         person.  On July 11, 1988, Dr. Ripperger opined:
 
         
 
              A 3% impairment rating of the right upper extremity and 5% 
 
              impairment rating of the left upper extremity combine to a 
 
              5% impairment of the whole man [sic].  That figure plus 15% 
 
              impairment of the left lower extremity combine to an 11% 
 
              impairment of the whole man [sic].  That impairment combined 
 
              with a 4% impairment of the whole man [sic] is equal to 16% 
 
              of the whole man [sic].
 
         
 
              On account of claimant's hand condition, Dr. Ripperger has 
 
         permanently restricted claimant from lifting over 40 pounds, from 
 
         lifting or gripping repetitively, and from using vibrating tools. 
 
         On account of claimant's leg condition, the doctor has 
 
         permanently restricted claimant from squatting, climbing, and 
 
         prolonged standing.
 
         
 
              Claimant subsequently began work as a carpenter's helper 
 
         earning $8.13 per hour on a day work basis.  Claimant left that 
 
         job on July 25, 1988 on account of a strike related work 
 
         stoppage. The strike subsequently resolved, but claimant was then 
 
         on layoff and has not been called back.
 
         
 
              Claimant has worked seasonally as a farm laborer earning 
 
         approximately $5.00 per hour since his Sivyer layoff.  Claimant 
 
         participated in the Job Partnership Training Act, training in 
 
         October 1988.  He was taught how to fill out applications, but 
 
         did not receive job assignments or referrals.  Claimant reported 
 
         that he has looked for work at approximately 100 industrial 
 
         plants since leaving Sivyer, but has received no job offers.  
 
         Claimant anticipated returning to farm work in May 1990.  
 
         Claimant reported he checks the Job Service job board every week 
 
         and denied that he has not had formal contact with Job Service 
 
         since November 1988.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant applied for work with Temp Associates during the 
 
         Sivyer strike.  In his Temp Associates' application, claimant 
 
         stated that his last earnings with Sivyer Steel were $11.50 per 
 
         hour.  His Job Service rate was $11.27 per hour.  Claimant also 
 
         reported that he was a high school graduate who had no physical 
 
         or health restrictions that would prevent his performing certain 
 
         jobs.  Claimant explained that he would have discussed his lack 
 
         of a high school diploma and his physical restrictions at his job 
 
         interview had he been called for one.  That explanation is found 
 
         credible and not outside the realm of normal behavior of 
 
         otherwise truthful and trustworthy individuals.  On the 
 
         application, claimant had circled print shop, assembly line, 
 
         inspection, inventory, painter, janitorial, machine operator, 
 
         truck driver and forklift driver as well as foundry as areas 
 
         where he had had three months or more work experience.  He had 
 
         indicated he could do medium to light weight work.  Claimant 
 
         applied at Temp Associates in an attempt to obtain part-time work 
 
         with earnings of no more than $150.00 per week during the Sivyer 
 
         strike while continuing to draw strike benefits.
 
         
 
              Claimant had a work injury in February 1986 wherein he 
 
         burned his back and arms while arc welding.  He was treated and 
 
         returned to work without restrictions subsequent to that 
 
         incident.  While he could perform his job after his work return, 
 
         he has had difficulty in excessively cold or warm environments 
 
         and has had tingling and itching subsequent to his burn incident.  
 
         Claimant can no longer run.without cracking and crunching in the 
 
         left knee; standing causes swelling in the knee.  He has quite a 
 
         bit of left knee pain in winter; the left knee "locks up."  He 
 
         takes Tylenol, but no prescribed medications for his knee 
 
         problems.  Claimant agreed that he no longer plays baseball or 
 
         bowls and attributed that to a combination of his left knee and 
 
         his age.
 
         
 
              Claimant agreed that he has not seen Dr. Ripperger for about 
 
         two years for either his hand or his knee conditions.  Claimant 
 
         agreed that the belt trip sander system is piece work and does 
 
         not involve vibrating equipment.  He denied that his transfer 
 
         from the arc welding job resulted from his burn injury and not 
 
         from his hand injury.  Claimant agreed he could work at the 
 
         salvage burner, but for the fact that it would require outdoor 
 
         work which would be difficult during cold or hot weather on 
 
         account of his burn injury.  The salvage welder job pays $9.72 
 
         per hour at a day rate. Arc welder pays $7.78 per hour at a piece 
 
         work rate, that being the base rate.
 
         
 
              A March 19, 1987 report of Frank E. Miller, M.D., relates 
 
         that claimant has a five percent total body "disability" based on 
 
         subjective symptoms from the burn injury.  He reports that 
 
         claimant should work where claimant is not exposed to excessive 
 
         heat or cold, but that, if claimant can work in his previous job 
 
         without significant symptoms which would decrease his functional 
 
         ability to work, he should return to it.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
                                CONCLUSIONS OF LAW
 
         
 
              Defendant has placed claimant's credibility at issue. 
 
         Claimant is found to have been a credible witness.  Claimant's 
 
         demeanor at hearing demonstrated an attempt to answer questions 
 
         truthfully and to explain himself as best he could, given obvious 
 
         limitations on his ability to be articulate and on his ability to 
 
         think abstractly.  While defendant makes much ado about 
 
         claimant's answers on his Temp Associates job application, the 
 
         answers to which defendant objects are not so outside the scope 
 
         of ordinary human behavior, that is, the tendency to portray 
 
         oneself in the best light possible in attempting to secure a job 
 
         interview, as to override the undersigned's general impression 
 
         that claimant is an individual professing a capacity for 
 
         truthfulness and personal integrity.
 
         
 
              We consider whether claimant has established injuries 
 
         arising out of and in the course of his employment.
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received injuries which arose out of and in the 
 
         course of his employment.  McDowell v. Town of Clarksville, 241 
 
         N.W.2d 904 (Iowa 1976); Musselman v. Central Telephone Co., 261 
 
         Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              The injury must both arise out of and be in the course of 
 
         the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 
 
         402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 of the 
 
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
 
         255 Iowa 847, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         
 
              The words "out of" refer to the cause or source of the 
 
         injury.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 402, 68 
 
         N.W.2d 63 (1955).
 
         
 
              The words "in the course of" refer to the time and place and 
 
         circumstances of the injury.  McClure v. Union et al. Counties, 
 
         188 N.W.2d 283 (Iowa 1971); Crowe v. DeSoto Consol. Sch. Dist., 
 
         246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 
              Claimant's credible testimony showed that he arc welded for 
 
         approximately five years and that such involved repetitive 
 
         movements in the upper extremities as are generally associated 
 
         with the development of carpal tunnel and ulnar nerve injuries. 
 
         From such, it is concluded that claimant has established a first 
 
         injury in September 1984 by way of his bilateral carpal tunnel 
 
         syndrome and left ulnar nerve condition.
 
         
 
              Likewise, it is undisputed that claimant hit his left knee 
 
         on a box in March 1987 and subsequently required arthroscopic 
 
         surgery in June 1987.  While claimant had had two prior left knee 
 
         incidents, one in 1986 and the other in 1987, neither of those 
 
         had been significant enough to result in lost work, surgery, or 
 
         restrictions.  Given that, it is concluded that claimant has 
 
         shown a second injury arising out of and in the course of his 
 
         employment by way of his left knee injury of March 1987.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The Second Injury Fund does not appear to dispute that 
 
         claimant sustained a burn injury to his back and arms in February 
 
         1986.  Claimant's credible testimony as well as the reports of 
 
         the doctors are sufficient to support a conclusion that that 
 
         incident also resulted in an injury to claimant which arose out 
 
         of and in the course of his employment.
 
         
 
              We next consider the causation question.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injuries are causally related to the 
 
         disability on which he now bases his claim.  Bodish v. Fischer, 
 
         Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  Lindahl v. L. O. 
 
         Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A possibility is 
 
         insufficient; a probability is necessary.  Burt v. John Deere 
 
         Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
         question of causal connection is essentially within the domain of 
 
         expert testimony.  Bradshaw v. Iowa Methodist Hospital, 251 Iowa 
 
         375, 101 N.W.2d 167 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              Medical reports of Dr. Ripperger, who performed claimant's 
 
         upper extremity procedures, and of Dr. Miller demonstrate that 
 
         claimant has permanent partial impairment and functional 
 
         restrictions on account of those conditions.  The Second Injury 
 
         Fund has offered no contrary evidence.  Therefore, it is 
 
         concluded that claimant has established causal relationship 
 
         between his September 1984 injury and claimed disability to his 
 
         upper extremities.  We note that permanent partial impairment 
 
         ratings given are to the upper extremities.  In the undersigned's 
 
         tenure as a deputy industrial commissioner, she has found it the 
 
         unusual case where a carpal tunnel syndrome produced permanent 
 
         partial impairment beyond the hand.  See section 17A.14(5).  
 
         Claimant has an ulnar nerve problem on the left.  That condition 
 
         would extend his impairment on the left into the arm.  No such 
 
         condition has been shown on the right, however.  On the other 
 
         hand, neither party has produced evidence demonstrating that 
 
         claimant's permanent partial impairment on the right is limited 
 
         to the hand only.  As claimant has the burden of showing 
 
         causation and nature and, extent of disability and as claimant 
 
         has not shown that permanent partial impairment on the right is 
 
         limited to the hand or provided an appropriate permanent partial 
 
         impairment rating for the right hand, the Second Injury Fund will 
 
         be given full credit against any finding of industrial disability 
 
         and as regards any deduction for a first injury as if claimant's 
 
         upper extremity condition extended into his arms bilaterally.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              As regards claimant's left knee condition, medical reports 
 
         of Dr. Ripperger support a 15 percent permanent partial 
 
         impairment of the leg as a result of claimant's March 1987 
 
         injury.  No contrary evidence has been presented.  While claimant 
 
         had previous incidents regarding the left knee, no evidence 
 
         supports a finding that these resulted in restrictions or other 
 
         evidence of a permanent condition.  Therefore, it is concluded 
 
         that claimant has established a causal relationship between his 
 
         left knee injury of March 1987 and current disability to the left 
 
         knee.
 
         
 
              We reach the question of whether claimant is entitled to 
 
         benefits under our Second Injury Fund Act, sections 85.63 through 
 
         85.69.  Before the Second Injury Fund is triggered, three 
 
         requirements must be met.  First, the employee must have lost or 
 
         lost the use of a hand, arm, foot, leg or eye.  Second, the 
 
         employee must sustain a loss or loss of use of another specified 
 
         member or organ through a compensable injury.  Third, permanent 
 
         disability must exist as to both the initial injury and the 
 
         second injury.  See Allen v. Second Injury Fund, 34 Biennial 
 
         Rep., Iowa Indus. Comm'r 15 (1980); Ross v. Servicemaster-Story 
 
         Co., 34 Biennial Rep., Iowa Industrial Comm'r 273 (1979).  The 
 
         Act exists to encourage the hiring of handicapped persons by 
 
         making the current employer responsible only for the amount of 
 
         disability related to an injury occurring under his employ as if 
 
         there were no preexisting disability.  See Anderson v. Second 
 
         Injury Fund, 262 N.W.2d 789, 791 (Iowa 1978); Lawyer and Higgs, 
 
         Iowa Workers' Compensation-Law and Practice, section 17-1.
 
         
 
              The Fund is responsible for the difference between total 
 
         disability and disability for which the employer at the time of 
 
         the second injury is responsible.  Section 85.64.  Second Injury 
 
         Fund v. Neelans, 436 N.W.2d 335 (Iowa 1989); Second Injury Fund 
 
         v. Mich. Coal Co., 274 N.W.2d .300 (Iowa 1970).
 
         
 
              The Second Injury Fund raises various arguments supporting 
 
         its assertion that claimant does not qualify for Second Injury 
 
         Fund benefits.  Generally, the commissioner has addressed most of 
 
         those arguments and rejected them at the appeal level.  See 
 
         Mockenhaupt v. George A. Hormel & Co., file numbers 767982, 
 
         847923, 847924 and 847925 (App. Decn., December 29, 1989); Pulju 
 
         v. IBP, Inc., file numbers 804656 and 814502 (App. Decn., July 
 
         24, 1989).  We will discuss the Fund's argument that a total loss 
 
         of use is required prior to entitlement to Second Injury Fund 
 
         benefits, however.
 
         
 
              While neither Mockenhaupt nor Pulju expressly address that 
 
         argument, rejection of the argument is consistent with those 
 
         decisions and is consistent with established law.  Construing 
 
         section 85.64 to require a total loss of a member or a total loss 
 
         of use of a member prior to second injury fund entitlement 
 
         produces results in statutory construction wholly inconsistent 
 
         with those achieved under section 85.34(2) where the phrase "loss 
 
         of" also appears.  Had the legislature intended that section 
 
         85.64 be construed differently than section 85.34, it could have 
 
         produced that result by expressly placing the word "total" in 
 
         section 85.64 as a modifier to the phrase "loss of" and the 
 
         phrase "loss of use."  The legislature's failure to do so 
 
         evidences a legislative intent that section 85.64 permit benefits 
 
         under the Second Injury Fund Act where claimant has a loss of 
 
         use, but not a total loss of use, of a member specified in the 
 
         Act.  Claimant has established a first injury by way of his loss 
 
         of use of his right and left upper extremities.  We note that 
 
         that loss of use relates primarily to his bilateral carpal tunnel 
 
         syndrome and his left ulnar nerve syndrome, but also relates to 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         his burn injury to his arms and back for which he received a five 
 
         percent permanent partial impairment.  Claimant has shown a 
 
         second injury producing loss of use of his left leg.  Therefore, 
 
         it is concluded that, pursuant to section 85.64, claimant has 
 
         established entitlement to Second Injury Fund benefits.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              We now reach the question of extent of claimant's Second 
 
         Injury Fund benefit entitlement.  Initially, we reject the Second 
 
         Injury Fund's argument that the Fund has no liability where the 
 
         second injury produces only a scheduled member liability as 
 
         against the employer.  That argument is contrary to the Iowa 
 
         Supreme Court's holding in Second Injury Fund v. Neelans, 436 
 
         N.W.2d 335 (Iowa 1989).
 
         
 
              Likewise, the Second Injury Fund's argument that the Fund is 
 
         not liable where the same employer provided work which caused 
 
         both injuries is rejected.  Retention of the once-injured worker 
 
         following his injury is a recognized social policy underlying our 
 
         workers' compensation act.  That policy is more consistent with 
 
         the original legislative intent underlying the Second Injury 
 
         Fund,Act, that is, providing a more favorable climate for the 
 
         employment of persons injured through service or encouraging 
 
         employment of handicapped workers, than is a policy which limits 
 
         Second Injury Fund benefits to only those individuals who 
 
         received their second injury with an employer other than the 
 
         employer is whose employ they received the first injury.
 
         
 
              We reach the question of claimant's industrial disability as 
 
         a result of his multiple conditions and restrictions.
 
         
 
              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).
 
         
 
              Claimant is 45 years old.  He has only a tenth grade 
 
         education and minimal skills.  Claimant is restricted from 
 
         working in extremes of temperature, from repetitively lifting or 
 
         gripping, from using vibrating tools, and from squatting, 
 
         climbing and prolonged standing.  Each of those restrictions 
 
         substantially impacts on claimant's ability to perform the heavy 
 
         manual labor or manufacturing trades by which he has earned his 
 
         livelihood throughout his work life.  That fact is demonstrated 
 
         by the fact that claimant required job transfers from his 
 
         employer after his bilateral arm injury and after his left leg 
 
         injury.  The transfer after the bilateral arm injury resulted in 
 
         a substantial decrease in wages.  The transfer after the leg 
 
         injury did not impact so significantly on claimant's then-current 
 
         wage as such was already substantially lower than the wage he had 
 
         been earning at the time of his arm injury, but did reflect that 
 
         the jobs claimant was actually capable of doing in the labor 
 
         market had further decreased.  Likewise, while claimant's burn 
 
         injury did not affect a change of duties at Sivyer Steel, it did 
 
         affect claimant's overall job mobility as claimant can no longer 
 
         work in extremes of climate.  Indeed, claimant testified at 
 
         hearing that the burn injury would prevent his return to at least 
 
         one position he had previously held at Sivyer Steel.  Claimant 
 
         has been laid off at Sivyer Steel for reasons not related to his 
 
         injuries.  Claimant appears well motivated to work and has made 
 
         reasonable efforts to find other employment, given his limited 
 
         physical abilities, experience and education.  He has found only 
 
         part-time farm work. That fact, when coupled with claimant's 
 
         numerous limitations recited above, reflects a substantial actual 
 
         loss of earnings for claimant on account of his multiple 
 
         conditions.  It is concluded that claimant has shown an actual 
 
         loss of earning capacity of 50 percent on account of his multiple 
 
         conditions.
 
         
 
              We ascertain the Second Injury Fund's liability by deducting 
 
         claimant's scheduled loss from his first bilateral arm injury, 
 
         his scheduled loss from his left leg injury, and his industrial 
 
         loss from his burn injury from claimant's overall actual loss of 
 
         earning capacity.  Second injury Fund v. Neelans, 436 N.W.2d 335 
 
         (Iowa 1989); Second Injury Fund v. Mich. Coal Co., 274 N.W.2d 300 
 
         (Iowa 1979).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant's scheduled loss for his first injury is assessed 
 
         pursuant to section 85.34(2)(s).  Simbro v. Delong's Sportswear, 
 
         332 N.W.2d 886 (Iowa 1983); Shank v. Mercy Hosp. Medical Center, 
 
         file number 719627 (App. Decn., August 28, 1989).  Under the 
 
         combined values chart of the Third Edition of the Guides to the 
 
         Evaluation of Permanent Impairment, three percent of the right 
 
         arm equals two percent of the body as a whole.  Five percent of 
 
         the left arm equals three percent of the body as a whole.  Three 
 
         percent of the body as a whole and two percent of the body as a 
 
         whole equals five percent of the body as a whole.  That result is 
 
         also consistent with Dr. Ripperger's finding of July 11, 1988. 
 
         Five percent of the body as a whole equals 25 benefit weeks.
 
         
 
              Claimant's scheduled loss of the left leg is assessed 
 
         pursuant to section 85.34(2)(o).  Dr. Ripperger has found that 
 
         claimant has a loss of 15 percent of the left leg.  Under the 
 
         cited section, that entitles claimant to 33 benefit weeks.
 
         
 
              Claimant sustained his burn injury subsequent to his 
 
         bilateral upper extremity injury and prior to his knee injury.  
 
         The burn injury involved a loss of use of members (arms) under 
 
         section 85.64, but also resulted in a five percent permanent 
 
         partial impairment to the body as a whole.  Hence, the burn 
 
         injury must be rated industrially.  Second Injury Fund v. Mich. 
 
         Coal Co., supra. As noted above, claimant could return to his 
 
         same job at Sivyer Steel after the burn injury, but the burn 
 
         injury limits his ability to work in excessively cold or warm 
 
         environments.  Even without claimant's other conditions, that 
 
         restriction would produce an actual loss of earning capacity for 
 
         an individual of claimant's limited education, experience and 
 
         abilities.  That actual loss of earnings is found to equate to an 
 
         industrial loss of seven percent or an entitlement to 35 weeks of 
 
         permanent partial disability benefits.
 
         
 
              Claimant's Second Injury Fund benefit can now be calculated 
 
         arithmetically.  Claimant's total industrial disability of 50 
 
         percent equals 250 weeks.  Two hundred fifty weeks minus 25 
 
         weeks, minus 33 weeks,.minus 35 weeks equals 157 weeks of 
 
         benefits remaining.  The Second Injury Fund is liable for those 
 
         157 weeks.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              The Second Injury Fund of Iowa pay claimant one hundred 
 
         fifty-seven (157) weeks of Second Injury Fund benefits at the 
 
         rate of two hundred twenty and 41/100 dollars ($220.41) per week 
 
         payable commencing May 17, 1988.
 
         
 
              The Second Injury Fund of Iowa pay all accrued amounts in a 
 
         lump sum.
 
         
 
              The Second Injury Fund of Iowa pay costs of this action 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The Second Injury Fund of Iowa file claim activity reports 
 
         with this agency as the statute may require pursuant to Division 
 
         of Industrial Services Rule 343-3.1.
 
         
 
              Signed and filed this 29th day of June, 1990.
 
              
 
         
 
         
 
         
 
         
 
                                            HELENJEAN WALLESER
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. John H. Westensee
 
         Attorney at Law
 
         1705 2nd Avenue
 
         P.O. Box 4270
 
         Rock Island, Illinois  61201
 
         
 
         Mr. Robert D. Wilson
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Building
 
         Des Moines, Iowa  50319
 
         
 
         Mr. E. J. Giovannetti
 
         Ms. Valerie A. Fandel
 
         Attorneys at Law
 
         Suite 111, Terrace Center
 
         2700 Grand Avenue
 
         Des Moines, Iowa  50312
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
                                            
 
 
 
 
 
 
 
 
 
 
 
                                            3201
 
                                            Filed June 29, 1990
 
                                            HELENJEAN WALLESER
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         ROBERT SPARBEL,                          File No. 852922
 
         
 
              Claimant,                             DECISION ON
 
         
 
         vs.                                       SECOND INJURY
 
         
 
         SECOND INJURY FUND OF IOWA,               FUND BENEFITS
 
         
 
              Defendant.
 
         
 
         
 
         3201
 
         
 
              Where claimant's condition of bilateral carpal tunnel 
 
         syndrome and left ulnar nerve condition was assessed as a 
 
         permanent partial impairment to the upper extremity and claimant 
 
         presented no evidence indicating that the impairment on the right 
 
         related to the hand only, Second Injury Fund was given credit for 
 
         full impairment of the upper extremities.  Claimant has the 
 
         burden of proving the nature and extent of disability and 
 
         claimant had not met claimant's burden.  The Second Injury Fund, 
 
         therefore, received the benefit of any difference between actual 
 
         disability and assigned impairment.
 
         
 
              Where claimant had a first injury involving bilateral carpal 
 
         tunnel and left ulnar nerve condition and a subsequent injury 
 
         involving burns to his trunk and his arms and a final injury to 
 
         his left knee, claimant qualified for Second Injury Fund 
 
         benefits. Under Neelans, the bilateral carpal tunnel and the left 
 
         ulnar nerve condition were subtracted from total industrial 
 
         disability after the left knee injury.  Under Mich. Coal, 
 
         industrial disability was assessed as far as the burn injury and 
 
         since the burn injury also involved scheduled members, that 
 
         industrial disability was also subtracted from the industrial 
 
         disability subsequent to the knee injury.  Second Injury Fund 
 
         liability was determined arithmetically by subtracting from the 
 
         total industrial disability subsequent to the knee injury the 
 
         scheduled benefit weeks for the bilateral carpal tunnel and left 
 
         ulnar nerve condition and the industrial weeks for the burn 
 
         injury as well as the scheduled weeks for the left knee 
 
         condition.