before the iowa industrial commissioner ____________________________________________________________ : PAUL D. LONGFELLOW, : : Claimant, : : vs. : : File No. 872842 GREENFIELD EQUIPMENT CO., : : A P P E A L Employer, : : D E C I S I O N and : : FEDERATED INSURANCE, : : Insurance Carrier, : Defendants. : ___________________________________________________________ The record, including the transcript of the hearing before the deputy and all exhibits admitted into the record, has been reviewed de novo on appeal. The decision of the deputy filed May 10, 1990 is affirmed and is adopted as the final agency action in this case. Claimant shall pay the costs of the appeal, including the preparation of the hearing transcript. Signed and filed this ____ day of September, 1991. ________________________________ BYRON K. ORTON INDUSTRIAL COMMISSIONER Copies To: Mr. C. R. Hannan Attorney at Law 215 South Main Street P.O. Box 1016 Council Bluffs, Iowa 51502 Mr. Frank T. Harrison Attorney at Law 2700 Grand Ave., Suite 111 Des Moines, Iowa 50312 9998 Filed September 17, 1991 Byron K. Orton DRR before the iowa industrial commissioner ____________________________________________________________ : PAUL D. LONGFELLOW, : : Claimant, : : vs. : : File No. 872842 GREENFIELD EQUIPMENT CO., : : A P P E A L Employer, : : D E C I S I O N and : : FEDERATED INSURANCE, : : Insurance Carrier, : Defendants. : ___________________________________________________________ 9998 Summary affirmance of deputy's decision filed May 10, 1991. BEFORE THE IOWA INDUSTRIAL COMMISSIONER PAUL D. LONGFELLOW, Claimant, VS. File No. 872842 GREENFIELD EQUIPMENT CO., A R B I T R A T I 0 N Employer, D E C I S I 0 N and FEDERATED INSURANCE, Insurance Carrier, Defendants. STATEMENT OF THE CASE This is a proceeding in arbitration brought by claimant Paul D. Longfellow against defendant employer Greenfield Equipment Company and defendant insurance carrier Federated Insurance to recover benefits under the Iowa Workers, Compensation Act as the result of an injury sustained on December .28, 1987. This matter came on for hearing before the undersigned in Council Bluffs, Iowa, on June 26, 1989. The cause was considered fully submitted at the close of hearing. The record in the proceeding consists of claimant's exhibits A through E, defendants' exhibits A through F, both inclusive, and the testimony of claimant, Anita Longfellow, and Dennis Derr. ISSUES Pursuant to the prehearing report submitted by the parties and approved at hearing, the following issues have been stipulated: that an employment relationship existed between claimant and employer on December 28, 1987; that claimant sustained an injury on December 28, 1987, arising out of and in the course of that employment; that the injury caused temporary disability; that if claimant has sustained permanent disability, it is an industrial disability to the body as a whole; that affirmative defenses are waived; that the fees charged for medical services and supplies are fair LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 2 and reasonable and the expenses were incurred for reasonable and necessary medical treatment; that defendants voluntarily paid 19.429 weeks of compensation at the rate of $200.14 per week prior to hearing. Issues presented for resolution include: whether the work injury caused permanent disability; the extent of claimant's entitlement to compensation for temporary and permanent disability and the commencement date of the latter; the rate of compensation (although the parties stipulated to gross weekly earnings of $311.00, a marital status of married and four exemptions); the extent of claimant's entitlement to medical benefits and whether the same are casually connected to the work injury and authorized by defendants; taxation of costs. REVIEW OF THE EVIDENCE Claimant, age 48, testified that he had never sought medical help or missed work with respect to back problems prior to the subject injury. He described the injury as occurring when he was putting field cultivators together and picking up a shank; while attempting to put one shank on a frame, he suffered a "catch" in his back from a bending position. Claimant lay down for approximately five minutes, but felt no better and had trouble getting up. He immediately made an appointment with a chiropractor, Dr. Katio, but felt no better. Thereafter, claimant was seen and/or treated by a succession of physicians, including John L. Hoyt, M.D., Wayne Madden, D.C., S. Randy Winston, M.D., Michael J. Morrison, M.D., Leonard E. Weber, M.D., and 46 Maurice P. Margules, M. D. Claimant eventually underwent surgery at the hands of Dr. Margules. He has not sought work since and indicated that he is unable to participate in heavy lifting, farm work or riding long distances in a vehicle. Claimant agreed that he advised an insurance adjuster that he had thrown his back out eight years before. However, he testified that Dr. Margules was incorrect in making a chart note that claimant's back began hurting in September, 1987 when riding in a truck. Claimant insisted that he has advised all of his physicians that he suffered numbness and tingling in his legs, except perhaps during the first months following his injury when he was laid up from pain. LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 3 Anita Longfellow, claimant's wife, testified that she was aware of no specific incident between March and July, 1988, that exacerbated claimant's back condition. Dr. Katio's surgeon's report of January 22, 1988, reflects that claimant was treated by spinal manipulation on December 29, 1987. Although his handwriting is difficult for this reader, it appears that he diagnosed lumbar strain complicated by lumbar facet syndrome. Claimant was advised to seek further help elsewhere to complete his care as Dr. Katio was leaving on vacation. John L. Hoyt, M.D., reported seeing claimant on January 5, 1988. His objective findings were of possible degenerative disc disease, but no overt signs of herniated disc as yet. He noted that there was no radiation down either leg, although claimant had aggravation of back pain on cough and was in obvious distress, suffering muscle spasm and pain. He reported further on January 8, 1988, that CT scan showed no bulging. Wayne J. Madden, D.C., saw claimant on January 12, 1988 and treated him with spinal manipulation. His findings were of acute severe lumbosacral strain. S. Randy Winston, M.D., reported on January 26, 1988 that claimant had injured himself experiencing some pain on the left side adjacent to the L4-5 level, and that he had a little radiation to the left hip and buttocks that had improved over the last several weeks with treatment. A review of a CAT scan of the lumbar spine was negative with respect to nerve root impingement, but he did identify a chip, new or old, at the lumbosacral joint on the left. Dr. Winston reported on April 20, 1988 that claimant suffered pain in the back and both legs to the knees, left more than right. Straight leg raising was negative. His impression was of chronic recurrent strain. On July 15, 1988, Dr. Winston reported claimant's complaint of numbness to the left lower extremity, worse now with walking and standing. On July 18, he reported to Dr. Madden that an MRI had been performed and showed a massive herniation at the L3-4 level. Dr. Winston finally reported on October 3, 1988 that claimant needed.a lumbar laminectomy and was to have had surgery on July 28, 1988, but responsibility was denied by the workers' compensation insurance carrier. Maurice P. Margules, M.D., testified by deposition on October 19, 1988 that he first met claimant on July 20, LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 4 1988. Claimant was hospitalized at Jennie Edmundson Memorial Hospital on July 21, 1988 and underwent surgery on July 27, being discharged on August 2. Dr. Margules' discharge summary reflected that claimant stated he was free of any problems until September, 1987, when he was driving a truck with an uncomfortable seat, and that he thereafter was suddenly seized with extremely severe pain in the lumbar region with pain and paresthesia in both lower extremities on December 29, 1987. He noted that MRI imaging was interpreted to show evidence of a massive disc herniation at L3-4 as well as some degenerative disc problem at L4-5. X-rays read by Creed Abell, M.D., on July 21, 1988, showed lumbar disc spaces to have a normal appearance. However, a myelogram performed on July 22, 1988 and read by C. Morris, M.D., showed a defect at L3-L4 and changes consistent with essentially central disc herniation at that level. A CT lumbar spine read the same day by Dr. Morris indicated a herniated L3-L4 disc with prominent effacement of the thecal sac. Dr. Winston had previously ordered magnetic resonance imaging on July 11, 1988. Radiologist Dr. Disbrow noted a massive central and left-sided herniated nucleus pulposis at L3-4 resulting in significant spinal stenosis with U-shaped deformity of the thecal sac measuring 2.5 millimeters. Disc degeneration with noncompressive disc bulge was seen at L4-L5. Dr. Winston's notes of July 27, 1988 concurred with this reading. Claimant was seen for evaluation by Michael J. Morrison, M.D., on April 5, 1988. Dr. Morrison's letter of the following day noted no evidence of nerve root irritation in the form of muscle weakness or atrophy, reflex changes or straight leg raising findings. He believed that claimant had reached maximum medical recovery and could return back to his job duties within 3-4 weeks following a program of weight reduction, muscle rehabilitation and stretching exercises to the lower back supplemented with bicycle riding and/or swimming and a program of anti-inflammatory medication. His permanency was expected to be "quite minimal to none." Claimant was also seen for evaluation by Leonard E. Weber, M.D., on April 5, 1988. Dr. Weber's letter of April 8 noted his impression of lumbosacral strain, resolving, with objectively normal neurologic examination. Computerized tomographic scanning did not show any evidence of disc herniation. Possible diagnoses included muscle strain, ligamentous strain or a tear in the annulus fibrosis of a disc, without overt herniation. Dr.. Weber found LONGFELLOW v. GREENFIELD EQUIPMENT Co. Page 5 claimant to be around the point of maximum medical recovery from a "practical standpoint." He believed that claimant could resume job activities at that time, but that limitations might be the avoidance of lifting more than 20 pounds frequently or 40 pounds occasionally, all lifting to be done from a squat position. After a month or so, weight limitations could be dropped, but claimant should still concentrate on proper lifting techniques. Dr. Weber found no permanent impairment. In his deposition, Dr. Margules testified that claimant's history was of pain in the lumbar region and the lower extremities posteriorly, left more severe than right. Claimant was described as "very specific" as to the onset of his problems, noting the truck incident of September, 1987. The December 29 lifting incident was of sudden seizure with extremely severe pain in the lumbar region and paresthesia in both lower extremities; prior thereto pain was located in the lumbar region, but radicular pain and paresthesia in the lower extremities occurred at and after the time of the subject injury. Past history was described as totally noncontributory to the onset of the problem in September, 1987. Based on claimant's history, Dr. Margules testified that the December 29, 1987 incident was the event that caused the acute herniation of his disc between the third and fourth lumbar vertebrae. The pain in claimant's lower extremities was caused by the compression of the nerve root by the disc herniation. At page 15 of his deposition, Dr. Margules stressed that paresthesia in the lower extremities was the important clinical manifestation of the herniation, because that symptom would not normally appear as the result of a sprain. The following exchange occurred on cross-examination: Q. If a computed tomography procedure was carried out in January which showed no disc herniation, would that be strong evidence that something happened after January that would more than slightly have aggravated his condition? A. January of-- Q. '88. A.--of '88? Well, yes, I must, though, say that we would--we were speaking of a computed tomography performed without contrast media. Yes, I'm sure it is. Because it's not used usually. LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 6 yes, it would be of some--indicating that maybe something occurred after that. Q. All right. You haven't seen the report or the tomography that was done in January? A. No, I haven't. (Dr. Margules deposition, page 21, line 21 through page 22, line 11) Dr. Margules also indicated that he did not consider computerized tomography without contrast media to be a reliable study and that he would not diagnose or undertake surgery on that basis. Dr. Margules was unable to rate claimant's impairment at the time of his deposition, but in a letter of April 26, 1989, opined that claimant had sustained a 15 percent permanent partial impairment of the body as a whole as a result of the subject injury. Dr. Morrison, a board-certified orthopaedic surgeon, testified by deposition on May 24, 1989. Dr. Morrison saw claimant on April 5 and again on July 26, 1988. In April, Dr. Morrison found that claimant walked without a limp, had normal toe-heel gait, no list or spasm in the back, no gross muscle weakness in either extremity, normal knee and ankle jerk reflexes and negative bilateral straight leg raising. He felt these findings were significant as not showing any weakness in either lower leg or significant pain that might cause limping. Claimant complained at examination of pain in the lower back with radiation (not paresthesia) to the leg. Dr. Morrison found no objective evidence of nerve root irritation on April 5, 1988. Impairment was minimal to none based on the fact that ,there were no objective physical findings. However, claimant's condition had changed rather dramatically when he was next seen on July 26, 1988. Claimant had significant evidence of nerve root irritation with straight leg raising, some spasm and some inability to stand erect. Dr. Morrison testified that he reviewed the January 5, 1988 CT scan and found no evidence of disc herniation or bulging of the disc at the levels examined. Dr. Morrison further testified that if the findings of the July magnetic resonance imaging test (massive central and left-sided herniated nucleus pulposis) had been the.case in April, he LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 7 would have expected the clinical picture in that,month to have been different. His conclusion was that claimant's injury carried some potential of causing a disc rupture, but that CT scans were not inconclusive for disc herniation and in April claimant showed no objective evidence of nerve root irritation and a negative CT scan; he concluded that claimant did not rupture a disc at the time of injury, but had strained his lower back. When he presented in July, 1988, claimant's picture was quite different and he obviously had a rather severe disc herniation requiring surgical intervention. Dr. Morrison also noted that the CT scan of January, 1988 was of acceptable quality and the radiologist that read it at that time was very qualified. He also stated that if the findings of the magnetic resonance imaging test in July had been present in January, "that easily could have been detectable on the CAT scan." Dr. Morrison testified that it was possible that the work injury had perhaps stretched or torn a ligament and led to the earlier incipient stages of a disc bulging or herniation, but there was no way to objectively document that injury until the disc becomes a bulging injury or an actual herniation. Claimant's condition in July could even have resulted from an injury the day before, although there was no history of any traumatic incident during the interim period. Leonard E. Weber, M.D., a board-certified neurologist, also testified by deposition on May 24, 1989. Dr. Weber saw claimant for evaluation on April 5, 1988. Dr. Weber discussed muscular and ligamentous strains and disc herniations in some detail. He noted that many of the symptoms can be identical. For example,.a herniated disc might not press onto nerve roots or the spinal canal and would have no symptoms of pain, numbness or weakness and could only be diagnosed on radiological evidence. Likewise, a muscle strain or ligament strain can cause referred pain into the lower extremities. The presence of radiculopathy or root-type syndromes makes a disc injury more.likely, but the absence is not necessarily helpful one way or the other. When claimant was seen, he gave a history of some past back discomfort and had some discomfort, on examination, but there had been approximately a 2-3 week period without the discomfort previously described. The doctor found claimant to have normal station, gait, and gait on heels and toes will full strength in all extremities. The significance is that the converse would suggest there had been a nerve root injury. Claimant had normal tone, no atrophy and no LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 8 fasciculations and sensory examination was normal. Again, a change in sensation that corresponds to the territory supplied by a particular nerve root is an indication there has been an injury to that nerve root. Dr. Weber understood that claimant had discomfort on the back of both thighs which sometimes goes down to the back of the calves like a muscle spasms that would occur on a daily basis with certain movements (e.g., getting in or out of a car), but he did not understand this "discomfort" to be pain or numbness. Deep tendon reflexes were normal, claimant had no pathological reflexes, and had full range of motion in the back except forward flexion. Extension was normal except for some midline discomfort at L4-L5. Claimant's lumbosacral paraspinous muscles were normal in tone. Dr. Weber's impression was of lumbosacral strain that was apparently resolving; neurologic examination was objectively normal except for some mild limitation of motion on forward flexion and some mild discomfort of the low back on extension. There was nothing clinical in the examination that would indicate pathology beyond that of a lumbosacral strain. With respect to the January CT scan, Dr. Weber indicated that he has not been formally trained in radiology and defers to the radiologist. On cross-examination, the following exchange occurred: Q. He also had radicular pain, I believe you said, into the hips and extending down the thighs. A. No that's not true. He had pain extending to those areas, but not necessarily radicular since we know that muscle strain or ligament strain can refer an identical pain down to the hips. In fact, when you have pain going to both thighs and not going below the thighs, simply on one side, it's more likely this is a referred pain of muscular ligamentous nature--unless you have a severe central herniation. (Dr. Weber deposition, page 27, lines 14 through 23) With respect to the July 11 MRI finding the massive central and left-sided herniated nucleus pulposis, Dr. Weber indicated that these findings were inconsistent with his April examination because of the relative lack of symptoms on the earlier occasion. LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 9 With respect to Dr. Margules' history and findings, Dr. Weber found some significant differences, particularly of paresthesia in both lower extremities at the time of the pain in the lumbar region on December 29. The following exchange occurred: Q. Is there anything in that history occurring after the December 29th date that indicates that there is another causative factor? A. Well, the report of the magnetic resonance imaging scanning showing what is interpreted as massive disc herniation at L3-4 certainly is a finding that would suggest a different diagnosis at this time. Q. A different diagnosis, Doctor, but a different causative factor? A. Of the symptoms that he was having at that time? Q. Yes, sir. A. That's what I'm saying. The CT scan not showing evidence of central disc herniation and the examination being essentially normal except for some limitation of motion of forward flexion and extension at the time of my examination, there are several things that this could be. It could be a disc tear, it could be a muscle strain, or it could be a ligamentous strain. The examination of Dr. Margules on July 21st of 1988 with paresthesia provoked by straight leg raising and the findings of magnetic scan with central disc herniation would lead him to the diagnosis that the paresthesia and the pain that he would be having at that time would likely be due to the disc herniation itself. Q. Okay. A. So Dr. Margules and I would differ in our conclusions at different points in time. (Dr. Weber deposition, page 39, line 5 through page 40, line 6) LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 10 And: Q. Doctor, if Mr. Longfellow had had a massive central and left-sided herniated nucleus pulposus resulting in significant spinal stenosis with a U-shaped deformity of the thecal sac measuring 2-1/2 millimeters on April 5th, 1988, would you have expected his symptom picture to be different when he saw you? A. Yes, sir. (Dr. Weber deposition, page 44, lines 19 through 25) APPLICABLE LAW AND ANALYSIS As has been seen, the parties have stipulated that claimant sustained an injury arising out of and in the course of his employment on December 28, 1987. It is not truly disputed that claimant eventually found himself in such a condition that back surgery was required in July, 1988. The fighting issue in this case is whether claimant has established the requisite casual nexus between the work injury and his condition some seven months later. The claimant has the burden of proving by a preponderance of the evidence that the injury of December 28, 1987 is casually 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. 0. 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 casual 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 casual connection. Burt, 247 Iowa 691, 73 N.W.2d 732. The opinion of experts need not be couched in definite, positive or unequivocal language. Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974). However, the expert opinion may be accepted or rejected, in whole or in part, by the trier of fact. Id. at 907. Further, the weight.to be given to such an opinion is for the finder of fact, and that may be . affected by the completeness of the premise given the expert and other surrounding circumstances. Bodish, 257 Iowa 516, 133 N.W.2d 867. See also Musselman v. Central Telephone Co. , 261 Iowa 352, 154 N.W.2d 128 (1967). LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 11 There is a difference in medical opinion on this crucial issue. Dr. Margules was the treating physician, at least insofar as claimant's surgical procedure. However, it is not necessarily the case that a treating physician's testimony is to be given more weight than that of a physician who examines claimant only in anticipation of litigation. Rockwell Graphics Systems, Inc. v. Prince, 366 N.W.2d 187 (Iowa 1985). Factors such as education, compensation, experience, the date of the examination and certification may go to the value of an individual physician's testimony as a question of fact, not law. A physician's experience may accord his or her testimony greater weight. Reiland v. Palco, Inc., 32nd Biennial Report of the Industrial Commissioner 56 (1975). As has been seen, claimant was first seen by a practitioner of chiropractic, Dr. Katio. Dr. Katio diagnosed lumbar strain, but there is no indication in this record as to the extent of claimant's complaints on the day of injury, particularly whether he immediately suffered radicular pain or paresthesia. Dr. Hoyt is the first physician to note of record what claimant's initial complaints may have been and specified that there was no radiation down either leg. His impression was of possible degenerative disc disease, but he saw no overt signs of herniated disc. His view of the initial CT scan was that there was no evidence of bulging. Dr. Winston found that claimant had a little radiation to the left hip and buttocks that had improved over the last several weeks, but found claimant's CT scan and neurologic examination to be negative with respect to nerve root impingement. It was only in July that Dr. Winston found the MRI to indicate a massive herniation at L3-4. Claimant was also treated by Dr. Madden, whose records do not show any discussion of radicular symptoms. Dr. Madden found claimant to suffer an acute severe lumbosacral strain. Claimant was seen for evaluation by a board-certified neurologist, Leonard Weber, and a board-certified orthopaedic surgeon, Michael Morrison, on April 5, 1988. Dr. Winston diagnosed resolving lumbosacral strain and Dr. Morrison had an impression of lumbar strain. Both physicians found claimant's neurological examination to be normal. Neither physician found evidence of a disc herniation. When Dr. Weber eventually reviewed the CT scan done in January, 1988, he agreed that it did not indicate any herniation or disc bulging. Asked about radicular pain, Dr. Weber noted that claimant had pain extending into the LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 12 lower extremities, but not necessarily radicular in nature since muscle strain or ligament strain can refer an identical pain down to the hips. He stated that when an individual has pain going to both thighs and not below, it is more likely to be a referred pain of muscular or ligamentous nature unless a severe central herniation exists. Dr. Weber testified that it would surprise him that surgery was done unless there was some sort of exacerbation and new findings on examination or by radiographic testing. Of course, there were new findings by radiographic testing. Magnetic resonance imaging of July 27, 1988 showed a massive central and left-sided herniated nucleus pulposis resulting in significant spinal stenosis with a 2.5 millimeter U-shaped deformity of the thecal sac. Dr. Weber further testified that findings of such significance should have appeared on the January CT scan if they had existed at that time. It was on July 15 that-claimant returned to see Dr. Winston complaining of numbness in the left lower extremity, worse now with walking and standing. Dr. Margules opined that claimant's herniation did occur at the time of the work injury. This was based on claimant's history, particularly including paresthesia since that date and continuing. The record evidenced does not convince this observer that such was the case. Dr. Morrison demonstrated that claimant had no paresthesia when seen on April 5 and believed that claimant's clinical condition had changed dramatically between then and when he was seen again in July, there being on the latter date significant evidence of nerve root irritation. Similarly, Dr. Morrison did not believe the January CT scan showed evidence of disc herniation (relying on the interpretation of the radiologist) and believed that the clinical picture claimant presented in April would have been different if a herniation existed at that time. This writer finds the opinions of Dr. Morrison and Dr. Weber to be more persuasive than that of Dr. Margules in that the history relied upon by Dr. Margules appears inaccurate and the clinical findings of Drs. Morrison and weber indicate that claimant did not suffer from a herniated disc in April, 1988. He certainly did thereafter, but it is unclear how this exacerbation came to pass. Where a work injury has been established, the employer is liable for all consequences that naturally and proximately flow from the original accident. Oldham v. Scofield & Welch, 222 Iowa 764, 266 N.W. 480 (1936). That is to say, naturally occurring sequelae of an original injury are compensable. However, it cannot be said on the LONGFELLOW v. GREENFIELD EQUIPMENT Co. Page 13 state of this record that claimant's eventual disc herniation has been shown to be a naturally occurring sequela of the original injury. Claimant has failed to establish by his burden of proof that his condition in July, 1988 was caused by the original work injury. Drs. Morrison and Weber found that claimant had sustained either minimal or no permanent impairment as of April, 1988, before the manifestation of his disc herniation. This is the best evidence as to his level of impairment resulting from the work injury. It is therefore held that claimant has failed to establish that he sustained permanent disability resulting from the subject work injury. The parties have stipulated that claimant sustained temporary disability by reason of the work injury. Under Iowa Code sections 85.33 and 85.32, temporary total disability is payable until the employee has returned to work or is medically capable of returning to employment substantially similar to that in which he was engaged at the time of injury, whichever first occurs. In this case, claimant has never returned to work. The best evidence, that of Drs. Morrison and Weber, is that claimant could have returned to unrestricted work 3-4 weeks following April 5, 1988. Using the four-week alternative as more realistically allowing the greater leeway, it is held that claimant's period of temporary total disability began on December 28, 1987 and extended through May 3, 1988, a total of 18 weeks, zero days. The parties stipulated to a gross average weekly wage of $311.00, a marital status of married, and an entitlement to four exemptions. A review of the "Guide to Iowa Workers' Compensation Claim Handling" published by this agency and effective July 1, 1987 indicates that an individual so situated is entitled to a benefit rate of $208.85. Therefore, claimant is entitled to temporary total disability benefits totalling $3,759.30. Medical expenses are also at issue. A review of the medical bills submitted indicates that they either relate to care and treatment after the herniation that is found not casually related to the original injury, or were not authorized (Nebraska-Iowa Radiology Consultants, Inc., exhibit B4; Creston Medical Clinic, exhibit B5; Dr. Madden, exhibit B6). A failure of authorization for medical treatment is a defense. Jeffrey v. Jack A. Schroeder Inc., 32nd Biennial Report of the Industrial Commissioner 121 (1974). All the medical bills submitted either lack a casual nexus to the original work injury or have not been LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 14 shown to be authorized. Therefore, medical benefits shall not be awarded under Iowa Code section 85.27. FINDINGS OF FACT THEREFORE, based on the evidence presented, the following ultimate facts are found: 1. As stipulated, claimant sustained an injury arising out of and in the course of his employment on December 28, 1987. 2. Claimant's injury has not been shown to be other than a lumbar strain or sprain which was expected to completely resolve, although claimant later in an unknown fashion exacerbated his back condition, suffering a herniated disc at L3-L4. 3. Claimant was disabled from work by reason of his stipulated work injury from December 28, 1987 through May 3, 1988 (18 weeks). 4. Although claimant eventually underwent surgery for his herniated disc, he has not shown that this exacerbation bears a casual relationship to the original work injury. 5. As stipulated, claimant had gross weekly earnings of $311.00, was married and had four exemptions at the time of the work injury. 6. Various medical expenses claimed in this case either were unauthorized or have not been shown to bear a casual relationship to the work injury. 7. As stipulated, defendants voluntarily paid claimant 19.429 weeks of compensation at the rate of $200.14 per week prior to hearing. This totals $3,888.52, which is in excess of claimant's entitlement. CONCLUSIONS OF LAW WHEREFORE, based on the principles of law previously cited, the following conclusions of law are made: 1. By reason of his stipulated work injury of December 28, 1987, claimant is entitled to temporary total disability benefits from that date through May 3, 1988 (18 weeks, zero days). 2. Claimant has failed to establish by his burden of proof that he sustained permanent industrial disability by LONGFELLOW v. GREENFIELD EQUIPMENT CO. Page 15 reason of the work injury, although he later suffered an exacerbation of unknown etiology. 3. Claimant's appropriate rate of compensation is $208.85 per week. 4. Claimant is not entitled to medical benefits under Iowa Code section 85.27 because incurred expenses either were unauthorized or lack a casual relationship to the work injury. 5. Defendants have voluntarily paid claimant temporary total disability benefits in excess of his entitlement. ORDER IT IS THEREFORE ORDERED: Claimant shall take nothing from this proceeding. Costs of this action shall be assessed to defendants pursuant to Division of Industrial Services Rule 343-4.33. Signed and filed this 10th day of May, 1990. DAVID RASEY DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr. C. R. Hannan Attorney at Law 215 South Main Street P.O. Box 1016 Council Bluffs, Iowa 51502 Mr. Frank T. Harrison Attorney at Law Suite 111, Terrace Center 2700 Grand Avenue Des Moines, Iowa 50312 1402 40 Filed May 10, 1990 DAVID RASEY BEFORE THE IOWA INDUSTRIAL COMMISSIONER PAUL D. LONGFELLOW, Claimant, VS. File No. 872842 GREENFIELD EQUIPMENT CO., A R B I T R A T I 0 N Employer, D E C I S I 0 N and FEDERATED INSURANCE, Insurance Carrier, Defendants. 1402.40 Claimant suffered stipulated back injury, but had no immediate ' complaints of radicular pain or paresthesia. CT scan showed no defect. Three months later, two boardcertified physicians diagnosed only resolving lumbar strain. Three months after that, claimant developed severe symptoms and was found to have suffered a massive disc herniation at L3-4. Surgeon opined that casual relationship existed, but based opinion on inaccurate history. opinions of evaluating physicians were accepted as consistent with history and clinical findings. Herniation found to be of unknown etiology and not proven to be sequela of injury. No. permanency was awarded. Page 1 before the iowa industrial commissioner ____________________________________________________________ : BARBARA STEELE, : : Claimant, : : File No. 873175 vs. : : MORSE RUBBER PRODUCTS COMPANY,: A R B I T R A T I O N : : D E C I S I O N Employer, : : and : : FIREMAN'S FUND INSURANCE CO., : : Insurance Carrier, : Defendants. : ___________________________________________________________ statement of the case This case came on for hearing on September 5, 1990, in Burlington, Iowa. This is a proceeding in arbitration where claimant seeks compensation for permanent partial disability benefits as a result of an alleged injury occurring on January 12, 1988. The record in the proceeding consists of the testimony of claimant and Joyce Patterson; and joint exhibits A, B, D through H, and 1 through 45. (The parties marked exhibits as each party's individual exhibits but, in fact, agreed they all should be joint.) At the time of this hearing on September 5, 1990, the attorneys referred to a prior case of Barbara Steele (File No. 816371) which was heard in February of 1990 by another deputy. The parties requested that the undersigned deputy take official notice of said decision and referred to it as exhibit 42 but mentioned that said decision had not yet been written. It was the belief of all concerned that it would be expeditious and advisable to wait, if possible, on the decision of the prior case as that decision may affect the party and the case herein under consideration. The undersigned has waited for that decision to be filed. That decision has now been filed as of October 30, 1990, and the undersigned will take official notice of that decision. Page 2 issues The issues for resolution are: 1. Whether claimant's January 12, 1988 injury arose out of and in the course of her employment; 2. Whether claimant's alleged disability is causally connected to her January 12, 1988 injury; and, 3. The nature and extent of claimant's disability and entitlement to disability benefits. findings of fact The undersigned deputy having heard the testimony and considered all the evidence, finds that: Claimant testified at the hearing and by way of her deposition on August 6, 1990. Claimant is 56 years old and completed the eleventh grade and does have her GED. Her work history has mainly been in production and factory work. Claimant has worked 15 years for defendant employer. Claimant related her February 11, 1986 work injury which went to hearing and is represented by the decision in File No. 816371 filed October 30, 1990. In that decision, claimant was awarded 25 percent industrial disability as a result of a 15 percent permanent impairment to her body as a whole due to an injury to her lower back. Claimant had been released to return to work with no restrictions as a result of the 1986 injury. Claimant related a 1987 injury in which she slipped and fell on a rowing machine and cut her Achilles tendon in two. Claimant contends she does little housework and says she can hardly bend over, carry, lift, sweep, vacuum, or do any work which would require her to reach because of her injuries and medical condition. Claimant contends she was not able to do all the above after her 1986 injury, but she said she is more limited now because of her January 12, 1988 injury. Claimant acknowledged she could not do much of the above after her 1986 injury and contends she and can't do them now. Claimant related her work history. Claimant has worked for defendant employer over a period of approximately 15 years beginning in 1973. She described the various jobs she has done for defendant employer. Claimant incurred a decompressive laminectomy at L4-5 on June 16, 1986. Claimant eventually returned to full-time work on December 23, 1987 with the approval of Jerry L. Jochims, M.D. At that time, claimant had a 20 to 30 pound weight restriction. Claimant had gradually worked up to this return to full-time work by working limited hours, basically 20 hours per week. Prior to claimant's return to work, claimant also had a cut Achilles tendon in May 1987 that kept her off work until October 1987. Since the holiday season and the defendant employer's two week Page 3 shutdown was in effect during this period when she returned to work, claimant actually worked three to four days full-time until she got hurt on January 12, 1988, while bending over and pounding the doffers (Joint Exhibit B, p. 35). Claimant hurt so bad she was taken to the hospital and put in traction. She was treated by Dr. Jochims, who was the treating doctor during her first injury in 1986. He kept her off work and she never has worked since. Claimant contends she could never again do the same work she was doing at the time of this January 12, 1988 injury. Claimant described a doffer as a piece of equipment that is in a cotton picker. It is a small rubber on a metal piece weighing one to one and one-half pounds which are stacked 100 in a box. In order to stack them, a person must bend over the box and use a mallet to pound them in the box so they fit. Claimant acknowledged she has not been without pain and has hurt a lot since her 1986 injury, but indicated she could tolerate it. She indicated she couldn't tolerate the pain after her January 12, 1988 injury (Jt. Ex. B, p. 37). Claimant testified that just prior to returning to work full-time December 23, 1987, she was working twenty hours per week and was in pain and agony but emphasized she could not financially afford to be on a twenty hour work week no matter how bad she hurt (Jt. Ex. B, p. 41). Claimant said she has pain in the same location now as she had after her first injury in 1986. Claimant refused to tell her weight during her testimony but admitted she is heavier now than she has ever been. She said she uses the TENS unit a lot. This unit was prescribed on February 17, 1988 (Jt. Ex. 21) by William A. Roberts, M.D., an orthopedic surgeon. Claimant has not worked since her January 12, 1988 injury at defendant employer and did apply for unemployment and received some benefits. She was later requested to return her benefits. Claimant contends she did look for some jobs but it appears she was not very industrious about it. Claimant hasn't looked for work since early 1988 (Jt. Ex. B, p. 48). She said she does not intend to work unless her condition improves. She is receiving social security benefits which are now $507 per month. Social security benefits originally began in March 1988. Claimant also receives $130 per month disability from defendant employer. Claimant said she has a bad heart and has had heart trouble for 20 years. The parties submitted numerous exhibits which were obviously a part of claimant's February 8, 1990 hearing (File No. 816371). The undersigned is not going to look behind the decision findings of Deputy Industrial Commissioner David Rasey regarding the above decision and hearing on February 8, 1990. The undersigned will take official notice of the decision of Deputy David Rasey. The undersigned, for purposes of this current decision, is presuming Deputy Rasey's decision will stand up under any appeal proceedings. Page 4 The parties have not done a good job of numbering exhibits. The parties submitted all the exhibits as joint exhibits even though they may be marked otherwise. Defendant's exhibit D shows that all the employees were terminated by defendant employer on July 15, 1988 because the company's assets were sold. The notes of William A. Roberts, M.D., dated April 13, 1988, reflects claimant's functional capacity test showed a lifting limitation and the doctor set a "no repetitive lifting of greater than 15 lbs." and "no repetitive bending, stooping or reaching" restriction. The doctor said claimant reached maximum recovery March 23, 1988 (Jt. Ex. 20, p. 96). On February 23, 1990, Dr. Roberts opined in his report that claimant had a 9 percent permanent partial impairment to her body as a whole. He indicated he reviewed the claimant's prior medical records but he would not address how her restrictions or impairments would have varied between claimant's 1986 and 1988 injuries (Jt. Ex. 40). Dr. Roberts testified by way of his deposition on March 13, 1990 (Jt. Ex. 43). His first contact with claimant was on January 20, 1988. The doctor opined that, based on claimant's medical history, claimant did aggravate a preexisting condition on January 12, 1988, and that some undetermined amount of permanent impairment resulted from this aggravation (Jt. Ex. 43, p. 9). Although the doctor could not determine the division of any degree of permanent impairment, it is obvious that if he had known of claimant's 1986 injury and impairment, he would not attribute all of the 9 percent to the alleged January 12, 1988 injury. Since he had no vocal point as to the February 13, 1986 injury and her healing and status from that injury as of January 11, 1988, he could not determine the extent of additional, if any, permanent partial impairment from the alleged January 12, 1988 injury. There appears no change in the restrictions Dr. Roberts gave claimant in April 1988. In his testimony, he said he would not change those restrictions from what he now knows. Claimant had a 20 to 30 pound lifting restriction and a 15 percent impairment as a result of claimant's February 13, 1986 injury. This rating was by Dr. Jochims. Dr. Jochims referred claimant to Dr. Roberts as to claimant's January 12, 1988 injury. There is only one impairment rating from this 1988 injury. The undersigned finds that the greater weight of medical evidence shows claimant materially aggravated, lighted up and worsened a preexisting low back condition that resulted from the 1986 injury. It is of great interest and concern that the doctor treating claimant for the 1986 injury opined a 15 percent permanent partial impairment and after a further aggravation has been found herein by the undersigned, claimant's impairment now is 9 percent according to Dr. Roberts, who was the treating specialist for claimant's 1988 injury. Dr. Roberts could not divide the impairment between the 1986 and 1988 injuries. Notwithstanding the record indicating claimant Page 5 has less impairment now than she did after her 1986 injury, the undersigned believes claimant does have a more severe medical problem and condition now than she did prior to January 12, 1988, as evidence by the increased medical restrictions. The parties stipulated claimant was off work January 13, 1988 to and including April 13, 1988. The undersigned finds claimant incurred a material aggravation of her previous existing low back condition which arose out of and in the course of claimant's employment on January 12, 1988, and that this injury resulted in a healing period beginning January 13, 1988 to and including April 13, 1988, which totals 13.143 weeks payable at the parties' stipulated rate of $104.80 per week. The undersigned further finds that claimant's low back aggravation was caused by claimant's January 12, 1988 injury. Claimant hasn't worked since his January 12, 1988 work injury. The undersigned questions claimant's motivation and yet it is understandable that pain and low back problems can be very debilitating, and particularly to one whose back and lifting ability are very important in performing the work she was doing at the time of the injury and to which she has been accustomed. Claimant has an increased weight restriction from 20 to 30 pounds now down to 15 pounds. She is already in a light duty work threshold. Claimant had only worked approximately three and no more than five days full-time before she incurred her 1988 aggravation injury. Her testimony indicates she seemed to question her ability to return full-time in December 1987 but needed the money. The doctor released her to work full-time at that time. She seems to have had much agony and pain still resulting from her 1986 injury at the time of her return to work. Claimant said she is now disabled for social security purposes. Social security has for the most part different criteria for determining disability entitlement. Also, the record doesn't show what was considered. It appears claimant has had problems that are not connected with her 1988 injury. The current record indicates claimant has not made a meaningful effort to find a job. It is understandable that her motivation is reduced to nothing because her obtaining a job would affect her entitlement to social security benefits and most likely her disability benefits from defendant employer. Claimant is 56 years old and appears to be of average intelligence. She has no real readily transferable skills considering her impairment and medical condition. Extensive retraining at her age is not very feasible. Claimant does have an increased loss of earning capacity due to her increased restrictions. She has not worked since her 1988 injury, but if claimant put in the effort she put in to return to work after her 1988 injury and need for financial resources, there would be a better test of her loss of Page 6 income. As mentioned above, other factors have now affected her motivation. Taking into consideration claimant's age, education, preexisting injury and impairment, her total medical and work history, her healing period and other factors used in determining one's industrial disability, the undersigned finds claimant has a 50 percent industrial disability. Claimant's January 12, 1988 work injury caused an increase in industrial disability to claimant. Assuming claimant's 25 percent industrial disability found as a result of her February 13, 1986 injury (File No. 816371) withstands any further appeals, claimant is entitled to 25 percent more industrial disability as a result of her January 12, 1988 injury. It is to be kept in mind that the undersigned has found that claimant has a 50 percent industrial disability. Therefore, if for any reason the disability found in case file No. 816371 is increased or decreased by further agency or court action, then the extent of industrial disability found in this current case will be affected accordingly. In other words, regardless of what might ultimately be determined through appeal in the prior injury case, that does not change the undersigned's opinion that at the time this current case was heard claimant had a total industrial disability of 50 percent. conclusions of law Claimant has the burden of proving by a preponderance of the evidence that she received an injury on January 12, 1988 which arose out of and in the course of her employment. McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 1976); Musselman v. Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967). The claimant has the burden of proving by a preponderance of the evidence that the injury of January 12, 1988 is causally related to the disability on which she now bases her claim. Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965). Lindahl v. L. O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945). A possibility is insufficient; a probability is necessary. Burt v. John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955). The question of causal connection is essentially within the domain of expert testimony. Bradshaw v. Iowa Methodist Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). 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. Page 7 While a claimant is not entitled to compensation for the results of a preexisting injury or disease, the mere existence at the time of a subsequent injury is not a defense. Rose v. John Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-61 (1956). If the claimant had a preexisting condition or disability that is aggravated, accelerated, worsened or lighted up so that it results in disability, claimant is entitled to recover. Nicks v. Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 (1962). The Iowa Supreme Court cites, apparently with approval, the C.J.S. statement that the aggravation should be material if it is to be compensable. Yeager v. Firestone Tire & Rubber Co., 253 Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. Workmen's Compensation sec. 555(17)a. Our supreme court has stated many times that a claimant may recover for a work connected aggravation of a preexisting condition. Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 N.W. 35 (1934). See also Auxier v. Woodward State Hosp. Sch., 266 N.W.2d 139 (Iowa 1978); Gosek v. Garmer and Stiles Co., 158 N.W.2d 731 (Iowa 1968); Barz v. Oler, 257 Iowa 508, 133 N.W.2d 704 (1965); Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963); Yeager, 253 Iowa 369, 112 N.W.2d 299; Ziegler v. United States Gypsum Co., 252 Iowa 613, 106 N.W.2d 591 (1960). An employee is not entitled to recover for the results of a preexisting injury or disease but can recover for an aggravation thereof which resulted in the disability found to exist. Olson, 255 Iowa 1112, 125 N.W.2d 251; Yeager, 253 Iowa 369, 112 N.W.2d 299; Ziegler, 252 Iowa 613, 106 N.W.2d 591 (1960). See also Barz, 257 Iowa 508, 133 N.W.2d 704; Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 N.W. 35 (1934). If claimant has an impairment to the body as a whole, an industrial disability has been sustained. Industrial disability was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 593, 258 N.W.2d 899, 902 (1935) as follows: "It is therefore plain that the legislature intended the term `disability' to mean `industrial disability' or loss of earning capacity and not a mere `functional disability' to be computed in the terms of percentages of the total physical and mental ability of a normal man." Iowa Code section 85.34(1) provides that if an employee has suffered a personal injury causing permanent partial disability, the employer shall pay compensation for a healing period from the day of the injury until (1) the employee returns to work; or (2) it is medically indicated that significant improvement from the injury is not anticipated; or (3) until the employee is medically capable of returning to substantially similar employment. Functional impairment is an element to be considered in determining industrial disability which is the reduction of earning capacity, but consideration must also be given to Page 8 the injured employee's age, education, qualifications, expe rience and inability to engage in employment for which he is fitted. Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963). Barton v. Nevada Poultry, 253 Iowa 285, 110 N.W.2d 660 (1961). A finding of impairment to the body as a whole found by a medical evaluator does not equate to industrial disabil ity. This is so as impairment and disability are not syn onymous. Degree of industrial disability can in fact be much different than the degree of impairment because in the first instance reference is to loss of earning capacity and in the latter to anatomical or functional abnormality or loss. Although loss of function is to be considered and disability can rarely be found without it, it is not so that a degree of industrial disability is proportionally related to a degree of impairment of bodily function. Factors to be considered in determining industrial dis ability include the employee's medical condition prior to the injury, immediately after the injury, and presently; the situs of the injury, its severity and the length of healing period; the work experience of the employee prior to the injury, after the injury and potential for rehabilitation; the employee's qualifications intellectually, emotionally and physically; earnings prior and subsequent to the injury; age; education; motivation; functional impairment as a result of the injury; and inability because of the injury to engage in employment for which the employee is fitted. Loss of earnings caused by a job transfer for reasons related to the injury is also relevant. These are matters which the finder of fact considers collectively in arriving at the determination of the degree of industrial disability. There are no weighting guidelines that indicate how each of the factors are to be considered. There are no guidelines which give, for example, age a weighted value of ten percent of the total value, education a value of fifteen percent of total, motivation - five percent; work experience - thirty percent, etc. Neither does a rating of functional impairment directly correlate to a degree of industrial disability to the body as a whole. In other words, there are no formulae which can be applied and then added up to determine the degree of industrial disability. It therefore becomes necessary for the deputy to draw upon prior experience, general and specialized knowledge to make the finding with regard to degree of industrial disability. See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, March 26, l985). It is further concluded that: Claimant incurred an injury on January 12, 1988 which arose out of and in the course of her employment and which injury caused a material worsening and acceleration and lightening of a preexisting low back condition, which preexisting condition had already resulted in an impairment and industrial disability to the claimant. Page 9 Claimant had a 15 percent permanent partial impairment to her body as a whole as a result of a prior February 13, 1986 injury. Claimant had a permanent 20 to 30 pound weight restriction prior to her January 12, 1988 work injury. Claimant's January 12, 1988 work injury caused an additional permanent weight restriction of no repetitive lifting of greater than 15 pounds and no repetitive bending, stooping or reaching. Claimant incurred a healing period beginning January 13, 1988 to and including April 13, 1988, amounting to 13.143 weeks payable at a rate of $104.80 as a result of her January 12, 1988 work injury. Claimant has a greater loss of earning capacity due to her January 12, 1988 work injury. Claimant has a combined 50 percent industrial disability as the result of claimant's January 12, 1988 and February 13, 1986 injuries. order THEREFORE, it is ordered: That defendants shall pay unto claimant healing period benefits at the rate of one hundred four and 80/100 ($104.80) per week for the period beginning January 13, 1988 to and including April 13, 1988, amounting to thirteen point one four three (13.143) weeks. That defendants shall pay unto claimant one hundred twenty-five (125) weeks of permanent partial disability benefits at the rate of one hundred four and 80/100 dollars ($104.80), beginning April 14, 1988. This is in addition to the one hundred twenty-five (125) weeks awarded in case No. 816371. That defendants shall pay accrued weekly benefits in a lump sum and shall receive credit against the award for weekly benefits previously paid. The parties stipulated that claimant has previously been paid twenty-three (23) weeks of benefits at one hundred four and 80/100 dollars ($104.80) per week. That defendants shall pay interest on benefits awarded herein as set forth in Iowa Code section 85.30. That defendants shall pay the costs of this action, pursuant to Division of Industrial Services Rule 343-4.33. That defendants shall file an activity report upon payment of this award as required by this agency, pursuant to Division of Industrial Services Rule 343-3.1 Signed and filed this _____ day of November, 1990. Page 10 ______________________________ BERNARD J. O'MALLEY DEPUTY INDUSTRIAL COMMISSIONER Copies to: Mr James P Hoffman Attorney at Law Middle Rd P O Box 1066 Keokuk IA 52632 Mr Richard G Book Attorney at Law 500 Liberty Bldg Des Moines IA 50309 5-1100; 5-1108.50; 1803 Filed November 14, 1990 Bernard J. O'Malley before the iowa industrial commissioner ____________________________________________________________ : BARBARA STEELE, : : Claimant, : : File No. 873175 vs. : : MORSE RUBBER PRODUCTS COMPANY,: A R B I T R A T I O N : : D E C I S I O N Employer, : : and : : FIREMAN'S FUND INSURANCE CO., : : Insurance Carrier, : Defendants. : ___________________________________________________________ 5-1100 Found claimant's injury arose out of and in the course of her employment. 5-1108.50 Found claimant's permanent partial disability causally connected to her work injury. 1803 Found claimant has a 50% industrial disability of which 25% is related to a January 12, 1988 injury, assuming a prior decision filed October 30, 1990 of another deputy involving a February 13, 1988 injury which found a 25% industrial disability withstands appeals, if any. Therefore, as an example, if the industrial disability in the October 30, 1990 decision is reduced on an appeal to 20%, then the January 12, 1988 injury would result in a 30% industrial disability and vice versa.