Page   1
 
            
 
            
 
            
 
            
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            BOBBY JONES,                  :
 
                                          :
 
                 Claimant,                :      File No. 865970
 
                                          :
 
            vs.                           :        A P P E A L
 
                                          :
 
            GEORGE A. HORMEL & CO.,       :      D E C I S I O N
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ___________________________________________________________
 
            The record, including the transcript of the hearing before 
 
            the deputy and all exhibits admitted into the record, has 
 
            been reviewed de novo on appeal.
 
            The decision of the deputy is affirmed and is adopted as the 
 
            final agency action in this case.
 
            In addition, the following analysis is made:
 
            Defendant alleges on appeal that claimant has failed to 
 
            carry his burden to show that his present carpal tunnel 
 
            syndrome is causally connected to his work.  Defendant 
 
            correctly points out that although lay testimony can 
 
            supplement expert testimony on the question of causal 
 
            connection, it cannot serve as a substitute for a complete 
 
            lack of expert testimony establishing causation.  However, 
 
            read as a whole, the medical evidence appears to attribute 
 
            claimant's present carpal tunnel syndrome to his work 
 
            environment.  In particular, claimant's exhibit 5, a report 
 
            by March E. Hines, M.D., states:
 
            
 
                    Bobby...began fatting hams around 1978 or 1979 
 
                 and began having hand numbness bilaterally in 
 
                 1979.  After he changed to shanking (open boning 
 
                 of hams), he had much less difficulty, although he 
 
                 had continued difficulties despite this.  He was 
 
                 off approximately three months but had no numbness 
 
                 and went back to racking and clipping hams 
 
                 approximately five weeks ago and began developing 
 
                 pain in the right palm with numbness in the median 
 
                 distribution.  This particular job required him to 
 
                 push a press with his right palm of his hand 
 
                 repeatedly.
 
            Although the record lacks an explicit statement of causal 
 
            connection, the medical reports do address claimant's carpal 
 
            tunnel syndrome as a problem stemming from claimant's work.  
 
            Claimant has carried his burden to show that his carpal 
 
            tunnel syndrome is caused by his work conditions. 
 
            Signed and filed this ____ day of April, 1990.
 
            
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                             DAVID E. LINQUIST
 
                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Stephen D. Lombardi
 
            Attorney at Law
 
            2190 N.W. 82nd St.
 
            Des Moines, Iowa 50322
 
            
 
            Mr. Richard R. Schlegel, II
 
            Attorney at Law
 
            105 1/2 North Market St.
 
            Ottumwa, Iowa 52501
 
            
 
            Mr. Stephen W. Spencer
 
            Attorney at Law
 
            P.O. Box 9130
 
            Des Moines, Iowa 50306-9130
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                          5-9999
 
                                          Filed April 19, 1990
 
                                          DAVID E. LINQUIST
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            BOBBY JONES,                  :
 
                                          :
 
                 Claimant,                :      File No. 865970
 
                                          :
 
            vs.                           :        A P P E A L
 
                                          :
 
            GEORGE A. HORMEL & CO.,       :      D E C I S I O N
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            5-9999
 
            
 
            Deputy's decision summarily affirmed on appeal, with only 
 
            minor additional analysis.
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         BOBBY JONES,                              File No. 865970
 
         
 
              Claimant                          A R B I T R A T I O N
 
         
 
         vs.                                       D E C I S I O N
 
         
 
         GEORGE A. HORMEL & CO.,                      F I L E D
 
         
 
              Employer,                              NOV 30 1989
 
              Self-Insured,
 
              Defendant.                         INDUSTRIAL SERVICES
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              The is a proceeding in arbitration brought by Bobby Jones, 
 
         claimant, against George A. Hormel & Company, employer and 
 
         self-insured, defendant for benefits as the result of an alleged 
 
         injury which occurred on March 27, 1987.  A hearing was held in 
 
         Ottumwa, Iowa, on October 5, 1989, and the case was fully 
 
         submitted at the close of the hearing.  Claimant was represented 
 
         by Stephen D. Lombardi.  Defendant was represented by Stephen W. 
 
         Spencer.  The record consists of the testimony of Bobby Jones, 
 
         claimant; Sheri Jones, claimant's wife; joint exhibits 3 through 
 
         12, joint exhibit 17 and defendant's exhibits A and B.  Defendant 
 
         objected to joint exhibits 13 and 16 because they were not timely 
 
         served.  Defense counsel said he had not seen them until the date 
 
         of the hearing. Claimant's counsel admitted that he first 
 
         acquired them on the date of the hearing.  Therefore, claimant's 
 
         exhibits 13 and 16 were excluded from evidence in this case.  The 
 
         exhibits do remain with the record as an offer of proof as 
 
         requested by claimant's counsel.  Claimant's counsel then 
 
         requested a continuance.  This request was denied by Deputy 
 
         Industrial Commissioner Helenjean Walleser.  The hearing deputy 
 
         ordered a transcript of hearing. Both attorneys submitted 
 
         excellent briefs.
 
         
 
                               STIPULATIONS
 
         
 
              The parties stipulated to the following matters:
 
         
 
              That an employer-employee relationship existed between 
 
         claimant and employer at the time of the alleged injury.
 
         
 
              That the extent of entitlement to weekly compensation for 
 
         temporary disability, if defendant is found liable for the 
 
         injury, is from April 24, 1987 to June 21, 1987.
 
         
 
              That the commencement date for permanent partial disability 
 
         benefits, in the event of such benefits are awarded, is June 21, 
 
         1987.
 
         
 
                                                
 
                                                         
 
              That the rate of compensation, in the event of an award of 
 
         benefits, is $257.22 per week.
 
         
 
              That the providers of medical services and supplies would 
 
         testify that the fees charged were reasonable and that the 
 
         treatment was reasonable and necessary for the alleged work 
 
         injury and defendant is not offering contrary evidence.
 
         
 
              That the causal connection of the expenses to treatment for 
 
         a medical condition upon which claimant is now basing his claim 
 
         is admitted, but that the causal connection of this condition to 
 
         a work injury remains as issue to be decided by this decision.
 
         
 
              That defendant makes no claim for credit for benefits paid 
 
         pursuant to an employee nonoccupational group health plan prior 
 
         to hearing.
 
         
 
              That defendant has paid 18.5 weeks of workers' compensation 
 
         benefits at the rate of $254.35 per week to claimant prior to 
 
         hearing.
 
         
 
              That there are no bifurcated claims.
 
         
 
              Whether defendant is entitled to a credit under Iowa Code 
 
         section 85.38(2), which was shown as an issue on the hearing 
 
         assignment order, was withdrawn as a hearing issue by defendant's 
 
         counsel at the time of the hearing.
 
         
 
                                   ISSUES
 
         
 
              The parties submitted the following issues for determination 
 
         at the time of the hearing:
 
         
 
              Whether claimant sustained an injury on March 27, 1987, 
 
         which arose out of and in the course of employment with 
 
         employer.
 
         
 
              Whether the injury was the cause of temporary or permanent 
 
         disability.
 
         
 
              Whether claimant is entitled to permanent disability 
 
         benefits.
 
         
 
              Whether claimant is entitled to an examination pursuant to 
 
         Iowa Code section 85.39.
 
         
 
                           SUMMARY OF THE EVIDENCE
 
         
 
              Claimant, born April 25, 1956, was 33 years old at the time 
 
         of the hearing.  He is married and has two dependant children.  
 
         He started to work for employer on August 28, 1978 and worked for 
 
         employer for a period of 9 years, until the plant closed on 
 
         August 19, 1987.  Claimant started in packaging taking the fat 
 
         off hams, (fatting hams) with a Whizzard knife, an air powered, 
 
         circular movement knife.  He worked up to ham boning and 
 
                                                
 
                                                         
 
         performed this job beginning in approximately 1980 for 
 
         approximately 5 or 6 years.
 
         
 
              Claimant demonstrated the numerous and extensive movements 
 
         of the hands, arms and wrists required to perform this job.  He 
 
         used his left arm and hand to grab the ham, spin it around, place 
 
         it in position, steady it, turn it extensively, and to eventually 
 
         throw the finished product of ham and bones to where they should 
 
         go.  He used a straight knife in the right hand to perform a 
 
         rather diverse movement to cut a knuckle, cut into the ham, cut 
 
         around the bone, cut three bones, slicing three different ways, 
 
         clean out the center and clean off the bone.  He had to bend the 
 
         bone so he could break through the cartilage and tendons.  These 
 
         movements required almost full extension and flexion of both the 
 
         right and left wrists.  He was required to debone (shank) 93 hams 
 
         per hour, eight to nine and one-half hours per day, five or six 
 
         days a week, and he did this for five or six years.
 
         
 
              Claimant also threw hams for six months in early 1987.  This 
 
         procedure involved bending over into a five foot deep vat and 
 
         hooking hams with a metal hook and putting them on the table to 
 
         be deboned.  He did this with both hands alternately.  For 
 
         occasional short periods claimant boned loins and trimmed hams.
 
         
 
              Claimant said that he developed shooting pains and 
 
         discomfort in his hands and they began going to sleep.  Claimant 
 
         testified that he first had trouble with both his right and left 
 
         upper extremities once in a while about two years prior to his 
 
         surgery. On these occasions employer would take him off the job 
 
         for a day. About six months prior to the surgery it began 
 
         bothering him to where he could not do the job and he started 
 
         going to the nurse frequently.
 
         
 
              Right carpal tunnel surgery was performed on May 7, 1987 by 
 
         Winn H. Gregory, M.D., a general surgeon (transcript 51).  The 
 
         company nurses taped both of his arms up to the middle of his 
 
         arms 50, 60 or 70 times for two years prior to the surgery.  
 
         Eventually he had numbness at home at night as well as at work 
 
         during the day.  Shooting pains, like he was stuck with a knife, 
 
         like a shock, ran up to his elbow and up his arm.  He lost 
 
         dexterity.  He had trouble hanging onto.his knife.  The knife 
 
         would fly out of his hands because he didn't realize how much 
 
         grip he had on it. Mostly, he had numbness and loss of feeling.  
 
         He would wake up at night and his hands would be asleep and 
 
         eventually began aching. If he grasped the steering wheel of his 
 
         car his hands would go to sleep.  He lost strength.  Sometimes 
 
         there was swelling.  Claimant said he experienced these symptoms 
 
         in both of his hands, wrists and arms (tr. pp 43-47).
 
         
 
              Claimant said the company sent him to see Marc E. Hines, 
 
         M.D., and Winn H. Gregory, M.D.  Claimant said he took an 
 
         anti-inflammatory pill prescribed by a company doctor until he 
 
         developed stomach pains and he was told to quit taking them 
 
         because they were beginning to eat his stomach.  The company 
 
         doctor took him off work sometimes and other times prescribed 
 
                                                
 
                                                         
 
         light duty with not too much use of the hands.  Claimant agreed 
 
         that he was off work from April 23, 1987 to June 21, 1987 because 
 
         of the right carpal tunnel surgery on May 7, 1987 (tr. pp. 49 & 
 
         50).  Claimant understood that carpal tunnel surgery was not done 
 
         on the left at the same time as the right because if both hands 
 
         were disabled at the same time he could not get dressed or do 
 
         other things.  Also, the doctor wanted to see the results of the 
 
         surgery on the right before doing the left (tr. pp. 52 & 53). 
 
         Carpal tunnel surgery was never performed on the left hand, wrist 
 
         or arm (tr. p. 74).
 
         
 
              Claimant demonstrated and described the scar on his right 
 
         hand, arm and wrist.  It started an inch above his wrist, then 
 
         crosses the wrist into the hand (tr. p. 57).
 
         
 
              Immediately after claimant returned to work he was pushing 
 
         on a 1,500 pound vat, had severe pain, saw the nurse and was told 
 
         he tore the scar tissue or something inside of his hand.  He was 
 
         given more time off to heal up before he was brought back to work 
 
         again (tr. p. 58).
 
         
 
              Claimant said that he never did return to the job of ham 
 
         boner, but rather he was put on a lighter job tumbling hams, 
 
         mostly pushing buttons.  He related that after the surgery he did 
 
         not feel he could bone hams; however, employer told him to try 
 
 
 
                           
 
                                                         
 
         it, but he was never given a chance to try it.  Later, claimant 
 
         was told by employer that his job was done away with.  Later, he 
 
         was told in the office, with his wife present, that he would 
 
         never be able to do that job again (tr. pp. 54 & 55).
 
         
 
              Claimant said he still experiences pain, night pain, 
 
         numbness, weak grip, loss of dexterity and judgment on how tight 
 
         to grasp things with his left hand, wrist and arm so he wouldn't 
 
         drop them.  He has similar problems in his right hand, wrist, and 
 
         arm.  He has lost discrimination for small components on his 
 
         present job (tr. pp. 59-62).  Claimant said he experiences 
 
         numbness holding the steering wheel of a car, a wand at a car 
 
         wash or when waxing a car, which can lead to a cramping sensation 
 
         and pain.  It is difficult to use a screwdriver.  He cannot open 
 
         a jar or do a lot of things he used to do.
 
         
 
              In addition to the nurses taping his hands, wrists and arms, 
 
         claimant was prescribed wrist braces by employer's medical 
 
         personnel that he wore both at work and at home.  Also, just 
 
         before the plant closed in August, the company asked him to 
 
         consent to vibratory shock therapy for both of his wrists and 
 
         claimant agreed to this and received these treatments.  (tr. p. 
 
         61).
 
         
 
              Claimant testified that he personally paid Dr. Hines $549 
 
         for an independent medical examination.  He said Dr. Gregory had 
 
         already issued a report on permanency at that time.  Claimant 
 
         said that no one from the company had ever disputed that his 
 
         right hand was caused by work (tr. pp. 64 & 65).
 
         
 
              Claimant acknowledged that he engaged in sports while he 
 
         worked at employer and he has begun to play league softball 
 
         again. He played eight games last year.  He pitches and bats 
 
         right handed.  He also bowled and played basketball a little 
 
         before the hand problems arose.  He admitted that he broke a 
 
         finger once and sprained a thumb once (tr. p. 79).
 
         
 
              Sheri Jones, claimant's wife, testified that claimant was 
 
         complaining of pain in the hand, wrist and arm when she began 
 
         dating him in the summer of 1985.  He complained about the right 
 
         hand the most, but the left hand was involved too, from 
 
         overcompensating with his left hand for use of his right hand.  
 
         The pain radiated all the way up the arm to the elbow.  She saw 
 
         the tape marks where his hands, wrists and arms were taped from 
 
         his hands to the middle of his arms when he came home from work.  
 
         Most of the time it had been taped on the right, but a lot of 
 
         times it was both arms (tr. pp. 83-85).  She said it is difficult 
 
         for him to hold a pencil and take notes, open a jar, throw a 
 
         frisbee or throw a football.  If he plays baseball or sports he 
 
         pays for it later. He has pain in both hands, wrists and arms.  He 
 
         lays at night with heating pads on them.  He sleeps with wrists 
 
         braces on both hands every night all the way from his hands up to 
 
         his forearms.  After the eight games of league softball last year, 
 
         claimant paid the price afterward with pain, swelling and aching.  
 
         She regretted that he could no longer rub her back (tr. pp. 
 
                                                
 
                                                         
 
         85-88).
 
         
 
              Employer 's first aid or health record on claimant, although 
 
         much of it is unreadable, does establish that claimant was 
 
         treated by employer's medical facility for both left and right 
 
         arm complaints prior to the injury date of March 27, 1987 
 
         (exhibit 3).
 
         
 
              Employer authorized claimant to see both Dr. Hines and Dr. 
 
         Gregory and those are the only two doctors who treated claimant. 
 
         After Dr. Hines diagnosed claimant with right carpal tunnel 
 
         syndrome, he returned claimant to Dr. Gregory, but returned him 
 
         to light duty with instruction to "Minimize right hand work".  
 
         (ex. 4).
 
         
 
              Dr. Hines first saw claimant on April 14, 1987.  He stated 
 
         in the first sentence of his report the claimant, "...began 
 
         fatting hams around 1978 or 1979 and began having hand numbness 
 
         bilaterally in 1979."  Dr. Hines then stated he was changed to 
 
         shanking, had much less difficulty, but continued to have 
 
         difficulties despite this.  The doctor then related that claimant 
 
         had not had problems while he was off for three months, but when 
 
         he went back to work racking and clipping hams, he began 
 
         developing pain in the right palm with numbness in the median 
 
         distribution.  The doctor stated, "This particular job required 
 
         him to push a press with his right palm of his hand repeatedly." 
 
         His job was changed again to using a hose with the right hand 
 
         which resulted in only occasional difficulties, but he 
 
         encountered increased difficulties with pain in his right hand 
 
         while driving and numbness at night.  Dr. Hines concluded, "This 
 
         patient has carpal tunnel syndrome.  There is considerable 
 
         evidence for this both clinically and on the basis of NCV and EMG 
 
         findings."  (ex. 6, p. 2).  He commented that his tests were 
 
         suggestive of both median and ulnar neuropathy at the wrist.  His 
 
         findings above related to the right upper extremity on April 24, 
 
         1987, but he did begin by relating a history of bilateral 
 
         numbness since 1979.
 
         
 
              Dr. Gregory performed a right carpal tunnel release for 
 
         right carpal tunnel syndrome on May 7, 1987 (ex. 7 & 9).  The 
 
         parties stipulated that claimant was taken off work from April 
 
         24, 1987 to June 21, 1987 and this is supported by the evidence 
 
         (exs. 4, 8, 10 & 11).  Dr. Gregory reported to defendant's claim 
 
         administrator on December 3, 1987 as follows:
 
         
 
              Your claimant, Bobby Joe Jones, File #87-HOW-0031, came in 
 
              for a percent disability determination because of problems 
 
              relating to an old carpal tunnel syndrome on his right 
 
              side.
 
         
 
              He is now left with weakness in his right hand, and weakness 
 
              of grip.  It is difficult for him to open jars, he has been 
 
              limited so that he can't do certain jobs and sports that he 
 
              usually could do.  His posterior extension of the wrist is 
 
              also limited in the excursion and I would say overall, 
 
                                                
 
                                                         
 
                   because of these problems, that he has a 5% disability.
 
         
 
         (ex. 12)
 
         
 
              Dr. Hines gave an independent evaluation for claimant on 
 
         February 17, 1989 (ex. 6).  In this very detailed and 
 
         comprehensive report he summarized claimant's treatment of the 
 
         injury concluding with, "...when he went back to work, he tore 
 
         open the area again and had a return in some of his dysfunction, 
 
         and.has been unable to use his hands for repetative (sic) 
 
         activity since that time."
 
         
 
              The second paragraph reads as follows:
 
         
 
              He has continued to have difficulties on the left; his 
 
              original difficulties were also in the left, although we did 
 
              not do an EMG and Nerve Conduction Velocity at that time, as 
 
              we wanted to wait and see how his right side would do.  I 
 
              have not seen him during this interval, but during this 
 
              period he has still had loss of strength in the right hand, 
 
              with decreased dexterity.  If he uses a screwdriver, for 
 
              instance, he gets slight swelling and numbness, with pain in 
 
              the scar area.  If he drives for more than 5-10 minutes, 
 
              this will create numbness in his tight hand, and 
 
              occasionally, this will radiate not only into the typical 
 
              median distribution, but will involve the little finger as 
 
              well as the whole hand.  He still has the same complaints in 
 
              his left hand, but not as severe.
 
         
 
         (ex. 6, p. 1)
 
         
 
              Dr. Hines' detailed examination included both upper 
 
         extremities.  He performed an electromyogram and nerve conduction 
 
         velocity examination on both upper extremities.  The tests 
 
         disclosed median and ulnar latencies indicative of mild residual 
 
         carpal tunnel on the right.  Again left median and ulnar nerve 
 
         latencies were suggestive of a very early carpal tunnel syndrome 
 
         on the left.  Dr. Hines summarized as follows:
 
         
 
              The EMG was extremely instructive, in that the patient had 
 
              denervation in the ulnar distribution and median 
 
              distribution bilaterally, slightly worse in the ulnar 
 
              distribution on the left, and relatively equal in the median 
 
              distribution below the wrist bilaterally.
 
         
 
              In conclusion, this patient has residual mild right carpal 
 
              tunnel syndrome on the right, with mild carpal tunnel 
 
              syndrome on the left.  Functionally, the patient is impaired 
 
              from doing repetative (sic) tasks with his wrists due to 
 
              this difficulty.  In addition to this, fine activities 
 
              requiring substantial manual dexterity are impaired because 
 
              of this difficulty, and this would be typical of a patient 
 
              with this type of problem.  This latter difficulty is most 
 
              important for him in view of his work in laser technology; 
 
              he does have to work with considerable fine electronic 
 
                                                
 
                                                         
 
                   parts, and this is required for him.
 
         
 
         (ex. 6, p. 2)
 
         
 
              Dr. Hines recommended wrist splints at night, Motrin, 
 
         physical therapy and abstinence from those activities that 
 
         increase his symptomology.  He then formed these conclusions:
 
         
 
              It is, therefore, my overall impression that this patient 
 
              has residual carpal tunnel syndrome bilaterally and residual 
 
              ulnar neuropathy, bilaterally, slightly worse in the carpal 
 
              tunnel distribution on the right, and slightly worse in the 
 
              ulnar on the left.  The methods which I have described to 
 
              treat the patient are used to prevent progression, but since 
 
              this patient has had problems continuing for a period of 2 
 
              years since the original incidence leading to these 
 
              disabling effects, I doubt that there is any reason to 
 
              believe that this patient will have no permanent improvement 
 
              beyond this point, particularly in view of the fact that he 
 
              has already tried surgery on at least one of the 
 
              distributions without substantial improvement.  It is, 
 
              therefore, my opinion that these problems are permanent in 
 
              the sense that they will continue, and I can give no date of 
 
              their anticipated improvement.
 
         
 
         (ex. 6, pp. 2 & 3)
 
         
 
              Dr. Hines then applied the Guides to Evaluation of Permanent 
 
         Impairment, second edition, published by the American Medical 
 
         Association and determined that claimant's dysfunction gives him 
 
         an overall:
 
         
 
              ...19% dysfunction on both upper extremities, that is, 19% 
 
     
 
                           
 
                                                         
 
              for each side.  This equates to approximately 11% impairment 
 
              to the whole person for each upper extremity.  If whole 
 
              person impairments are used, then an 11% dysfunction 
 
              combined with an 11% dysfunction, gives approximately a 15% 
 
              dysfunction to the whole person, as a result of both upper 
 
              extremity impairments.
 
         
 
         (ex. 6, pp. 3 & 4)
 
         
 
              However, when 11 percent and 11 percent are combined on the 
 
         combined values chart of the AMA Guides, second edition, page 
 
         240, the result is 21 percent of the whole person.
 
         
 
              You do not combine 19 percent and 19 percent of each upper 
 
         extremity as proposed by claimant's counsel and arrive at 34 
 
         percent.
 
         
 
                       APPLICABLE LAW AND ANALYSIS
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(1).
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received an injury on March 27, 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 March 27, 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, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
                                                
 
                                                         
 
         may be affected,by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 
 
         N.W.2d 128 (1967).
 
         
 
              Claimant did sustain the burden of proof by a preponderance 
 
         of the evidence that he sustained an injury on March 27, 1987, 
 
         which arose out of and in the course of employment with employer. 
 
         Claimant has proven a classic case of bilateral carpal tunnel 
 
         syndrome caused by repetitive hand, wrist and arm movements 
 
         during nine years of employment with employer.  Most of that time 
 
         claimant deboned hams.  The extremely extensive and diverse 
 
         repetitive motions of both hands, wrists and arms are described 
 
         above.  Claimant also operated a Whizzard knife for a 
 
         considerable period of time, threw hams, boned loins and trimmed 
 
         hams.  Boning 93 hams per hour for an eight hour day amounts to 
 
         733 hams per day.  It amounts to 3,665 hams in a five day week.  
 
         That totals 182,250 hams in a 50 week year.  Claimant performed 
 
         this task for five or six years.
 
         
 
              At first, employer would take claimant off the job.for a 
 
         day. Employer taped his upper extremities from the hands to 
 
         midarm 50, 60 or 70 times in the two years prior to surgery.  
 
         Claimant was instructed to take anti-inflammatory pills.  
 
         Claimant eventually lost control of the straight knife he used in 
 
         his right hand.  He could not feel how tight he was gripping it 
 
         and it flew out of his hand.  Eventually it felt like shocks in 
 
         his right arm.  He developed night numbness and pain and 
 
         sensitivity to vibration like the steering wheel of a car and a 
 
         car washing wand.
 
         
 
              Dr. Hines, a board certified neurologist, saw claimant on 
 
         April 24, 1987, at the employer's request and said claimant began 
 
         having hand numbness bilaterally in 1979.  Dr. Hines related how 
 
         changing claimant's jobs and taking time off work reduced his 
 
         symptomology.
 
         
 
              Dr. Gregory performed right carpal tunnel surgery on May 7, 
 
         1987 and determined that claimant had a 5 percent disability, but 
 
         he did not indicate if it was for the hand or the arm.  Claimant 
 
         demonstrated that the surgical scar is approximately one inch 
 
         above his wrist into his arm area and voiced several arm and 
 
         elbow complaints.
 
         
 
              Claimant understood that the right carpal tunnel surgery was 
 
         performed first because his condition was worse in the right arm 
 
         and because the doctor did not want to disable both arms at the 
 
         same time.  Dr. Hines confirmed that although claimant had 
 
         difficulties originally on the left, "...we did not do an EMG and 
 
         Nerve Conduction Velocity at the time, as we wanted to wait and 
 
         see how his right side would do."  (ex. 6, p. 1)
 
         
 
              Dr. Hines' later examination on February 17, 1989, 
 
         established that claimant sustained bilateral carpal tunnel 
 
         syndrome which affected both the median and ulnar nerves on both 
 
                                                
 
                                                         
 
         upper extremities.  The ulnar was worse on the left; and the 
 
         median was worse on the right.  Dr. Hines commented, "...this 
 
         patient has had problems continuing for a period of 2 years since 
 
         the original incidence leading to these disabling effects,.... 
 
         (ex. 6, p. 3).
 
         
 
              Dr. Hines also confirmed that claimant sustained another 
 
         injury when he returned to work after the surgery and moved 1,500 
 
         pound vats and tore open the previous surgical area.
 
         
 
              Dr. Hines stated, "Functionally, the patient is impaired 
 
         from doing repetitive tasks with his wrists, and will be unable 
 
         to do repetitive tasks with his wrists due to this difficulty."  
 
         (ex. 6, p. 2).  He concluded that claimant's condition was 
 
         permanent.  He determined after extremely detailed studies and 
 
         measurements that claimant sustained a 19 percent permanent 
 
         impairment in each upper extremity.  This converts to 11 percent 
 
         of the body as a whole for each upper extremity (AMA Guides, 
 
         second edition, table 20, p. 23).  Then, 11 percent and 11 
 
         percent combine to 21 percent of the whole person on the combined 
 
         values chart on page 240.
 
         
 
              Defendant asserts that neither Dr. Gregory, Dr. Hines, or 
 
         any other doctor made a specific statement that claimant's injury 
 
         was caused by his employment.  This is true.  However, claimant 
 
         points out that 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 (1966).  Furthermore, the 
 
         employment need not be the only factor.  A cause is proximate if 
 
         it is a substantial factor in bringing about the result.  It only 
 
         needs to be one cause, it does not have to be the only cause.  
 
         Blacksmith v. All-American, Inc., 290 N.W.2d 348, 354 (Iowa 
 
         1980).
 
         
 
              In this record, all of the evidence describes a classic case 
 
         of employment caused bilateral carpal tunnel syndrome from 
 
         repetitive hand, wrist and arm movement over a period of nine 
 
         years employment with employer.  Claimant's testimony is 
 
         corroborated by his wife.  Claimant's testimony was not 
 
         contradicted, controverted, rebutted or refuted.  Defendant 
 
         called no witnesses.  Defendant's exhibits A and B demonstrate 
 
         that claimant has had some athletic injuries and some common 
 
         illnesses in the past, but none of them are even suggestive of 
 
         any connection with carpal tunnel syndrome nor is there any 
 
         evidence, medical or nonmedical, that there is any connection.  
 
         Employer has not demonstrated any other cause for claimant's 
 
         bilateral carpal tunnel syndrome.  At no time during the long 
 
         treatment process did employer ever assert that claimant's 
 
         condition was not caused by his employment.  Everything that 
 
         employer did do confirms that they believed that claimant had 
 
         suffered work caused carpal tunnel injury, they gave him a day 
 
         off occasionally, they rotated him around to different jobs, they 
 
         taped his upper extremities from the hand to the midarm 50, 60 or 
 
                                                
 
                                                         
 
         70 times, they prescribed wrist splints and wrist braces, they 
 
         prescribed anti-inflammatory medications, they sent claimant to a 
 
         neurologist and general surgeon, and even requested him to accept 
 
         experimental vibratory shock therapy which claimant consented to 
 
         do.  Employer should be commended for treating the condition so 
 
         conscientiously and so thoroughly in an attempt to benefit 
 
         claimant with all known medical medalities.  However, these same 
 
         actions certainly stand for some evidence that claimant's work 
 
         was the cause of his bilateral carpal tunnel injury and that the 
 
         injury is the cause of his resulting 21 percent impairment to the 
 
         body as a whole.
 
         
 
              Taken as a whole, all of the evidence makes out a case of 
 
         classic work caused bilateral carpal tunnel syndrome.  There is 
 
         no evidence of any other cause for the injury or the disability.  
 
         By weighing the evidence and in simple justice it must be 
 
         concluded that claimant did sustain the burden of proof by a 
 
         preponderance of the evidence that he did sustain an injury 
 
         arising out of and in the course of his employment and that the 
 
         injury is the case of both temporary and permanent disability.  
 
         There is no evidence to the contrary.
 
         
 
              The parties stipulated to the fact that claimant is entitled 
 
         to temporary disability benefits from April 24, 1987 to June 21, 
 
         1987.
 
         
 
              Dr. Hines' evaluation provides the information that claimant 
 
         is entitled to a 21 percent impairment to the body as as whole as 
 
         a result of bilateral upper extremity injuries that occurred 
 
         simultaneously as provided by Iowa Code section 85.34(2)(s).
 
         
 
              Dr. Gregory's one paragraph evaluation is cursory and 
 
         fragmentary.  The left arm is not even mentioned.  Dr. Gregory 
 
 
 
                       
 
                                                         
 
         does not specify whether he is referring to the hand or the arm. 
 
         By comparison, Dr. Hines' examination and evaluation is 
 
         comprehensive and highly.detailed.  Dr. Hines' evaluation is much 
 
         more responsible and reliable than Dr. Gregory's.  Dr. Hines is 
 
         board certified.  Dr. Hines' opinion is adopted as the most 
 
         reliable examination, evaluation and report.  Rockwell Graphics 
 
         Systems, Inc. v. Prince, 366 N.W.2d 187, 192 (Iowa 1985).  His 
 
         board certification is also helpful.  Reiland v. Palco, Inc., 
 
         Thirty-second Biennial Report of the Industrial Commissioner, 56 
 
         (1975).; Dickey v. ITT Continental Baking Co., Thirty-fourth 
 
         Biennial Report of the Industrial Commissioner 89 (1979).
 
         
 
              Dr. Gregory gave an impairment rating on December 3, 1987. 
 
         Claimant considered it too low.  Claimant was entitled to an 
 
         examination and evaluation from a physician of his own choice.  
 
         He chose Dr. Hines because Dr. Hines had treated him before and 
 
         knew his condition.  Dr. Hines charged $549.  These charges are 
 
         reasonable for the examination and evaluation performed (ex. 17). 
 
         Claimant is entitled to reimbursement.
 
         
 
                             FINDINGS OF FACT
 
         
 
              Wherefore, based on the evidence presented, the following 
 
         findings of fact are made:
 
         
 
              That claimant was employed by employer for nine years, from 
 
         August 28, 1978 until the plant closed on August 19, 1987.
 
         
 
              That claimant performed jobs that required repetitive 
 
         movements of his hands, wrists and arms for nine years.
 
         
 
              That claimant began developing bilateral carpal tunnel in 
 
         1979.
 
         
 
              That in 1985, two years prior to surgery, employer took 
 
         claimant off work for a day occasionally when his symptoms became 
 
         worse.
 
         
 
              That for two years prior to the right carpal tunnel surgery, 
 
         employer taped claimant's arms 50, 60 or 70 times, prescribed 
 
         anti-inflammatory medications, rotated claimant to different jobs 
 
         and gave him time off to reduce his symptoms, sent claimant to a 
 
         neurologist for EMG/NCV tests, and eventually provided claimant 
 
         with carpal tunnel surgery.
 
         
 
              That after the surgery, claimant tore out the surgical area 
 
         while pushing 1,500 pound vats at work.
 
         
 
              That employer provided claimant with experimental vibratory 
 
         shock therapy treatments for his carpal tunnel condition.
 
         
 
              That no medical practitioner specifically stated that 
 
         claimant's bilateral carpal tunnel condition was caused by his 
 
         work.
 
         
 
                                                
 
                                                         
 
              That Dr. Hines indicated the job changes provided by 
 
         employer and time off provided by employer provided relief from 
 
         the condition and that assignment to repetitive tasks worsened 
 
         his condition.
 
         
 
              That Dr. Hines stated claimant's symptoms started originally 
 
         two years ago and have resulted in the disability that he 
 
         treated.
 
         
 
              That no other cause for the carpal tunnel condition is 
 
         suggested or supported by the evidence.
 
         
 
              That neither the employer, employee, or the medical 
 
         practitioners ever suggested any other reason for the carpal 
 
         tunnel condition other than claimant's repetitive work with his 
 
         hands, wrists and arms.
 
         
 
              That claimant sustained an injury of bilateral carpal tunnel 
 
         syndrome arising out of and in the course of employment on March 
 
         27, 1987, caused by repetitive use of his hands, wrists and arms 
 
         fatting hams with a Whizzard knife, deboning (shanking) hams, 
 
         throwing hams, deboning loins and trimming hams.
 
         
 
              That Dr. Hines, a board certified neurologists, found 
 
         bilateral carpal tunnel originating in 1979.
 
         
 
              That Dr. Hines' tests disclosed that claimant sustained a 21 
 
         percent impairment of the body as a whole.
 
         
 
              That employers' doctor gave a rating which claimant believed 
 
         to be too low and claimant employed Dr. Hines as a physician of 
 
         his own choice to give an examination, evaluation and rating at a 
 
         later date.
 
         
 
              That the charge of $549 for Dr. Hines' examination was 
 
         reasonable.
 
         
 
                            CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based on the evidence presented and the foregoing 
 
         principles of law, the following conclusions of law are made.
 
         
 
              That claimant sustained the burden of proof by a 
 
         preponderance of the evidence and that all of the evidence 
 
         presented establishes that claimant sustained an injury on March 
 
         27, 1987, of bilateral carpal tunnel syndrome which arose out of 
 
         and in the course of employment with employer.
 
         
 
              That the injury was the cause of temporary disability from 
 
         April 24, 1987 to June 21, 1987.
 
         
 
              That claimant is entitled to 8.429 weeks of healing period 
 
         benefits,for this period of time.
 
         
 
              That the injury was the cause of permanent disability.
 
                                                
 
                                                         
 
         
 
              That claimant is entitled to 105 weeks of permanent partial 
 
         benefits under Iowa Code section 85.34(2)(s).
 
         
 
              That claimant is entitled to an independent examination and 
 
         evaluation pursuant to Iowa Code section 85.39 from Dr. Hines in 
 
         the amount of $549.
 
         
 
                                    ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That defendant pay to claimant eight point four two nine 
 
         (8.429) weeks of healing period benefits to claimant at the rate 
 
         of Two Hundred Fifty-seven and 22/100 Dollars ($257.22) per week 
 
         in the total amount of Two Thousand One.Hundred Sixty-eight and 
 
         11/100 Dollars ($2,168.11) for the period from April 24, 1987 to 
 
         June 21, 1987.
 
         
 
              That defendant pay to claimant one hundred five (105) weeks 
 
         of permanent partial disability benefits at the rate of Two 
 
         Hundred Fifty-seven and 22/100 Dollars ($257.22) in the total 
 
         amount of Twenty-seven Thousand Eight and 10/100 Dollars 
 
         ($27,008.10) commencing on June 21, 1987 as stipulated to by the 
 
         parties.
 
         
 
              That all of these weekly compensation 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 eighteen point 
 
         five (18.5) weeks of workers' compensation benefits paid to 
 
         claimant at the rate of Two Hundred Fifty-four and 35/100 Dollars 
 
         ($254.35) per week in the total amount of Four Thousand Seven 
 
         Hundred Five and 48/100 Dollars ($4,705.48).
 
         
 
              That defendant pay to claimant the sum of Five Hundred 
 
         Forty-nine Dollars ($549) for an examination and evaluation 
 
         pursuant to Iowa Code section 85.39.
 
         
 
              That the costs of this action are charged to defendant 
 
         pursuant to Division of Industrial Services Rule 343-4.33, 
 
         including the cost of the transcript.
 
         
 
              That defendant file claim activity reports as requested by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
              Signed and filed this 30th day of November, 1989.
 
         
 
         
 
         
 
         
 
                                                
 
                                                         
 
         
 
         
 
                                            WALTER R. McMANUS, JR.
 
                                            DEPUTY INDUSTRIAL 
 
                                            COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. Stephen D. Lombardi
 
         Attorney at Law
 
         2190 N.W. 82nd St
 
         Des Moines, Iowa  50322
 
         
 
         Mr. Richard R. Schlegel, II
 
         Attorney at Law
 
         105 1/2 North Market St.
 
         Ottumwa, Iowa  52501
 
         
 
         Mr. Stephen W. Spencer
 
         Attorney at Law
 
         PO Box 9130
 
         Des Moines, Iowa  50306-9130
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                       1106; 1108.50; 1401; 1402.30; 
 
                                       1402.40; 1402.60; 1801; 1803;
 
                                       2209; 51801; 51803; 52502
 
                                       Filed November 30, 1989
 
                                       WALTER R. McMANUS, JR.
 
         
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         BOBBY JONES,
 
         
 
              Claimant,                                 File No. 865970
 
         
 
         vs.                                         A R B I T R A T I 0 N
 
         
 
         GEORGE A. HORMEL & CO.,                        D E C I S I 0 N
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         1106; 1108.50; 1401; 1402.20; 1402.30; 1402.40; 1402.60; 1801; 
 
         1803; 2209
 
         
 
              Claimant testified to a classic case of bilateral carpal 
 
         tunnel from use of his hands, wrists and arms for nine years 
 
         primarily fatting hams and boning hams.  His testimony was 
 
         corroborated by his wife and the medical evidence.  Claimant's 
 
         testimony and medical evidence was not controverted, 
 
         contradicted, rebutted or refuted by defendant's evidence.  
 
         Defendant called no witnesses.  Defendant's exhibits of 
 
         claimant's athletic injuries and common health complaints had 
 
         nothing to do with bilateral carpal tunnel syndrome.  Neither one 
 
         of the two doctors said in so many precise words that the injury 
 
         was specifically caused by claimant's employment.  However, one 
 
         of the physicians made a number of remarks that indicated that 
 
         the injury was caused by the employment.  Held:  claimant did 
 
         sustain bilateral carpal tunnel arising out of and in the course 
 
         of employment with employer.
 
         
 
         51801; 51803
 
         
 
              Claimant awarded temporary disability benefits for the 
 
         period stipulated by the parties.  Claimant awarded 105 weeks of 
 
         permanent partial disability based on a 21 percent impairment of 
 
         the body as a whole based on rather detailed and comprehensive 
 
         report of the board certified neurologist pursuant to Iowa Code 
 
         section 85.34(2)(2).
 
         
 
         52502
 
         
 
              Claimant was clearly entitled to a section 85.39 
 
         examination. The amount of $549 was reasonable based on the 
 
                                                
 
                                                         
 
         itemized bill that included extensive EMG/NCV testing by the 
 
         neurologist.
 
 
 
         
 
 
        
 
 
 
 
 
        
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        KENNETH BRAASCH,
 
        
 
            Claimant,
 
                                                           File No. 
 
        865997
 
        vs.
 
        
 
        FARMLAND FOODS,                                    A R B I T R A 
 
        T I O N
 
        
 
            Employer,                              D E C I S I O N
 
        
 
        and                                             F I L E D
 
        
 
        AETNA CASUALTY & SURETY                            AUG 22 1989
 
        
 
            Insurance Carrier,              IOWA INDUSTRIAL 
 
        COMMISSIONER
 
            Defendants.
 
        
 
        
 
                                      INTRODUCTION
 
        
 
             This is a proceeding in arbitration brought by the claimant, 
 
             Kenneth Braasch, against Farmland Foods, employer, and Aetna 
 
             Casualty & Surety Company, insurance carrier, to recover benefits 
 
             as a result of an alleged injury sustained on November 4, 1987. 
 
             This matter came on for hearing before the deputy industrial 
 
             commissioner in Sioux City, Iowa, on June 20, 1989. The record 
 
             consists of the testimony of claimant, claimant's wife, and 
 
             Rodney Koch; and joint exhibits 1 through 35.
 
        
 
                                      ISSUES
 
        
 
             The issues for resolution are:
 
        
 
            1. Whether claimant's injury arose out of and in the course 
 
        of his employment on or around November 4, 1987;
 
        
 
            2. Whether claimant's recovery is barred by the statute of 
 
        limitations as set out in Iowa Code section 85.26;
 
        
 
            3. Whether there is a causal connection between claimant's 
 
        alleged injury and any disability for which he now suffers; and
 
        
 
            4. The nature and extent of claimant's disability.
 
        
 
                                 REVIEW OF THE EVIDENCE
 
        
 
             Claimant testified he began working for defendant employer 
 
             at age 16, shortly after completing the tenth grade. Claimant 
 
             said he has had no other formal education nor has he obtained a 
 
             GED since he left high school. Claimant has been employed with 
 
             defendant employer continuously from 1958 to the present. 
 
             Claimant described the various jobs he has had with Farmland 
 
             Foods up to his serviceman job in the boning room on the date of 
 
             his alleged injury, November 4, 1987. Over approximately thirty 
 
             years, claimant's pay has gone from $1.25 per hour in 1958 to 
 
             $9.35 per hour presently. Claimant stated he had never injured 
 

 
        
 
 
 
 
 
             his back before beginning employment at Farmland. Claimant 
 
             emphasized that prior to beginning the serviceman job in the 
 
             boning room in 1981, he had no low back problems.
 
        
 
             Claimant said his duties in the boning room involves 
 
             skinning hams, picking up pallets weighing from 35 to 75 pounds, 
 
             and folding boxes. Claimant indicated his work since 1981 has 
 
             been repetitive-type work. Claimant testified he first 
 
             experienced back pain in 1984. Claimant said his low back pain 
 
             went down into his leg and it felt like his hip was out all the 
 
             time. Claimant indicated the pain became so severe that he could 
 
             no longer stand it and sought medical help with Dennis Crabb, 
 
             M.D., on December 18, 1984. Claimant was off work eight weeks. 
 
             He said he applied but did not receive workers' compensation 
 
             benefits for those eight weeks. He only received sick pay. 
 
             Claimant said that the workload did not decrease on his return to 
 
             work but, in fact, the standards increased every time a new 
 
             contract was negotiated. Claimant testified he still feels a 
 
             little pain since his 1984 injury and has had some chiropractic 
 
             treatments for this pain. Claimant said that on November 4, 1987, 
 
             he could not move. Claimant said his wife helped him put on his 
 
             shoes. He stated he continued to work for three days and then 
 
             had to stop working. Claimant returned to work in January 1988. 
 
             Claimant said that after one week he still had a little pain just 
 
             like he has in court today, but that the pain did not bother him 
 
             that much. Claimant said his pain became worse and he went to see 
 
             Ronald Dreyer, a chiropractor, and P. L. Myer, D.O., in February 
 
             1988. Dr. Myer referred claimant to Maurice P. Margules, M.D., 
 
             who immediately put claimant through several tests. Claimant 
 
             said Dr. Margules discovered a herniated disc and performed 
 
             surgery shortly thereafter. Claimant was off work from February 
 
             3, 1988 up to and not including April 13, 1988. Claimant said 
 
             his operation was successful.
 
        
 
            Claimant acknowledged he has a garage next door to his house 
 
        where he and his son do mechanic work. Claimant contends his son 
 
        works full-time and does all the heavy work and claimant works 
 
        part-time as a hobby. Claimant said he performs such work as 
 
        installing carburetors, fixing brakes, uses and lifts various 
 
        hand tools and hydraulic lifts. Claimant admitted this business 
 
        has never shown a profit. Claimant also indicated he is a 
 
        volunteer fireman in Deloit, Iowa. Claimant related one instance 
 
        in January 1988 in which he went to a fire, picked up a fire hose 
 
        and his back went out again in the same place it had before. 
 
        Claimant also slipped off a fire truck the evening of the fire. 
 
        Claimant said he felt so bad he went to Dr. Dreyer.
 
        
 
            Claimant returned to work in April 1988 as a knife 
 
        sharpener, which claimant said is considered a light duty job. 
 
        Claimant said he feels pretty good today. Claimant indicated he 
 
        gets a little numbness in the right leg in the back side and has 
 
        no reflexes in the right back side of his ankle. Claimant said 
 
        he looked for a job with the county while he was off work. 
 
        Claimant indicated he cannot work there if he has back problems. 
 
        Claimant said that in addition to his back problem, he has 
 
        glaucoma and a hearing problem and it is hard to get another job. 
 
        Claimant stated he is No. 4 in seniority at Farmland overall and 
 
        still No. 1 seniority in the boning department. Claimant 
 
        acknowledged he is making the same wages now as he was when he 
 
        was allegedly injured in November 1987. Claimant contends he 
 
        could never handle his former job in the boning room due to his 
 
        back.
 
        
 
            Claimant indicated that William Hamsa, Jr., M.D., prescribed 
 
        a lumbar corset to wear when claimant had back complaints in 
 
        December 1984.
 

 
        
 
 
 
 
 
        
 
            Claimant admitted that he saw D.N. Crabb, M.D., in June 1987 
 
        and told him that he thought his problem was the same thing he 
 
        had in December 1984.
 
        
 
            Darlene Braasch, claimant's wife, testified. Her testimony 
 
        was very short and cumulative.
 
        
 
            Rodney Koch testified that he has worked at Farmland Foods 
 
        almost 15 years. He said he has known claimant since they were 
 
        coworkers on the kill floor approximately 15 years ago. Koch 
 
        indicated he is now claimant's supervisor and has seen no 
 
        physical problem with claimant performing his job. Koch 
 
        emphasized that claimant is a good worker and there has been no 
 
        disruption in the working conditions due to claimant's alleged 
 
        physical condition.
 
        
 
            William R. Hamsa, Jr., M.D., who first examined claimant on 
 
        December 17, 1984, wrote on March 4, 1988:
 
        
 
                 In the remote past, the patient had been seen by myself 
 
             with an unstable lumbar disc and an Sl root irritation of 
 
             the right lower extremity. This was in December 1984. He 
 
             was treated conservatively and his symptoms completely 
 
             disappeared, and he was asymptomatic until the onset of the 
 
             present problem.
 
             
 
          ....
 
        
 
                    Films taken of the patient's lumbar spine including an 
 
                      AP and a lateal [sic] with the AP including the pelvis and 
 
                      dome of the hips as well as a spot lateral of the L5-S1 
 
                      interspace showed a mild lordosis with mild degenerative 
 
                      disc disease between L5 and Sl.
 
        
 
               My impression was unstable lumbar disc with definite 
 
             nonspecific neuritis, right lower extremity, probably S1 
 
             root.
 
        
 
          ....
 
        
 
               It would be my opinion that this man's employment was a 
 
             contributing factor in the unstable lumbosacral disc with 
 
             the Sl root irritation of right lower extremity. As to the 
 
             definitive decision on this problem, that would be up to the 
 
             physician who performed the lumbar laminectomy.
 
        
 
        (Joint Exhibit 26, pages 2-3)
 
        
 
            Maurice P. Margules, M.D., a neurologist, testified by 
 
        deposition on May 18, 1988, that claimant "showed evidence of 
 
        tilting of his lumbar spine to the left" which he felt was a 
 
        result of "spasm of the claimant's paraxial musculature which 
 
        pulls the spine to one side and causes the patient to tilt his 
 
        body." (Jt. Ex. 31 p. 15) Dr. Margules also testified claimant 
 
        had an indication of an "irritation of the sciatic nerve or the 
 
        roots forming the sciatic nerve by whatever process, whether it's 
 
        inflammatory or compression or otherwise." (Jt. Ex. 31, p. 16) 
 
        Dr. Margules further testified that claimant had "an interruption 
 
        of the reflex circuit involving the Sl nerve root." (Jt. Ex. 31, 
 
        p. 16) Dr. Margules testified that claimant's condition was the 
 
        "result of compression due to a disc herniation between the fifth 
 
        lumbar and first sacral." (Jt. Ex. 31, p. 17) Dr. Margules 
 
        opined as to the cause of the compression:
 
        
 
             That was strictly based obviously on what the patient had 
 

 
        
 
 
 
 
 
             told me, what he had discussed. And I felt that the onset 
 
             of this problem was in November of 1987 and -- because from 
 
             then on then this man had trouble. From then on he had 
 
             similar problems. He continued to work and do multiple 
 
             functions, obviously, because he worked as a fireman He also 
 
             had his own body shop in which he does work and et cetera, 
 
             and until it became obviously intolerable and that's the 
 
             reason he came to see me, because the pain became 
 
             intolerable so he couldn't work.
 
        
 
        (Jt. Ex. 31, pp. 17-18)
 
        
 
             As to the etiology of claimant's lumbar spine problem, Dr. 
 
             Margules opined:
 
        
 
             My opinion is that the disc herniation which became the 
 
             actual cause of his radicular pain was the result of the 
 
             trauma that he had sustained at work. Surgically this 
 
             individual I think had a very large disc herniation which 
 
             obviously caused so much pressure on the nerve that it made 
 
             it imperative for him to seek help. And I think this 
 
             changed, obviously, over time. In '87 he most likely had 
 
             some element of radicular compression but not as severely as 
 
             he did in -- when I saw him then. And I think that's why he 
 
             was forced to do something about it.
 
             
 
        (Jt. Ex. 31, pp. 23-24)
 
        
 
             As to whether the work claimant did over the lengthy period 
 
             of time at Farmland aggravated, accelerated or lighted up over a 
 
             period of time, or caused the disc herniation, Dr. Margules 
 
             opined:
 
        
 
             I would say that certainly it was an aggravating factor. If 
 
             the man had some pre-existing disease of which he was 
 
             unaware, I'm sure then the activities that he was having 
 
             were a triggering cause of this acute problem that occurred, 
 
             first in 1987 and then became then so prevalent that he was 
 
             -- it forced him to discontinue his work.
 
             
 
        (Jt. Ex. 31, p. 24)
 
        
 
             Dr. Margules acknowledged that work as a mechanic bending 
 
             over machines would certainly be stressful to the back condition. 
 
             Dr. Margules also acknowledged that sometimes chiropractic 
 
             treatment can be detrimental to an individual who has a 
 
             preexisting disc disease. Also, a fireman's work would also be a 
 
             difficult thing for someone with a back condition. Dr. Margules 
 
             opined that claimant working on his job at the packing plant as a 
 
             line servicer and skinner from 1984 until November 1987 would 
 
             have aggravated, accelerated or lighted up the condition that was 
 
             existing in 1984 (Jt. ex. 31, p. 33). Dr. Margules testified his 
 
             rating of 10 to 15 percent of the body as a whole includes 
 
             whatever preexisting condition Mr. Braasch had prior to his 
 
             surgery (Jt. ex. 31, p. 34). Dr. Margules noted in the Jennie 
 
             Edmundson Memorial Hospital records on or around February 15, 
 
             1988:
 
        
 
                  The history at this time is that of an onset of acute 
 
                      pain in September, 1984 as the result of activities 
 
                      connected with stacking pallets. At that time, the patient 
 
                      had an acute pain in the lumbar spine with radicular pain in 
 
                      the RIGHT lower extremity. This has been treated 
 
                      conservatively, and since then the patient has never been 
 
                      free of pain having had multiple recurrences of pain. It is 
 
                      felt at this time that the patient's findings are those of 
 

 
        
 
 
 
 
 
                      an [sic] chronic radicular compression of the S1 root on the 
 
                      RIGHT, most likely due to a disc herniation at this level.
 
             
 
               ....
 
             
 
                  Surgery was performed on the 12th of February 1988, at 
 
                      which time a large disc herniation was excised at the L5-Sl 
 
                      interspace through the RIGHT lateral approach.
 
             
 
             
 
             
 
                   FINAL DIAGNOSIS: Herniated lumbar disc, L5-Sl 
 
                                      interspace, RIGHT, due to trauma 
 
                                      initially sustained in November 1987.
 
                  
 
                  
 
                    ....
 
                  
 
                  On the 4 of November, 1987, because of severe pain in the 
 
                      RIGHT lower extremity, he discontinued work for 
 
                      approximately two months and returned to work in January, 
 
                      1988. The patient also works as a volunteer fireman in 
 
                      Deloit, Iowa, and feels that he again reinjured his back 
 
                      while fighting a fire outside of Deloit, Iowa, while 
 
                      handling hoses.
 
             
 
        (Jt. Ex. 23, p. 2-3)
 
        
 
             Edward M. Schima, M.D., a practicing neurologist and an 
 
             associate clinical professor of neurology at Creighton 
 
             University, testified by deposition taken March 17, 1988, that he 
 
             first saw claimant on August 10, 1988, and in reviewing 
 
             claimant's medical record, he indicated claimant's complaints in 
 
             1984 were similar to those in November of 1987. Dr. Schima was 
 
             asked and answered as follows:
 
        
 
             Q. Doctor, you've given a lO-percent impairment rating in 
 
             this case. To what would we attribute that lO-percent 
 
             impairment rating?
 
             
 
             A. Well, there are guidelines and there is an AMA monograph 
 
             on this where you take the pain, residual pain, weakness, 
 
             which he had none, and also the fact he's had surgery and he 
 
             does not have a normal back, and you make an educated guess, 
 
             and that's what it is. It is not scientific. So that was 
 
             based on the fact that he's still having symptoms and his 
 
             back has been operated on that I arrived at the 10 percent.
 
                  
 
             Q. Doctor, in--on the final page of your report you say 
 
             that his back difficulties are related to multiple factors.
 
             
 
             A. Uh-huh
 
             
 
             Q. And are the factors that you set out there the ones that 
 
             you were considering?
 
             
 
            A. Yes
 
        
 
             Q. Doctor, if a physician did not see Mr. Braasch until 
 
             after he had this trouble with the fall from the truck and 
 
             his firefighting activities and his mechanical activities, 
 
             would there be any way to pinpoint a cause of his back 
 
             complaints?
 
                  
 
             A. No.
 
             
 

 
        
 
 
 
 
 
               ....
 
             
 
             Q. Doctor, do you have an opinion as to whether or not his 
 
             work which he did over a period of 26 years at the Farmland 
 
             plant was a material and substantial contributing factor in 
 
             the development of the deteriorating disc?
 
                  
 
             A. Well, what's the difference between material and 
 
             substantial and contributing? I don't--
 
             
 
             Q. You're saying to you it means the same thing?
 
             
 
             A. I don't know. If it means something else-- It's a 
 
             contributing factor. Now, if there is any specific 
 
             connotation of those other terms, I don't--
 
             
 
             Q. Just that it was?
 
             
 
             A. It was a contributing factor.
 
                  
 
        (Jt. Ex. 32, pp. 11-14)
 
        
 
            On September 7, 1988, Dr. Schima wrote:
 
        
 
                  COMMENT: The story begins in 1984 with the onset of low 
 
                      back and right leg pain that seemed to respond to 
 
                      conservative therapy, a recurrence in the fall of 1987 and 
 
                      eventual surgery in February of this year. The neurological 
 
                      examination today reveals excellent range of motion but a 
 
                      decreased ankle [sic] jerk on the right side which is almost 
 
                      certainly a residual from his previous S1 radiculopathy.
 
             
 
                  He seems to have had a fairly good result from surgery. 
 
                      I suspect that his back difficulties are related to multiple 
 
                      factors including his employment at Farmland Foods, his fall 
 
                      from a truck, his fire fighting activities, as well as his 
 
                      work as a mechanic, and I do not think that one can pinpoint 
 
                      any single unequivocal cause.
 
             
 
               There is a certain degree of residual functional 
 
             impairment which I would estimate at 10% of the whole man. 
 
             This is only partially a result of his employment at 
 
             Farmland Foods since there were other activities which also 
 
             played a significant role.
 
             
 
        (Jt. Ex. 29, p. 4)
 
        
 
                            APPLICABLE LAW AND ANALYSIS
 
        
 
             Claimant has the burden of proving by a preponderance of the 
 
             evidence that he received an injury on November 4, 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 November 4, 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, 
 
        the expert opinion may be accepted or rejected, in whole or in 
 
        part, by the trier of fact. Id. at 907. Further, the weight to 
 
        be given to such an opinion is for the finder of fact, and that 
 
        may be affected by the completeness of the premise given the 
 
        expert and other surrounding circumstances. Bodish, 257 Iowa 
 
        516, 133 N.W.2d 867. See also Musselman, 261 Iowa 352, 154 
 
        N.W.2d 128.
 
        
 
             While a claimant is not entitled to compensation for the 
 
             results of a preexisting injury or disease, the mere existence at 
 
             the time of a subsequent injury is not a defense. Rose v. John 
 
             Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2nd 756, (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).
 
        
 
            When an aggravation occurs in the performance of an 
 
        employer's work and a causal connection is established, claimant 
 
        may recover to the extent of the impairment. Ziegler v. United 
 
        States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591, (1960).
 
        
 
            The Iowa Supreme Court cites, apparently with approval, the 
 
        C.J.S. statement that the aggravation should be material if it is 
 
        to be compensable. Yeager v. Firestone Tire & Rubber Co., 253 
 
        Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. Workmen's 
 
        Compensation section 555(17)a.
 
        
 
            The words "out of" refer to the cause or source of the 
 
        injury. The words "in the course of" refer to the time and place 
 
        and circumstances of the injury. See Cedar Rapids Community Sch. 
 
        v. Cady, 278 N.W.2d 298 (Iowa 1979; McClure v. Union, Et Al., 
 
        Counties, 188 N.W.2d 283 (1971); Crowe, 246 Iowa 402, 68 N.W.2d 
 
        63. An employer takes an employee subject to any active or 
 
        dormant health impairments, and a work connected injury which 
 
        more than slightly aggravates the condition is considered to be a 
 
        personal injury. Ziegler, 252 Iowa 613, 620, 106 N.W.2d 591, and 
 
        cases cited.
 
        
 
            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."
 
        
 
            Apportionment of disability between a preexisting condition 
 
        and an injury is proper only when there was some ascertainable 
 
        disability which existed independently before the injury 
 
        occurred. Varied Enterprises, Inc. v. Sumner, 353 N.W.2d 407 
 
        (Iowa 1984).
 

 
        
 
 
 
 
 
        
 
             The burden of showing that disability is attributable to a 
 
             preexisting condition is, of course, placed upon the defendant. 
 
             If evidence to establish a proper apportionment is absent, the 
 
             defendant is responsible for the entire disability that exists. 
 
             Varied Enterprises, Inc., 353 N.W.2d 407; Becker v. D & E 
 
             Distributing Co., 247 N.W.2d 727, 731 (Iowa 1976); 2A Larson, 
 
             Workmen's Compensation Law,  59.22; 22 Am.Jur.2d,  122; 2 Damages 
 
             & Tort Actions  15.34[1](a).
 
        
 
            It is not necessary that claimant prove his disability 
 
        results from a sudden unexpected traumatic event. It is 
 
        sufficient to show that a disability developed gradually or 
 
        progressively from work activity over a period of time. McKeever 
 
        Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 1985). The 
 
        McKeever court also held that the date of injury in a gradual 
 
        injury case is the time when pain prevents the employee from 
 
        continuing to work. In McKeever the injury date coincides with 
 
        the time claimant was finally compelled to give up his job. This 
 
        date was then utilized in determining rate and the timeliness of 
 
        the claimant's claim under Iowa Code section 85.26 and notice 
 
        under Iowa Code section 85.23.
 
        
 
            Claimant is 47 years old and has worked almost 31 years for 
 
        defendant employer. He has worked his way through various 
 
        positions to become No. 1 in seniority in the serviceman-boning 
 
        department, where he can no longer perform the duties due to his 
 
        present physical condition. Claimant is No. 4 in overall 
 
        seniority. This seniority status does not come easy. It is 
 
        recognized that work in the meat packing industry is hard work 
 
        and as claimant testified, it involves considerable repetitive 
 
        work. It is obvious that claimant has devoted his working life to 
 
        defendant employer. There have been no complaints with claimant 
 
        as a worker over these 31 years. Claimant has very limited 
 
        education. He did not finish high school and has not obtained a 
 
        GED. He has no transferable skills other than to another like 
 
        job in the meat packing industry.
 
        
 
            Defendants contend that claimant's injuries are from an 
 
        injury or accident outside his employment. Claimant is a very 
 
        industrious individual. He had outside interests as a mechanic 
 
        helping his son, and as a volunteer firefighter. There is 
 
        evidence that claimant does stooping, bending and lifting as a 
 
        mechanic, but there is no evidence that this was the cause of 
 
        claimant's medical condition. There is evidence that claimant 
 
        hurt his back in January 1988 when he was lifting some fire hose 
 
        and, on the same day, slipped or fell off a fire truck. Claimant 
 
        volunteered the information as to this incident to Dr. Margules. 
 
        There is no medical evidence showing this incident caused 
 
        claimant's current condition. Defendants speculate it could have 
 
        been a contributing factor. Dr. Margules opined that claimant's 
 
        herniated disc on which he performed surgery on February 12, 1986 
 
        was due to trauma initially sustained in November 1987.
 
        
 
             There is evidence that claimant had an unstable lumbar disc 
 
             and an S1 root irritation of the right lower extremity in 
 
             December 1984. Dr. Hamsa wrote that he treated claimant 
 
             conservatively and "his symptoms completely disappeared and that 
 
             claimant was asymptomatic until the onset of the present 
 
             problem." (Jt. Ex. 26, p. 2)
 
        
 
            Dr. Schima, who examined claimant several months after the 
 
        November 1987 injury concluded there could be more than one or 
 
        two causes of claimant's disability other than the November 1987 
 
        injury. He could not pinpoint the causation of claimant's 
 
        November 4, 1987 injury.
 

 
        
 
 
 
 
 
        
 
            The undersigned believes Dr. Hamsa when he said claimant's 
 
        symptoms from the December 1984 work-related condition completely 
 
        disappeared and claimant was asymptomatic until the onset of the 
 
        present problem.
 
        
 
            The undersigned finds claimant's November 4, 1987 repetitive 
 
        injury to his low back arose out of and in the course of his 
 
        employment and that claimant's action is not barred by the 
 
        statute of limitations as claimant's petition was filed March 10, 
 
        1988, within the two year statute of limitations as prescribed in 
 
        Iowa Code section 85.26.
 
        
 
            Claimant had a preexisting condition at the time of his 
 
        injury on November 4, 1987. This condition had not bothered 
 
        claimant prior to 1981, and in 1984 claimant had a low back 
 
        problem which had completely disappeared by the time of the 
 
        November 4, 1987 repetitive injury, as stated by Dr. Hamsa. 
 
        Within two months after the December 4 incident, claimant was 
 
        working without interruption until he could no longer work on 
 
        November 4, 1987. The undersigned finds claimant's current 
 
        disability is causally connected to his repetitive injury on 
 
        November 4, 1987, which injury materially aggravated, accelerated 
 
        and worsened claimant's preexisting degenerative disc and nerve 
 
        root condition 
 
        
 
            Dr. Schima opined a 10 percent body as a whole impairment to 
 
        claimant due to his low back condition. Although Dr. Schima 
 
        could not pinpoint the causation, he also could not proportion 
 
        the percent of impairment to any one factor that he indicates 
 
        could have caused claimant's low back condition. Dr. Margules 
 
        determined the causation as discussed earlier and opined a 10 to 
 
        15 percent impairment of claimant's whole body, including any 
 
        preexisting condition. There is no evidence of any ascertainable 
 
        disability which existed independently before the injury of 
 
        November 4, 1987. Under the Varied Enterprises, Inc. case, the 
 
        burden is on defendants to show that the disability is 
 
        attributable to a preexisting condition. The evidence is void of 
 
        any apportionment; therefore, defendants are responsible for the 
 
        entire disability that exists. The undersigned finds claimant 
 
        has a 10 percent impairment to the body as a whole.
 
        
 
             Claimant was paid sick leave benefits of $2,158.50, for 
 
             which the parties stipulated there would be a credit if any 
 
             benefits for healing period or temporary total disability was 
 
             awarded herein.
 
        
 
            Claimant is earning the same hourly wage now as he was at 
 
        the time of his injury of November 4, 1987. Claimant therefore 
 
        has no actual loss of earnings. Although loss of earnings is 
 
        something to be considered in determining industrial disability, 
 
        it is not the deciding factor. Claimant's continued employment 
 
        helps reduce what may otherwise result in greater reduction in 
 
        earning capacity. Claimant testified he is feeling pretty good 
 
        at the present time. Claimant's November 4, 1987 injury resulted 
 
        in excising a large herniated disc at the L5-Sl interspace 
 
        through the right lateral approach on February 12, 1988. 
 
        Claimant is fortunate to be able to continue working. Due to his 
 
        seniority, he has a light duty job of sharpening knives which 
 
        enables him to continue working in the meat packing industry. 
 
        Claimant wouldn't be so lucky working for another employer with 
 
        whom he didn't have seniority. Taking into consideration those 
 
        factors in determining industrial disability, the undersigned 
 
        finds claimant has a 20 percent industrial disability.
 
        
 
            The parties agreed to the time claimant was off work due to 
 

 
        
 
 
 
 
 
        the November 4, 1987 injury. Claimant is entitled to healing 
 
        period benefits for the period from November 4, 1987 to January 
 
        3, 1988, inclusive, and from February 3, 1988 to April 12, 1988, 
 
        inclusive, totaling 18.714 weeks.
 
        
 
            The parties submitted medical bills incurred by claimant, 
 
        which were disputed as to their causal connection to claimant's 
 
        injury of November 4, 1987. Everything else regarding the 
 
        necessity of the bills and the reasonableness was stipulated. 
 
        The causal connection issue has been disposed of and the causal 
 
        connection of these bills in the amount of $5,220.49;has been 
 
        determined. Defendants shall pay these bills totaling $5,220.49 
 
        and receive credit for the $4,108.20 defendants have already paid 
 
        toward that bill.
 
        
 
                                 FINDINGS OF FACT
 
        
 
             1. Claimant's disability is the result of a work-related 
 
             low back repetitive injury on November 4, 1987.
 
        
 
            2. Claimant had a preexisting degenerative disc and nerve 
 
        root condition involving the L5 and Sl vertebrae which was 
 
        materially aggravated, accelerated and worsened by claimant's 
 
        repetitive injury on November 4, 1987.
 
        
 
            3. Claimant's work-related repetitive injury occurred on 
 
        November 4, 1987, and claimant's petition filed on March 10, 1988 
 
        is timely filed and in compliance with Iowa Code section 85.26.
 
        
 
             4. Claimant incurred a 10 percent permanent impairment to 
 
             the body as a whole as a result of his repetitive work-related 
 
             injury on November 4, 1987.
 
        
 
            5. Claimant incurred healing periods for the stipulated 
 
        time off from November 4, 1987 to January 3, 1988, inclusive, and 
 
        February 3, 1988 to April 12, 1988, inclusive.
 
        
 
            6. Claimant has a reduction in earning capacity as a result 
 
        of his November 4, 1987 injury.
 
        
 
            7. Claimant's medical bills in the amount of $5,220.49 is a 
 
        result of claimant's November 4, 1987 work-related injury.
 
        
 
            8. Claimant was paid $2,158.20 in sick leave benefits and 
 
        was paid no healing period or temporary total disability benefits 
 
        during his time off as a result of his November 4, 1987 injury.
 
        
 
                                 CONCLUSIONS OF LAW
 
        
 
             Claimant's repetitive low back injury arose out of and in 
 
             the course of his employment on November 4, 1987.
 
        
 
            Claimant's disability is causally connected his repetitive 
 
        low back injury on November 4, 1987.
 
        
 
            Claimant's preexisting degenerative disc condition involving 
 
        L5-Sl was materially aggravated, accelerated and worsened by his 
 
        November 4, 1987 injury.
 
        
 
            Claimant timely filed his petition in accordance with Iowa 
 
        Code section 85.26.
 
        
 
            Claimant incurred healing period from November 4, 1987 to 
 
        January 3, 1988, inclusive, and February 3, 1988 to April 12, 
 
        1988, inclusive.
 
        
 

 
        
 
 
 
 
 
            Claimant received $2,158.20 sick leave for which credit is 
 
        to be given defendants.
 
        
 
            Claimant is entitled to have his medical bills of $5,220.49 
 
        paid in full by defendants and credit be given for any bills 
 
        previously paid.
 
        
 
            Claimant has a 20 percent industrial disability.
 
        
 
                                      ORDER
 
                  
 
             THEREFORE, it is ordered:
 
                  
 
             That defendants shall pay unto claimant healing period 
 
             benefits at the rate of two hundred seventy-seven and 15/100 
 
             dollars ($277.15) per week for the period beginning November 4, 
 
             1987 to January 3, 1988, inclusive, and beginning February 3, 
 
             1988 to April 12, 1988, inclusive, totaling eighteen point four 
 
             two nine (18.714) weeks.
 
             
 
             That defendants shall pay unto claimant one hundred (100) 
 
             weeks of permanent partial disability benefits at the rate of two 
 
             hundred seventy-seven and 15/100 dollars ($277.15) per week 
 
             commencing April 13, 1988.
 
             
 
            That defendants shall reimburse claimant, or the medical 
 
        provider if not already paid:
 
        
 
            A. Bluffs Neurosurgical Associates, dated
 
            February 10, 1988 through September 28, 1988    $3,690.00
 
        
 
            B. Dr. Ronald H. Dreyer, dated December 8,
 
            1984 through February 5, 1988                      418.20
 
        
 
            C. Jennie Edmundson Hospital, dated June 24,
 
            1988                                               176.73
 
        
 
            D. Medical Anesthesia Associates, P.C., dated
 
            June 29, 1988                                       33.20
 
        
 
            E. Dr. Michael N. Crawford, dated July 1988        67.10
 
        
 
            F. P.L. Meyer, D.O., dated July 27, 1988           25.00
 
        
 
            G. Dr. William R. Hamsa, Jr., dated January
 
            6, 1988                                            165.00
 
        
 
            H. Walters Pharmacy, dated February 3, 1988        20.56
 
        
 
            I. Copies of checks to Dr. Margules               256.50
 
                Copies of checks to Dr. Ronald Dreyer         368.20
 
        
 
                                     Total                  $5,220.49
 
        
 
                                     Already paid            4,108.20
 
        
 
                                     Balance                $1,112.29
 
        
 
             Defendants shall pay the accrued weekly benefits in a lump 
 
             sum and shall receive credit against the award for weekly 
 
             benefits. Defendants shall receive two thousand one hundred 
 
             fifty-eight and 50/100 dollars ($2,158.50) credit for the sick 
 
             leave benefits paid claimant.
 
        
 
             Defendants shall pay interest on benefits awarded herein as 
 
             set out in Iowa Code section 85.30.
 

 
        
 
 
 
 
 
        
 
            Defendants shall pay the costs of this action pursuant to 
 
        Division of Industrial Services Rule 343-4.33, which includes 
 
        bills of Blair & Associates in the amount of one hundred 
 
        forty-one and 50/100 dollars ($141.50); Bluffs Neurosurgical 
 
        Associates, P.C., in the amount of one hundred fifty dollars 
 
        ($150.00); Dr. Ronald Dreyer, in the amount of forty dollars 
 
        ($40.00); and Dr. William R. Hamsa, in the amount of seventy-five 
 
        dollars ($75.00). 
 
        
 
            Defendants shall file an activity report upon payment of 
 
        this award as requested by this agency pursuant to Division of 
 
        Industrial Services Rule 343-3.1.
 
        
 
            Signed and filed this 22nd day of August, 1989.
 
        
 
        
 
        
 
        
 
        
 
                                       BERNARD J. O'MALLEY
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
        
 
        Copies to:
 
        
 
        Mr. Sheldon M. Gallner
 
        Attorney at Law
 
        803 3rd Ave
 
        P.O. Box 1588
 
        Council Bluffs, IA 51502
 
        
 
        Ms. Judith Ann Higgs
 
        Attorney at Law
 
        200 Home Federal Bldg
 
        P.O. Box 3086
 
        Sioux City, IA 51102
 
        
 
        
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            KENNETH BRAASCH,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 865997
 
            FARMLAND FOODS,               :
 
                                          :        A P P E A L
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            AETNA CASUALTY & SURETY       :
 
            COMPANY,                      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 Defendants appeal from an arbitration decision awarding 
 
            20 percent industrial disability as a result of claimant's 
 
            November 4, 1987 work injury.
 
            
 
                 The record on appeal consists of the transcript of the 
 
            arbitration decision and joint exhibits 1 through 35.  
 
            Defendants filed a brief on appeal.
 
            
 
                                      issues
 
            
 
                 Defendants state the issues on appeal are:
 
            
 
                   I.  Did the Deputy industrial commissioner err 
 
                 in finding an injury which arose out of and in the 
 
                 course of claimant's employment on November 4, 
 
                 1987?
 
            
 
                  II.  Did the deputy industrial commissioner err 
 
                 in failing to find claimant's recovery was barred 
 
                 by the statute of limitations?
 
            
 
                 III.  Did the deputy industrial commissioner err 
 
                 in finding a causal connection between claimant's 
 
                 alleged injury and any disability which he now 
 
                 suffers?
 
            
 
                  IV.  Did the deputy industrial commissioner err 
 
                 in awarding healing period benefits?
 
            
 
                   V.  Did the deputy industrial commissioner err 
 
                 in finding that claimant has a 20% industrial 
 
                 disability?
 
            
 
                              review of the evidence
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 The arbitration decision filed August 22, 1989 
 
            adequately and accurately reflects the pertinent evidence 
 
            and it will not be reiterated herein.
 
            
 
                                  applicable law
 
            
 
                 The citations of law in the arbitration decision are 
 
            appropriate to the issues and evidence.
 
            
 
                                     analysis
 
            
 
                 The analysis of the evidence in conjunction with the 
 
            law in the arbitration decision is adopted.  The following 
 
            additional analysis is appropriate.
 
            
 
                 Defendants contend that claimant's injury began in 
 
            December of 1984 and did not arise out of the course of 
 
            claimant's employment on November 4, 1987.  Claimant sought 
 
            treatment in December 1984 for low back pain.  Claimant was 
 
            off work but never received workers' compensation benefits.  
 
            Claimant received conservative treatment and was released to 
 
            return to work in January 1985 without restrictions. (Joint 
 
            Exhibit 8 and 9)  While claimant's symptoms in November 1987 
 
            were similar to those claimant experienced in 1984, 
 
            claimant's November 1987 work injury was not the 
 
            continuation of claimant's 1984 injury.  Claimant returned 
 
            to work following his December 1984 injury and continued to 
 
            perform his job duties which included a great deal of heavy 
 
            lifting and bending. 
 
            
 
                 Claimant began work with defendant employer in October 
 
            1954.  Claimant worked various positions throughout 
 
            defendants operations.  Claimant began working as a 
 
            serviceman in the boning room in 1981.  Claimant's 
 
            responsibilities as a serviceman included stacking pallets 
 
            that weigh between thirty-five and seventy pounds, pulling 
 
            boxes out and folding boxes.  (Transcript, Pages 8-9)  
 
            Claimant's back injury is consistent with claimant's work 
 
            assignments.  Claimant's work required bending, twisting and 
 
            lifting heavy objects on a repetitive basis and claimant's 
 
            back injury is consistent with the work.  
 
            
 
                 In addition, defendants assert that claimant may have 
 
            been injured in June of 1987 or in February of 1988.  Dennis 
 
            Crabb, M.D., treated claimant in June of 1987 for similar 
 
            problems.  Claimant reported an incident when he was 
 
            performing duties as a volunteer fire fighter in January 
 
            1988 when he strained his back and another incident where 
 
            claimant slipped getting into a truck.  Claimant did not 
 
            miss work immediately after the January 1988 incident.
 
            
 
                 On November 4, 1987 claimant sought the treatment of 
 
            Ronald Dreyer, D.C., for low back pain that slowly began to 
 
            worsen.  Claimant received conservative treatment and was 
 
            released to return to work January 4, 1988.  Claimant 
 
            continued to experience back pain.  In February 1988 
 
            claimant was seen by Maurice P. Margules, M.D., who 
 
            diagnosed a herniated lumbar disc due to trauma initially 
 
            sustained in November 1987.  (Jt. Ex. 23, p. 2 and 
 
            Deposition of M. P. Margules, M.D., p. 17)  Claimant's prior 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            examinations revealed moderate or mild lordosis.  Surgery 
 
            was performed on February 12, 1988 by Dr. Margules who 
 
            excised large disc herniation at the L5-S1 level.  
 
            Claimant's November 4, 1987 work injury arose out of and in 
 
            the course of his employment with defendants.  Claimant 
 
            timely filed his originial notice and petition and his claim 
 
            is not barred by the statute of limitations.
 
            
 
                 On the issue of casual connection, Edward M. Schima, 
 
            M.D., was unable to pinpoint whether claimant's work or his 
 
            other activities caused his back problems.  While Dr. 
 
            Schima's clinical qualifications are impressive, he examined 
 
            claimant almost six months after claimant's surgery.  Dr. 
 
            Margules treated claimant after the onset of acute pain and 
 
            performed surgery.  Dr. Margules' opinion that there was a 
 
            causal connection between claimant's injury is given greater 
 
            weight.  Dr. Margules opined that claimant's work caused 
 
            claimant's back problems and that the cause was not due to a 
 
            specific trauma but a combination of work activities leading 
 
            to acute onset of pain.
 
            
 
                 Claimant proved entitlement to healing period benefits 
 
            from November 4, 1987 through January 4, 1988.  In addition, 
 
            claimant proved entitlement to healing period benefits from 
 
            February 3, 1988 through April 12, 1988.  Defendants contend 
 
            that claimant reinjured his back while performing his duties 
 
            as a volunteer fire fighter and claimant is not entitled to 
 
            healing period benefits during this period.  Claimant 
 
            reported that the fire fighting incident occurred on January 
 
            21, 1988.  Claimant did not miss work until February 3, 
 
            1988, more than a week after the fire fighting incident.  
 
            Claimant returned to his service line position on January 4, 
 
            1988 and performed his duties which included heavy lifting 
 
            and bending.  Claimant's pain worsened.  Claimant sought 
 
            treatment and Dr. Margules performed surgery on February 12, 
 
            1988.  Claimant proved entitlement to healing period 
 
            benefits from November 4, 1987 through January 4, 1988 and 
 
            from February 3, 1988 through April 12, 1988.
 
            
 
                 On the issue of industrial disability, claimant was 
 
            born on January 7, 1942.  Claimant completed ten years of 
 
            school and has not received his GED.  Claimant started work 
 
            with defendant employer on October 25, 1958 and is near the 
 
            top of the seniority system.  Claimant injured his back in 
 
            December 1984 but returned to work.  Claimant sought 
 
            treatment on November 4, 1987 for his low back pain.  
 
            Claimant returned to work on January 4, 1988 and performed 
 
            his same duties.  Claimant's back pain worsened and he 
 
            sought additional treatment on February 3, 1988.  Surgery 
 
            was performed February 12, 1988 for claimant's herniated 
 
            lumbar disc.  Dr. Margules opined that claimant's functional 
 
            impairment was 10 to 15 percent of the body as a whole as a 
 
            result of his back injury.  Dr. Schima opined that claimant 
 
            sustained a 10 percent functional impairment on account of 
 
            his low back condition.  Claimant suffers from a hearing 
 
            loss.  As a result of claimant's seniority, claimant 
 
            obtained a position sharpening knives which falls within 
 
            claimant's work restrictions.  Claimant is earning the same 
 
            wage as he earned prior to his work injury.  Claimant proved 
 
            entitlement to 20 percent industrial disability as a result 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            of his November 4, 1987 work injury.
 
            
 
                                 findings of fact
 
            
 
                 1.  Claimant's disability is the result of a 
 
            work-related low back repetitive injury on November 4, 1987.
 
            
 
                 2.  Claimant had a preexisting degenerative disc and 
 
            nerve root condition involving the L5 and S1 vertebrae which 
 
            was materially aggravated, accelerated and worsened by 
 
            claimant's repetitive injury on November 4, 1987.
 
            
 
                 3.  Claimant's work-related repetitive injury occurred 
 
            on November 4, 1987 and claimant's petition filed on March 
 
            10, 1988 is timely and in compliance with Iowa Code section 
 
            85.26.
 
            
 
                 4.  Claimant was born January 7, 1942.
 
            
 
                 5.  Claimant completed ten years of school and has not 
 
            received his GED.
 
            
 
                 6.  Claimant has been employed with defendant employer 
 
            since October 25, 1958 and has worked various positions in 
 
            the defendant's plant.
 
            
 
                 7.  Claimant is near the top of the seniority system at 
 
            defendant's plant.
 
            
 
                 8.  Claimant obtained a position sharpening knives that 
 
            falls within his work restrictions.  Claimant is receiving 
 
            the same wage sharpening knives as he did as a service line 
 
            person.
 
            
 
                 9.  Claimant is restricted to sedentary type of 
 
            employment and was advised to discontinue his activities as 
 
            a volunteer fire fighter.
 
            
 
                 10. Claimant incurred a 10 percent functional 
 
            impairment to the body as a whole as a result of his 
 
            repetitive work-related injury on November 4, 1987.
 
            
 
                 11. Claimant proved entitlement to healing period 
 
            benefits from November 4, 1987 to January 3, 1988, 
 
            inclusively, and from February 3, 1988 to April 12, 1988 
 
            inclusively.
 
            
 
                 12. Claimant sustained a 20 percent reduction in 
 
            earning capacity as a result of his November 4, 1987 work 
 
            injury and subsequent back surgery.
 
            
 
                 13. Claimant's medical bills in the amount of $5,220.49 
 
            are a result of claimant's November 4, 1987 work injury.
 
            
 
                 14. Claimant was paid $2,158.20 in sick leave benefits 
 
            and was paid no healing period or temporary total disability 
 
            benefits during his time off as a result of his November 4, 
 
            1987 work injury.
 
            
 
                                Conclusions of Law
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            
 
                 Claimant proved that his low back injury arose out of 
 
            and in the course of his employment on November 4, 1987.
 
            
 
                 Claimant timely filed his petition in accordance with 
 
            Iowa Code section 85.26.
 
            
 
                 Claimant proved that his November 4, 1987 work-related 
 
            low back injury is casually connected with the disability he 
 
            now suffers.
 
            
 
                 Claimant proved entitlement to healing period benefits 
 
            from November 4, 1987 to January 4, 1988, inclusively, and 
 
            February 3, 1988 to April 12, 1988, inclusively.
 
            
 
                 Claimant proved entitlement to 20 percent industrial 
 
            disability.
 
            
 
                 WHEREFORE, the decision of the deputy of affirmed.
 
            
 
                                      order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants pay unto claimant healing period 
 
            benefits at the rate of two hundred seventy-seven and 15/100 
 
            dollars ($277.15) per week for the period beginning November 
 
            4, 1987 to January 3, 1988, inclusively and beginning 
 
            February 3, 1988 to April 12, 1988, inclusively.
 
            
 
                 That defendants pay unto claimant one hundred (100) 
 
            weeks of permanent partial disability benefits at the rate 
 
            of two hundred seventy-seven and 15/100 dollars ($277.15) 
 
            per week commencing April 13, 1988.  
 
            
 
                 That defendants reimburse claimant, or the medical 
 
            provider if not already paid:
 
            
 
                 A.  Bluffs Neurosurgical Associates, dated
 
                 February 10, 1988 through September 28, 1988    
 
            $3,690.00
 
            
 
                 B.  Dr. Ronald H. Dreyer, dated December 8,
 
                 1984 through February 5, 1988                      
 
            418.20
 
            
 
                 C.  Jennie Edmundson Hospital, dated June 24,
 
                 1988                                               
 
            176.73
 
            
 
                 D.  Medical Anesthesia Associates, P. C., dated
 
                 June 29, 1988                                       
 
            33.20
 
            
 
                 E.  Dr. Michael N. Crawford, dated July 1988        
 
            67.10
 
            
 
                 F.  P. L. Meyer, D. O., dated July 27, 1988         
 
            25.00
 
            
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
                 G.  Dr. William R. Hamsa, Jr., dated January
 
                 6, 2988                                            
 
            165.00
 
            
 
                 H.  Walters Pharmacy, dated February 3, 1988        
 
            20.56
 
            
 
                 I.  Copies of checks to Dr. Margules               
 
            256.50
 
                     Copies of checks to Dr. Ronald Dreyer          
 
            368.20
 
            
 
                                          Total                  
 
            $5,220.49
 
            
 
                                          Already Paid            
 
            4,108.20
 
            
 
                                          Balance                
 
            $1,112.29
 
            
 
                 That defendants shall pay the accrued weekly benefits 
 
            in a lump sum and shall receive credit against the award for 
 
            weekly benefits.  Defendants shall receive two thousand one 
 
            hundred fifty-eight and 50/100 dollars ($2,158.50) credit 
 
            for the sick leave benefits paid claimant.
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set out in Iowa Code section 85.30.
 
            
 
                 That defendants shall pay the costs of this action 
 
            pursuant to Division of Industrial Services Rule 343-4.33, 
 
            which includes bills of Blair & Associates in the amount of 
 
            one hundred forty-one and 50/100 dollars ($141.50); Bluffs 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            Neurosurgical Associates, P.C., in the amount of one hundred 
 
            fifty dollars ($150.00); Dr. Ronald Dreyer, in the amount of 
 
            forty dollars ($40.00); and Dr. William R. Hamsa, in the 
 
            amount of seventy-five dollars ($75.00).
 
            
 
                 That defendants pay the costs of this proceeding 
 
            including the costs of transription of the arbitration 
 
            hearing.
 
            
 
                 That defendants file claim activity reports pursuant to 
 
            Division of Industrial Services Rule 343-3.1(2).
 
            
 
                 Signed and filed this ____ day of September, 1990.
 
            
 
            
 
            
 
            
 
                                          
 
            ________________________________
 
                                                   CLAIR R. CRAMER
 
                                           ACTING INDUSTRIAL 
 
            COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Sheldon M. Gallner
 
            Attorney at Law
 
            803 3rd Avenue
 
            PO Box 1588
 
            Council Bluffs, Iowa 51502
 
            
 
            Ms. Judith Ann Higgs
 
            Attorney at Law
 
            200 Home Federal Bldg.
 
            PO Box 3086
 
            Sioux City, Iowa 51102
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
                                       5-1100;5-1402.3;5-2402;5-1108;
 
                                       5-1402.40;5-1802;5-1803
 
                                       Filed September 26, 1990
 
                                       CLAIR R. CRAMER
 
         before the iowa industrial commissioner
 
         ____________________________________________________________
 
                                       :
 
         KENNETH BRAASCH,              :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :      File No. 865997
 
         FARMLAND FOODS,               :
 
                                       :        A P P E A L
 
              Employer,                :
 
                                       :      D E C I S I O N
 
         and                           :
 
                                       :
 
         AETNA CASUALTY & SURETY       :
 
         COMPANY,                      :
 
                                       :
 
              Insurance Carrier,       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         5-1100, 5-1402.3
 
         Claimant proved that his low back injury arose out of and in the 
 
         course of his employment on November 4, 1987.
 
         
 
         5-2402
 
         Claimant timely filed his petition in accordance with Iowa Code 
 
         section 85.26.
 
         
 
         5-1108, 5-1402.40
 
         Claimant proved that his November 4, 1987 work-related low back 
 
         injury is causally connected with the disability he now suffers.
 
         
 
         5-1802
 
         Claimant proved entitlement to healing period benefits from 
 
         November 4, 1987 to January 4, 1988, inclusively and February 3, 
 
         1988 to April 12, 1988 inclusively.
 
         
 
         5-1803
 
         Claimant proved entitlement to 20 percent industrial disability.
 
         
 
 
        
 
 
 
 
 
        
 
                                       5-1803; 5-1100; 5-1108;
 
                                       5-1402.30; 5-1402.40
 
                                       5-1701; 5-2402; 2206
 
                                       Filed August 22, 1989
 
                                       Bernard J. O'Malley
 
        
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        KENNETH BRAASCH,
 
        
 
            Claimant,
 
                                                       File No. 865997
 
        vs.
 
        
 
        FARMLAND FOODS,                                A R B I T R A T I 
 
        O N
 
        
 
            Employer,                                 D E C I S I O N
 
        
 
        and
 
        
 
        AETNA CASUALTY & SURETY
 
        COMPANY,
 
        
 
             Insurance Carrier,
 
             Defendants.
 
             
 
             
 
        5-1100; 5-1402.30
 
        
 
             Claimant proved his injury arose out of and in the course of 
 
             his employment. This 47-year-old claimant worked almost 31 years 
 
             for defendant employer.
 
        
 
        5-1108; 5-1402.40
 
        
 
             Claimant proved his disability was causally connected to his 
 
             injury.
 
        
 
        2206
 
        
 
             Claimant had a preexisting degenerative disc and nerve root 
 
             condition which was materially aggravated, accelerated and 
 
             worsened by claimant's repetitive injury on November 4, 1987.
 
        
 
        5-2402
 
        
 
             Claimant was found to have a repetitive work injury on 
 
             November 4, 1987; therefore, claimant's petition filed March 10, 
 
             1988 was timely as per 85.26, Iowa Code.
 
        
 
        5-1803
 
        
 
             Claimant incurred a 20 percent industrial disability as a 
 
             result of his repetitive work-related injury.
 
        
 
        5-1701
 
        
 
             Defendants received credit for the sick pay that was paid 
 
             claimant during his healing period.