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                     before the iowa industrial commissioner
 
         ____________________________________________________________
 
                                       :
 
         LINDA LITTLE,                 :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :      File No. 873368
 
         BONDURANT-FARRAR COMMUNITY    :
 
         SCHOOLS,                      :
 
                                       :        A P P E A L
 
              Employer,                :
 
                                       :      D E C I S I O N
 
         and                           :
 
                                       :
 
         EMPLOYERS MUTUAL INSURANCE    :
 
         COMPANIES,                    :
 
                                       :
 
              Insurance Carrier,       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Defendants appeal from an arbitration decision awarding 
 
         permanent partial disability benefits as the result of an alleged 
 
         injury on October 27, 1987.  The record on appeal consists of the 
 
         transcript of the arbitration proceeding and joint exhibits 1 
 
         through 16.  Both parties filed briefs on appeal.  
 
         
 
                                      ISSUE
 
         
 
              The issue that is dispositive on appeal is whether claimant 
 
         sustained her burden of proof showing an entitlement to permanent 
 
         partial disability benefits.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be set forth herein. 
 
         
 
                                  APPLICABLE LAW
 
         
 
              Pain that is not substantiated by clinical findings is not a 
 
         substitute for impairment.  Waller v. Chamberlain Manufacturing, 
 
         II Iowa Industrial Commissioner Report 419, 425. 
 
         
 
     
 
         
 
         
 
         Page   2
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         A defendant employer's refusal to give any sort of work to a 
 
         claimant after he suffers his affliction may justify an award of 
 
         disability.  McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 
 
         1980). 
 
         
 
              A claimant who has no increase in functional impairment but 
 
         who cannot return to his old job because his employer believes 
 
         the injury disqualifies him, resulting in a palpable reduction in 
 
         earning capacity, is not precluded from a finding of industrial 
 
         disability.  Blacksmith v. All-American, Inc., 290 N.W.2d 348 
 
         (Iowa 1980); Risius v. Todd Corporation, Appeal Decision, May 31, 
 
         1990.
 
         
 
                                     ANALYSIS
 
         
 
              Claimant worked as a custodian at a public school.  Claimant 
 
         began experiencing pain in her back, which was aggravated when 
 
         she performed her work duties.  Claimant eventually left work due 
 
         to her pain. 
 
         
 
              Claimant's treating physician, Charles Denhart, M.D., has 
 
         recommended that claimant not return to her custodial work due to 
 
         the aggravation of pain her work causes.  Dr. Denhart conducted 
 
         x-rays, an EMG, a bone scan, and other tests, all of which showed 
 
         normal results.  Dr. Denhart diagnosed claimant as suffering from 
 
         myofascial pain.  Dr. Denhart's report, dated October 8, 1988, 
 
         states:
 
         
 
              She does not have any motor weakness, sensory 
 
              abnormalities, or loss of range of motion, although I 
 
              believe that she does have the pain and it is 
 
              exacerbated by her work.  She does not have any 
 
              abnormalities on physical exam, and I do not believe 
 
              she has a functional impairment as a result of this 
 
              pain.  (Emphasis added.)
 
         
 
         (Joint Exhibit 1, page 13.)
 
         
 
              Claimant was also examined by Scott B. Neff, D.O.  On June 
 
         6, 1988, Dr. Neff opined:
 
         
 
              [A]ccording to the AMA Guidelines she does not have any 
 
              significant impairment.  Her x-ray studies have showed 
 
              a small bulging disc at the T8 level which apparently 
 
              is not of any consequence.  Her other studies have been 
 
              normal.  (Emphasis added.)
 
         
 
         (Jt. Ex. 2, p. 1)
 
         
 
     
 
         
 
         
 
         Page   3
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         In his deposition, Dr. Neff testified as follows:
 
         
 
              Q.  After your examination of Linda Little, Doctor, 
 
              have you reached an opinion or do you have an opinion 
 
              based upon your examination of the treatment, the 
 
              records of treatment, the medical history, your 
 
              examination of this patient, as well as your training 
 
              and experience, reached an opinion as to whether or not 
 
              as a consequence of her complaints she has any 
 
              functional disability?
 
         
 
              A.  Yes, I have an opinion.
 
         
 
              Q.  And would you tell us that opinion, please?
 
         
 
              A.  As I stated in my report of 6 June 1988, based on 
 
              my findings and the records that I have reviewed, the 
 
              AMA and orthopedic guidelines would not impart an 
 
              impairment to this patient, based on normal motion and 
 
              no diagnosis of any significant pathology.
 
         
 
                  Essentially, it was the opinion of Doctor Denhart, 
 
              and apparently everyone else, that she had sore 
 
              muscles; and that in and of itself is not a disabling 
 
              condition.
 
         
 
              ....
 
         
 
              Q.  Is it true that you stated in your report that you 
 
              found tenderness over her left sacroiliac joint?
 
         
 
              A.  That's correct.
 
         
 
              Q.  And over her paravertebral muscles?
 
         
 
              A.  That's correct.
 
         
 
              Q.  Okay.  Is that an objective finding?
 
         
 
              A.  Yes, it is.
 
         
 
              ....
 
         
 
              Q.  You also reported that you found that she was sore 
 
              in the medial border of the left scapula?
 
         
 
              A.  That's correct.
 
         
 
              Q.  And that's consistent with the trigger point 
 
              myofascial type syndrome?
 
         
 
              A.  That's correct.  That's English for sore muscle.
 
         
 
              ....
 
         
 
              Q.  Well, I guess I was asking you direct, does she 
 
              have a problem?
 

 
         
 
         Page   4
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
              A.  No. 
 
         
 
              Q.  All right.  She has no problem?
 
         
 
              A.  She has sore muscles.
 
         
 
              Q.  But that is not a problem in your opinion.
 
         
 
              A.  Well, it's not something for which surgery is 
 
              recommended or narcotic medication or bed rest or 
 
              disablement or even restriction but short of the 
 
              heaviest repetitive manual labor.  It's sore muscles.
 
         
 
              ....
 
         
 
                  There will be the possibility of recurrence of sore 
 
              muscles, but the same would be true if she were doing 
 
              housework or gardening or painting the ceiling in her 
 
              bathroom.
 
         
 
                  So the subjective recurrence of symptoms is not a 
 
              diagnosis.  Were she desirous of doing that job and had 
 
     
 
         
 
         
 
         Page   5
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
              no other alternative and no source of funds except for 
 
              that type of employment, she would continue that 
 
              employment or would take aspirin.
 
         
 
              Q.  Well, is that a medical diagnosis, whether she 
 
              would continue that job if it's the only one available?
 
         
 
              A.  No, it's not a medical diagnosis.  That's a 
 
              statement that this is a subjective symptom complex 
 
              based on nothing seriously being wrong.  (Emphasis 
 
              added.)
 
         
 
         (Jt. Ex. 15, pp. 13-30)
 
         
 
              Dr. Denhart, in his deposition, stated as follows:
 
         
 
              Q.  Based upon your examination of this patient, the 
 
              treatment that you prescribed, your education 
 
              experience, do you have an opinion today as to whether 
 
              or not this lady has a permanent functional impairment 
 
              as a result of this pain expressed to you?
 
         
 
              A.  Assuming nothing has changed, yes.
 
         
 
              Q.  And does that remain that she does not have a 
 
              functional impairment?
 
         
 
              A.  Correct.
 
         
 
              ....
 
         
 
              Q.  Can you state whether or not it remains your 
 
              opinion, based on reasonable medical certainty, that 
 
              Linda Little should not be in a job that requires 
 
              lifting or bending and that she should have the 
 
              opportunity to sit and stand at will?
 
         
 
              ....
 
         
 
              A.  Again, my position on this is, is that she is 
 
              functionally capable of doing what she does, and I feel 
 
              that way because of the normal neurologic exam and the 
 
              fact she was able to perform in the work-hardening 
 
              program and the fact that at least at that time or at 
 
              least shortly before she was able to perform her work, 
 
              albeit uncomfortable, but that it's my feeling that for 
 
              a long term, retaining her job, it would be unrealistic 
 
              to ask her to put up with what I believe is, despite 
 
              the fact that it comes only as a subjective complaint, 
 
              is significant pain on her part.  So that's my position 
 
              on the matter.
 
         
 
              ....
 
         
 
              Q.  Now, Mr. Spaulding has made several references to 
 
              subjective tests versus objective tests.  Dr. Denhart, 
 
              you mentioned early on that there was a finding, I 
 

 
         
 
         Page   6
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
              think you called it a dermatographia?
 
         
 
              A.  Skin writing.
 
         
 
              Q.  Is that an objective finding?
 
         
 
              A.  Yes.
 
         
 
              Q.  What in your professional opinion was the cause of 
 
              that you found in Linda Little?
 
         
 
              A.  It is a finding that is seen with myofascial pain, 
 
              and I do believe it is linked with the myofascial pain.
 
         
 
              ....
 
         
 
              Q.  Is it then your opinion, based on reasonable 
 
              medical certainty, that Linda should lead a more -- or 
 
              work in a more sedentary line of occupation than that 
 
              which she previously engaged in at the Bondurant-Farrar 
 
              School District as a janitor?
 
         
 
              A.  I need to go back to my position again.  She can do 
 
              it, but I believe she has the pain and I think it's 
 
              unrealistic if she has a significant amount of pain to 
 
              expect that, you know, someone who's probably got 
 
              thirty more years to work could put up with it for that 
 
              long.
 
         
 
         (Jt. Ex. 14, pp. 45-65)
 
         
 
              Claimant was not given any work restrictions by either 
 
         physician, other than Dr. Denhart's recommendation that she 
 
         consider finding more sedentary work.  However, Vicki Torvik, 
 
         OTR/L, Work Hardening Consultant, stated:
 
         
 
                 I place this patient at the Medium Work category 
 
              which is defined by the U.S. Labor Department as:  
 
              maximum occasional lifting of up to 50 pounds.  
 
              Frequent lifting of up to 25 pounds:  typically on feet 
 
              minimum of six hours out of an eight hour day.  
 
              Modification to this definition is to keep her lifting 
 
              to no more than 40 to 50 pounds for a maximum 
 
              occasional lift.
 
         
 
         (Jt. Ex. 7, pp. 9-10)
 
         
 
              Physical impairment is only one factor in the determination 
 
         of industrial disability.  However, generally industrial 
 
         disability can rarely be found without physical impairment.  
 
         Greenlee v. Northbrook Manor Care Center, Vol. 1, No. 3 State of 
 
         Iowa, Industrial Commissioner Decisions 592.  In this case, 
 
         claimant has no permanent physical impairment.  Both physicians 
 
         indicate this.  Claimant states she has pain, and there is some 
 
         objective confirmation of this in the form of the dermatography 
 
         results.  The evidence indicates that this is a "soft" finding, 
 
         and even if this test does confirm the presence of pain, pain in 
 

 
         
 
         Page   7
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         and of itself does not constitute a permanent physical 
 
         impairment.  
 
         
 
              The evidence also shows test results and recommendations 
 
         concerning maximum weights claimant can lift, and recommendations 
 
         concerning prolonged standing or sitting.  However, these are 
 
         test results, not restrictions, and the source of this evidence 
 
         is a non-physician.  The fact remains that claimant's doctors 
 
         still rate claimant as having no permanent physical impairment. 
 
         
 
              Claimant has been diagnosed as suffering from myofascial 
 
         pain.  Dr. Neff describes this condition as "sore muscles."  
 
         Claimant's x-ray, MRI, and other test results are all normal.  
 
         The evidence indicates that claimant developed myofascial pain 
 
         after strenuous activities in her job as a custodian.  Dr. Neff 
 
         cautioned against confusing a symptom with a disease or injury.  
 
         Taken as a whole, the evidence indicates that claimant does not 
 
         suffer a permanent physical impairment.
 
         
 
              Claimant has already been paid temporary disability benefits 
 
         for her time off work.  Claimant is now seeking permanent 
 
         disability benefits.  Claimant bears the burden of proof.  
 
         Claimant has failed to show by a preponderance of the evidence 
 
         that she has suffered a cumulative injury that has resulted in a 
 
         permanent physical impairment.  
 
         
 
              A permanent physical impairment is not always necessary in 
 
         order to be awarded industrial disability.  Even in the absence 
 
         of permanent impairment, industrial disability can be awarded 
 
         where the employer refuses to rehire the claimant because of the 
 
         injury, or where the injured worker is transferred to another 
 
         position that results in a loss of earnings because of the 
 
         injury.  
 
         
 
              In this case, the employer did not refuse to rehire claimant 
 
         or transfer claimant to a lower paying job because of her injury.  
 
         The employer offered claimant a lighter duty job paying $8,600 
 
         less per year, but claimant did not regard this job as being 
 
         lighter duty and declined the offer.  Claimant acknowledged that 
 
         the employer made efforts to keep her on the job because she was 
 
         a valued employee.
 
         
 
              Claimant eventually left her employment with the school 
 
         district, and accepted a position that paid $6,600 less per year.  
 
         Claimant maintains that she did so because of the pain she 
 
         experienced working for defendant-employer.  However, although 
 
         Dr. Denhart suggested she seek more sedentary work, there is no 
 
         medical evidence that claimant was told by either Dr. Denhart or 
 
         Dr. Neff she could not return to her work as a custodian.  The 
 
         absence of work restrictions and medical statements that claimant 
 
         has no permanent impairment indicate that there is no medical 
 
         reason claimant could not continue working at her custodian job 
 
         other than the fact that this work resulted in muscle soreness. 
 
         
 
              Thus, none of the employer conduct that sometimes justifies 
 
         an award of industrial disability, despite the lack of permanent 
 
         physical impairment, exists in this case.  It appears that 
 

 
         
 
         Page   8
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         although claimant has shown she suffers from "muscle soreness," 
 
         the medical evidence taken as a whole shows that this is not a 
 
         permanent impairment.  Claimant apparently cannot perform the 
 
         duties of the custodial job not because of an injury, but because 
 
         the work is simply too strenuous for her.  Based on the facts in 
 
         this case, without some evidence of permanent physical impairment 
 
         as a result of the injury, and absent the kind of employer 
 
         conduct outlined in McSpadden and Blacksmith, claimant has failed 
 
         to carry her burden of proof to show a work injury resulting in 
 
         industrial disability.  Claimant has not shown entitlement to 
 
         permanent disability benefits.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant worked as a custodian for defendant-employer. 
 
         
 
              2.  Claimant's custodial work was occasionally strenuous.
 
         
 
              3.  Claimant developed myofascial pain in her back as a 
 
         result of her work activity.
 
         
 
              4.  Dr. Denhart found that claimant's condition does not 
 
         result in any permanent physical impairment.
 
         
 
              5.  Dr. Neff found that claimant's condition does not result 
 

 
         
 
         Page   9
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         in any permanent impairment.  Dr. Neff described claimant's 
 
         condition as "muscle soreness."
 
         
 
              6.  Claimant's EMG, bone scan, and x-ray results are all 
 
         normal.
 
         
 
              7.  Claimant has no physician-imposed lifting restrictions 
 
         or work restrictions.
 
         
 
              8.  Defendant-employer did not refuse to rehire claimant.
 
         
 
              9.  Defendant-employer did not transfer claimant to a 
 
         lower-paying position as a result of her back pain.
 
         
 
              10. Defendant-employer made efforts to accommodate claimant.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant has failed to carry her burden of proof to show 
 
         that she has suffered a work injury that has resulted in  
 
         permanent physical impairment.
 
         
 
              Claimant has failed to carry her burden of proof to show 
 
         employer conduct that justifies a finding of industrial 
 
         disability in the absence of physical impairment.
 
         
 
              Claimant is not entitled to further benefits.
 
         
 
              WHEREFORE, the decision of the deputy is reversed. 
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered: 
 
         
 
              That claimant shall take nothing from these proceedings. 
 
         
 
              That defendants shall pay the costs of this action including 
 
         the cost of the transcription of the hearing proceeding.
 
         
 
              Signed and filed this ____ day of January, 1991.
 
         
 
         
 
         
 
                                       ________________________________
 
                                                CLAIR R. CRAMER
 
                                        ACTING INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Donald G. Beattie
 
         Attorney at Law
 
         204 8th Street SE
 
         Altoona, Iowa 50009
 
         
 
         Mr. Larry D. Spaulding
 
         Attorney at Law
 
         1100 Des Moines Bldg.
 

 
         
 
         Page  10
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         Des Moines, Iowa 50309-2464
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
            1803 - 2602
 
            Filed January 9, 1991
 
            BJO
 
            Clair R. Cramer
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            LINDA LITTLE,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 873368
 
            BONDURANT-FARRAR COMMUNITY    :
 
            SCHOOLS,                      :
 
                                          :        A P P E A L
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            EMPLOYERS MUTUAL INSURANCE    :
 
            COMPANIES,                    :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            
 
            1803, 2602
 
            The medical evidence showed claimant had no permanent 
 
            impairment.  Claimant showed only that her job caused "sore 
 
            muscles."  Even though she would continue to have myofascial 
 
            pain if she continued to work at this job, the evidence 
 
            showed that claimant's condition was caused not by a 
 
            cumulative injury, but by the fact that the work was too 
 
            strenuous for her.  There was no employer conduct under 
 
            Blacksmith v. All-American, Inc., 290 N.W.2d 348 (Iowa 
 
            1980), justifying an award of industrial disability in the 
 
            absence of permanency.  Benefits denied.
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LINDA LITTLE,
 
         
 
              Claimant,
 
                                                   File No. 873368
 
         vs.
 
                                                A R B I T R A T I O N
 
         BONDURANT-FARRAR COMMUNITY
 
         SCHOOLS,                                  D E C I S I O N
 
         
 
              Employer,                               F I L E D
 
         
 
         and                                         SEP 22 1989
 
         
 
         EMPLOYERS MUTUAL INSURANCE          IOWA INDUSTRIAL COMMISSIONER
 
         COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by claimant, 
 
         Linda K. Little, against Bondurant Farrar Community School 
 
         District, employer, and Employers Mutual Insurance Companies, 
 
         insurance carrier, to recover benefits as a result of an alleged 
 
         injury occurring on August 1, 1987.  This matter came on for 
 
         hearing before the deputy industrial commissioner in Des Moines, 
 
         Iowa, on August 15, 1989.  The record consists of the testimony 
 
         of the claimant, Ray Dowler, Gene Mathis, and Roger Ohde; and 
 
         joint exhibits 1 through 16.
 
         
 
                                     ISSUES
 
         
 
              The issues for resolution are:
 
         
 
              1.  Whether claimant received an injury on August 1, 1987 
 
         which arose out of and in the course of her employment;
 
         
 
              2.  Whether there is a causal relationship between the 
 
         claimant's alleged injury and her alleged disability; and
 
         
 
              3.  The extent of claimant's permanent disability.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              Linda Little is almost 42 years old.  Claimant testified she 
 
         went through the eleventh grade of high school and then later 
 
         obtained her GED from DMACC.  Claimant said she had no college 
 
         training.  Claimant stated she took a four week locksmith, 
 
         plumbing, electricity and hardware course at DMACC in 1987 in 
 
         order to be more informed on various repair duties of her job. 
 
                                                
 
                                                         
 
         Claimant said she became a certified locksmith through a 
 
         correspondence course.  Claimant said she also went to night 
 
         classes to become a certified nurse's aide in 1973.  Claimant 
 
         described the jobs she has had since leaving high school.  Those 
 
         have been basically manual labor minimum wage jobs.
 
         
 
              Claimant began working for the Bondurant-Farrar Community 
 
         Schools in August 1974.  Claimant stated she applied for study 
 
         hall supervisor and custodian and was hired as a custodian with 
 
         no prior experience.  Claimant testified she originally was 
 
         assistant to the head custodian.  She indicated her duties as 
 
         assistant custodian were to be mainly vacuuming and window 
 
         cleaning.  These were considered to be light duty.  Claimant said 
 
         that she was appointed as a head custodian in 1975 after having 
 
         been passed up for the job two times.  The job opening occurred 
 
         when other personnel resigned or newly hired personnel were not 
 
         able to do the job.  Claimant indicated that from 1975 to August 
 
         1988, she was the only head custodian at Anderson Elementary 
 
         School. Claimant emphasized her job evaluations were above 
 
         average or excellent and she always received the same percent 
 
         wage increase as a teacher.  Claimant testified she made $2.50 
 
         per hour in 1974 and $8.23 hour ($18,675 per year) in August 
 
         1988.  Claimant emphasized she liked her job and its security, 
 
         her ability to work inside and outside, its close proximity to 
 
         her house (two blocks) and no clock punching.  Claimant described 
 
         the fringe benefits as health and life insurance, 90 day sick 
 
         leave, IPERS, 14 days vacation plus holidays.
 
         
 
              Claimant said her job involves several duties, some of which 
 
         were mowing lawn, snow removal with shovel and snowblower, 
 
         hanging the flag, placing stop signs, delivering food from other 
 
         buildings, vacuuming, scrubbing floors, setting up and taking 
 
         down tables for various events, repair plumbing, stripping 
 
         floors, and greasing the blower fan motor.  Claimant testified 
 
         that many of her duties were heavy work.  Claimant stated her job 
 
         required. carrying five gallon buckets of water, lifting heavy 
 
         boxes of paper supplies, lifting trays of food daily to place 
 
         them in a school van for transportation to another school 
 
         building during the school year, emptying trash barrels, and 
 
         moving heavy furniture for vacuuming and cleaning.  Claimant said 
 
         that some of the cleaning equipment is hard to use and very 
 
         heavy.  Claimant stated that summer work involves more difficult 
 
         heavy work. Claimant was required to strip the floors, move more 
 
         heavy equipment and desks and move wall partitions and file 
 
         cabinets. Claimant described the difficulty in using the shampoo 
 
         and Pylaster machine.
 
         
 
              Claimant indicated that part-time summer help was to have 
 
         been hired by the school district.  Claimant stated that summer 
 
         help was hired for every summer except two, but no extra help was 
 
         hired during the 1987 summer even though she requested help. 
 
         Claimant emphasized she did not get cooperation and help from the 
 
         high school janitor.
 
         
 
              Claimant testified that on or around August 1, 1987, she was 
 
                                                
 
                                                         
 
         moving furniture, stooping and stripping floors when she noticed a 
 
         gradual pain between her shoulder and spine and low back area.  
 
         She indicated she was working alone and had to move the heavy 
 
         furniture herself.  Claimant said she continued working because 
 
         she thought her condition would resolve itself.  Claimant 
 
         testified her condition worsened and she left work and went to a 
 
         chiropractor on October 27, 1987.  Claimant did not return to work 
 
         until April 1, 1988.  Claimant said that during the October 1987 
 
         to April 1988 period, she had therapy, ultrasound, and went 
 
         through a low back occupational therapy clinic.
 
         
 
              Claimant said that although Charles Denhart, M.D., suggested 
 
         she look for a different job, claimant returned to her school 
 
         job. Claimant stated her pain was continual as it is today.  
 
         Claimant said that during the first month of her return in April 
 
         1988, she worked four hours and another person did her work for 
 
         the remaining four hours.  On May 1, 1988, claimant received no 
 
         more help.  Claimant indicated Dr. Denhart concluded in June 1988 
 
         that claimant must give up the job.
 
         
 
              Claimant signed a new school contract in June 1988 for $8.23 
 
         per hour ($18,600 per year).  Claimant said that Ray Dowler was 
 
         sent as additional help in the summer of 1988 because of the 
 
         problems she was having.
 
         
 
              Claimant acknowledged that defendant employer offered her 
 
         another job as assistant custodian at the high school at $5.50 
 
         per hour ($10,000 per year).  Although claimant indicated this 
 
         was to be a lighter duty job, it was not.  Claimant contends she 
 
         still had to perform jobs like moving heavy furniture,. carrying 
 
         out garbage, sweeping floors, changing bulbs, dusting furniture, 
 
         cleaning toilets, vacuuming, sliding desks and mowing.  Claimant 
 
         said defendant employer tried to work with her as they wanted to 
 
         retain her as an employee, but claimant said she could not 
 
         perform the custodian work required.
 
         
 
              Claimant left defendant employer on August 26, 1988.  
 
         Claimant stated she began working on that date as a sales 
 
         representative at Pace Warehouse at $12,000 per year plus 
 
         commission.  Claimant stated she sells Pace memberships.  Claimant 
 
         said she earned $12,265 in the last year.  Claimant indicated this 
 
         job was all she could find.  Claimant stated she likes sales work.  
 
         Claimant indicated she has no future at Pace because the area will 
 
         become saturated and she will eventually work herself out of a 
 
         job. Claimant said she has had two other interviews and is keeping 
 
         her eyes open for other jobs.
 
         
 
              Claimant believes she will have to return to school for more 
 
         education if she hopes to find a better position.  Claimant 
 
         indicated she would like to take courses in human relations, 
 
         spelling and math.
 
         
 
              Claimant said she cannot stand to sit all day.  Claimant 
 
         indicated she used to dance a lot and can't do much anymore. 
 
         Claimant emphasized she has never had back problems or any 
 
                                                
 
                                                         
 
         specific injuries prior to August 1, 1987.
 
         
 
              Ray Dowler testified he began working for the school 
 
         district June 8, 1987 as a night janitor at the high school.  
 
         Dowler said he began helping claimant on June 8, 1988 as a 
 
         custodian in Anderson Elementary School.  Dowler said that Roger 
 
         Ohde, Superintendent of Schools for the Bondurant-Farrar School 
 
         District, told him on July 8, 1988 that he would be custodian of 
 
         Anderson Elementary School because Ohde did not think claimant 
 
         could come back and perform her duties.  Dowler said claimant was 
 
         having problems doing most of the tasks.  He cited instances in 
 
         1988 in which claimant almost passed out while working and could 
 
         not continue.  Dowler stated he worked 75 percent of the day with 
 
         claimant and 50 percent of the day next to her.  Dowler indicated 
 
         that Mr. Ohde wanted him to learn Linda's job.  Dowler emphasized 
 
         that he did not want to be responsible for Linda leaving her job 
 
         nor did he want to take her job away.  He said he wanted Linda to 
 
         quit on her own if she was going to quit.  Dowler said he did not 
 
         want to be responsible for her losing her job.
 
         
 
              Dowler acknowledged that the custodian job is hard and 
 
         strenuous.  He emphasized that he has had problems lifting, 
 
         moving partitions, mopping, scrubbing walls, especially by 
 
         himself.  He said he is also doing it alone this summer and is 
 
         having difficulty.  Dowler stated that claimant never said she 
 
 
 
                              
 
                                                         
 
         was leaving her job for any other reason but for her health.  
 
         Dowler volunteered that claimant enjoyed her job and that it was 
 
         a nice place to work.  Dowler said he enjoys the job.  Dowler 
 
         said his pay was the same as what claimant was making, namely, 
 
         $18,600 per year, when he took over her job in August 1988.  
 
         Dowler said he is now making approximately $19,500.
 
         
 
              Dowler said his back aches now and has occasional stiffness 
 
         from the job.  Dowler emphasized he has not talked about the case 
 
         with claimant and she would not know what his testimony was going 
 
         to be until he testified.  Dowler said he never talked to 
 
         claimant's attorney until he walked into the hearing room.  
 
         Dowler indicated he was subpoenaed to testify.
 
         
 
              Jean Mathis testified she is the owner of a retail liquor 
 
         store and has known claimant four and one-half years.  Mathis said 
 
         she sees claimant four to five times a week, sometimes seven days 
 
         a week.  Mathis described claimant as being very active with no 
 
         complaints prior to August 1, 1987.  Mathis said claimant did a 
 
         lot of bicycling and dancing.  Mathis said she had a hard time 
 
         keeping up with claimant.  Mathis stated claimant never talked of 
 
         leaving her school job, and seemed very happy with her job.  
 
         Mathis never observed any health problem with claimant prior to 
 
         August 1, 1987. Mathis said that after the August 1987 incident, 
 
         claimant talked about her back hurting between the shoulder blades 
 
         and that the condition had worsened.  Mathis said claimant went 
 
         dancing very little, quit bicycling and motorcycling.  Mathis 
 
         observed claimant could not pick up her grandchildren without 
 
         suffering pain.
 
         
 
              Roger Ohde, superintendent of the Bondurant-Farrar School 
 
         District for 16 years, testified that he knows claimant.  He said 
 
         he never knew she suffered from a neck or back injury.  Ohde said 
 
         he was first aware of her problem when she started missing more 
 
         work.  Ohde said Linda did not miss a lot of work her first ten 
 
         years on the job.  Ohde acknowledged that the employees who knew 
 
         Linda said she was hurting.  Ohde said that the school district 
 
         made provisions to help claimant, including having other 
 
         personnel do her heavy work and buying some new lifting 
 
         equipment.  Ohde acknowledged that there were some things 
 
         claimant was no longer able to do.  Ohde admitted that basically 
 
         claimant was offered Dowler's job and vice versa.  Ohde said 
 
         claimant was a valued employee and had received good evaluations.  
 
         He said claimant was motivated and had a good relationship with 
 
         the other employees and was honest in her dealings.
 
         
 
              Charles F. Denhart, M.D., Physical Medicine & 
 
         Rehabilitation, testified that claimant was referred to him by 
 
         Dr. Craig Gerhart, and he first saw claimant on January 4, 1988.  
 
         He indicated claimant did not relate her pain between the 
 
         shoulder blades on the left in August 1987 to any specific 
 
         injury, but she indicated it came on slowly.  The doctor said 
 
         that by October 1987, claimant became worse and pain went to her 
 
         low back and into her legs.  He indicated claimant had stopped 
 
         working in October 1987 due to her condition.  Dr. Denhart said 
 
                                                
 
                                                         
 
         claimant's MRI and bone scan, sensory examination and range of 
 
         motion in the upper lower extremities are normal.  He indicated 
 
         claimant has interscapular myofascial pain. Dr. Denhart indicated 
 
         claimant expressed a desire to return to work but was also 
 
         concerned about the lifting she may be required to do.  The 
 
         doctor said claimant acquired skills to better manage her chronic 
 
         pain.  Dr. Denhart said he thought claimant should be looking 
 
         into finding a new type of employment, more in the sedentary 
 
         line.
 
         
 
              Dr. Denhart acknowledged writing a letter to defendant 
 
         insurance carrier on October 8, 1988 in response to a request for 
 
         an opinion as to causal connection and whether claimant sustained 
 
         a functional disability or permanent partial impairment.  Dr. 
 
         Denhart was then asked:
 
         
 
              Q.  Based upon your examination of this patient, the 
 
              treatment that you prescribed, your education experience, do 
 
              you have an opinion today as to whether or not this lady has 
 
              a permanent functional impairment as a resuit of this pain 
 
              expressed to you?
 
         
 
              A.  Assuming nothing has changed, yes.
 
         
 
              Q.  And does that remain that she does not have a functional 
 
              impairment?
 
         
 
              A.  Correct.
 
         
 
              Q.  You saw, as you mentioned, Mr. Beattie, her attorney, 
 
              and Linda on December 19th of last year, and your note -- do 
 
              you have that in front of you, doctor, of 12-19 of '88?
 
         
 
              A.  Yes.
 
         
 
              Q.  Indicates that I guess Mr. Beattie wanted to ask you a 
 
              few questions about myofascial pain, about what you felt 
 
              about her pain?
 
         
 
              A.  Uh-huh.
 
         
 
              Q.  According to this note you stated, "I told him that 
 
              while functionally I did not think she had a disability, 
 
              that I did think she had pain and this inhibited her from 
 
              her work, and specifically it was pain made worse by 
 
              bending, stooping, and lifting as she had had with her 
 
              previous job.  He said that she would probably require a 
 
              deposition to that effect at some point in the future," and 
 
              I guess today is the point in the future he's referring to?
 
         
 
              A.  That's correct.
 
         
 
              Q.  This inability or the inhibition from her doing her work 
 
              and specifically that certain activities exacerbated her 
 
              pain, that opinion is based solely upon what this lady has 
 
                                                
 
                                                         
 
                   told you her subjective complaints were when engaged in 
 
              these activities?
 
         
 
              A.  That's correct.
 
         
 
         (Denhart Deposition; Joint Exhibit 14, pages 51-52)
 
         
 
              Dr. Denhart could not causally connect claimant's pain or 
 
         disability to her injury of August 1, 1987.  He said he did not 
 
         think claimant was exaggerating.  Dr. Denhart acknowledged that 
 
         the skin writing or dermatography test indicating myofascial pain 
 
         is an objective finding and is not subjective.  Dr. Denhart 
 
         acknowledged that the reason claimant went through a work 
 
         hardening program was to be able to increase her activity and 
 
         learn how to live with her pain.  Dr. Denhart said that a person 
 
         with myofascial pain can hurt without neurological findings.
 
         
 
              Scott B. Neff, D.O., an orthopedic surgeon, testified that 
 
         he reviewed various medical records of claimant prior to seeing 
 
         her on June 8, 1988.  Dr. Neff understood from claimant that she 
 
         injured her shoulder and upper back on August 1, 1987 at work 
 
         while lifting or pushing some furniture.  Dr. Neff said 
 
         claimant's physical examination was normal except claimant had 
 
         tenderness to palpation over the left sacroiliac joint and the 
 
         muscles on either side of the spine at that level, and tenderness 
 
         in the medial border of the left shoulder blade or scapula, which 
 
         is typical of a trigger point or a myofascial type syndrome.  Dr. 
 
         Neff opined: "As I stated in my report of 6 June 1988, based on 
 
         my findings and the records that I have reviewed, the AMA and 
 
         orthopedic guidelines would not impart an impairment to this 
 
         patient, based on normal motion and no diagnosis of any 
 
         significant pathology." (Neff Dep., Jt. Ex. 15, pp. 13-14)  Dr. 
 
         Neff acknowledged that claimant has a muscular soft tissue 
 
         problem.
 
         
 
              The records of Kirk Green, D.O., of Orthopedic Associates, 
 
         P.C., reflect:  "She saw [sic] chiropractor treatment, which did 
 
         not relieve her pain and as well caused low-back pain."  (Jt. Ex. 
 
         4, p. 1)  The progress report of Resource Opportunity, Inc., 
 
         dated June 20, 1988, contained, in part, the following summary 
 
         and impression:
 
         
 
                   It is the consultant's opinion that employment may be 
 
              located for Ms. Little within her established limitations.  
 
              It has been recommended by the client's attending physician 
 
              that she discontinue her employment as a school custodian and 
 
              pursue alternative vocational options at this time.  A viable 
 
              salary level for Ms. Little within the Des Moines, Iowa 
 
              geographical area would most probably fall within the $5.00 
 
              to $7.00 per hour level.
 
         
 
         (Jt. Ex. 3, p. 12)
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
                                                
 
                                                         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that she received an injury on August 1, 1987 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 August 1, 1987 is causally 
 
         related to the disability on which she now bases her claim.  
 
         Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  
 
         Lindahl v. L.O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 
         possibility is insufficient; a probability is necessary.  Burt v. 
 
         John Deere Waterloo 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).
 
         
 
              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."
 
         
 
              The opinion of the supreme court in Olson v. Goodyear 
 
         Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963) at 1121, 
 
         cited with approval a decision of the industrial commissioner for 
 
         the following proposition:
 
         
 
              Disability * * * as defined by the Compensation Act means 
 
              industrial disability, although functional disability is an 
 
              element to be considered . . . In determining industrial 
 
              disability, consideration may be given to the injured 
 
              employee's age, education, qualifications, experience and 
 
              his inability, because of the injury, to engage in 
 
              employment for which he is fitted.
 
         
 
              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 almost 42 years old.  She has a GED.  Claimant 
 
         has worked the majority of her adult life for defendant employer. 
 
         Claimant is five feet three inches in height and weighs 
 
         approximately 135 pounds.  Her job has involved considerable 
 
         heavy manual labor.  Claimant is an average built woman for her 
 
         size who became the head custodian in 1975 for Anderson 
 
         Elementary School (grade school).  She was passed over twice when 
 
         a vacancy occurred before she was appointed.  There is no 
 
         specific evidence as to why she was not appointed when the head 
 
         custodian vacancy first occurred.  Taking into consideration the 
 
         physical stature of claimant, it could be that the school 
 
         wondered if she was able to perform the physically demanding 
 
         duties of the job as head custodian.  The evidence shows that the 
 
         head custodian receives little help from other personnel, 
 
         particularly at certain times of the year.  The last few years, 
 
         the school district has provided little help when claimant needed 
 
         it during the summer.
 
         
 
              There is an issue whether claimant sustained a work-related 
 
         injury on August 1, 1987.  The greater weight of evidence shows 
 
         claimant had no shoulder or back problems prior to August 1, 
 
         1987. Claimant was moving some furniture in the process of 
 
                                                
 
                                                         
 
         stripping floors when she noticed a gradual pain between her 
 
         shoulder, spine and back.  Claimant did not think it was serious 
 
         and thought it would go away.  Claimant continued working but the 
 
         pain worsened over time until October 27, 1987, when she went to 
 
         a chiropractor.
 
         
 
              Claimant has referred to her injury as gradual due to 
 
         repetitive trauma.  Under McKeever, an employee is disabled or 
 
         injured when, because of pain or physical inability, she can no 
 
         longer work.  Claimant is a hard working, motivated individual. 
 
         Her daily presence at the work site was very important.  On 
 
         August 1, 1987, she was performing services that are done during 
 
         the summer school recess because of the absence of students.  
 
         School began shortly thereafter.   Claimant continued working 
 
         with her pain until October 27, 1987, when she could no longer 
 
         work.
 
         
 
              The undersigned finds that claimant first experienced her 
 
         shoulder and back pain on August 1, 1987, as a result of the 
 
         heavy repetitive nature of her custodial work.  Claimant 
 
         continued to work for the benefit of her employer.  Claimant 
 
         received a cumulative injury on October 27, 1987, which injury 
 
         arose out of and in the course of her employment.
 
         
 
              Claimant had no injuries or accidents prior to August 1, 
 
         1987.  The medical testimony indicates claimant has no rated 
 
         functional impairment.  The greater weight of medical evidence 
 
         shows claimant has interscapular myofascial pain in her shoulders 
 
         and low back.  This is a muscle pain condition that began on 
 
         August 1, 1987.  There is no explanation other than it began due 
 
         to the heavy duty nature of claimant's work.  Its continuing 
 
         nature is a fact.  Dr. Denhart believes claimant's condition is 
 
         real and advised her to find a new type of employment, more of 
 
         the sedentary type.  Dr. Denhart believes the custodial-type work 
 
         claimant performed was worsening her pain due to the required 
 
         bending, stooping and lifting.
 
         
 
              The undersigned finds that claimant's cumulative injury on 
 
         October 27, 1987 is causally connected to her shoulder and back 
 
         injury from which she now suffers.
 
         
 
              Claimant is now in sales representative work.  Claimant said 
 
         she likes sales work, but it is obvious she will work her way out 
 
         of her present job due to its nature.  The undersigned believes 
 
         claimant when she says she quit her school custodian job because 
 
         of pain and because the job aggravates her condition.  Claimant 
 
         had signed a new one year contract in June 1988.  The school 
 
         superintendent considered claimant a valuable employee.  
 
         Claimant's replacement, Mr. Dowler, who is physically larger than 
 
         claimant, described the heavy duty nature of custodial work.  
 
         Claimant is presently making approximately $12,265 per year.  
 
         Claimant was making $18,600 when she quit defendant employer on 
 
         October 26, 1988.  Her former job is now paying $19,500, which is 
 
         37 percent more than what claimant is currently earning.  Claimant 
 
         has no current transferable skills other than as a custodian.  It 
 
                                                
 
                                                         
 
         is obvious claimant can no longer perform custodial-type work or 
 
         any type of heavy work.
 
         
 
              Claimant indicated she would like to return to school in 
 
         order to have an opportunity to further her ability to get a 
 
         better job.  Claimant tested twelfth grade in reading ability, 
 
         beginning seventh grade in spelling, and ending tenth grade in 
 
         arithmetic.
 
         
 
              Permanent disability can be found despite the absence of a 
 
         permanent impairment rating from a physician.  Although no 
 
         specific restrictions were imposed on claimant, she was advised 
 
         to find a job other than custodial because of her condition.  Dr. 
 
         Denhart suggested claimant should do sedentary work.  It is clear 
 
         from the testimony of the superintendent of schools that claimant 
 
         could not do the work required of a head custodian.  Defendant 
 
         employer offered claimant an assistant custodian job, which would 
 
         involve less heavy duty.  Claimant was an assistant custodian 
 
         prior to accepting her head custodian job in 1975.  The assistant 
 
         custodian job paid $5.50 per hour versus $8.05 paid the head 
 
         custodian.  This is approximately 32 percent less.  The 
 
         undersigned believes that if it were not for the cumulative 
 
         injury to claimant on October 27, 1987, claimant would still be 
 
         the custodian at Anderson Elementary School in the 
 
         Bondurant-Farrar School District, making $19,500.  All the 
 
         parties involved did everything they could to keep claimant as an 
 
         employee.  Defendant is to be congratulated on its efforts.  
 
         Claimant had everything going for her until her injury.  Claimant 
 
         had no reason to quit other than for her injury.  Claimant took 
 
         some courses on the side to help her in her custodial work.  
 
         Although loss of earnings is not loss of earning capacity, it is 
 
         one of the criteria to consider in determining industrial 
 
         disability.  Taking into consideration claimant's age, education, 
 
         motivation, loss of income, injuries or lack of injuries before 
 
         and after, claimant's cumulative injury, and considering all 
 
         those other elements necessary in determining claimant's 
 
         industrial disability, the undersigned finds claimant has 
 
         incurred a 30 percent loss of earning capacity.
 
         
 
              Claimant is found to be a credible witness.
 
         
 
              The parties stipulated to the time claimant was off work. 
 
         Claimant received her full salary during this time and the 
 
         parties stipulated that healing period, temporary total 
 
         disability or temporary permanent disability is not an issue for 
 
         the undersigned to consider.
 
         
 
              The parties bifurcated the issue of 86.13 from these 
 
         proceedings.
 
         
 
                               FINDINGS OF FACT
 
         
 
              1.  Claimant received a work-related cumulative injury on 
 
         October 27, 1987.
 
         
 
                                                
 
                                                         
 
              2.  Claimant's work-related cumulative injury was triggered 
 
         by work-related events of moving heavy furniture, stooping, and 
 
         stripping floors on August 1, 1987.
 
         
 
              3.  Claimant's current disability is the result of 
 
         claimant's cumulative injury on October 27, 1987.
 
         
 
              4.  Claimant's job as head custodian involved heavy duty 
 
         work.
 
         
 
              5.  Defendant employer did not provide sufficient help for 
 
         claimant with her job prior to August 1, 1987.
 
         
 
              6.  Claimant was making $18,600 per year on October 27, 1987 
 
         as head custodian for defendant employer.
 
         
 
              7.  Defendant employer acknowledged claimant is not able to 
 
         handle the job as head custodian.
 
         
 
              8.  Claimant was advised by a medical doctor that she should 
 
         leave her job as custodian and find a sedentary job.
 
         
 
              9.  Defendant employer offered claimant's job as assistant 
 
         custodian, which involved less heavy duty work than the head 
 
         custodian job.  This job transfer would result in approximately 
 
         32 percent less income and still would involve some heavy duty 
 
         work.
 
         
 
              10.  Claimant is presently employed as a sales 
 
         representative making approximately 32 percent less income than 
 
         what she was making at the time of her October 27, 1987 injury.
 
         
 
              11.  Claimant has been paid all healing period benefits to 
 
 
 
                               
 
                                                         
 
         which she may be entitled and as stipulated by the parties.
 
         
 
              12.  Claimant is motivated.
 
         
 
              13.  Claimant has a reduction in earning capacity.
 
         
 
                             CONCLUSIONS OF LAW
 
         
 
              Claimant's cumulative work injury arose out of and in the 
 
         course of claimant's employment on October 27, 1987.
 
         
 
              Claimant's disability is causally connected to her 
 
         cumulative injury of October 27, 1987.
 
         
 
              Claimant has a 30 percent industrial disability.
 
         
 
              Claimant has received all healing period benefits to which 
 
         she is entitled.
 
         
 
                                     ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That claimant has been paid all healing period benefits 
 
         which she is entitled to and as stipulated to by the parties.
 
         
 
              That defendants shall pay unto claimant one hundred fifty 
 
         (150) weeks of permanent partial disability benefits at the rate 
 
         of two hundred eighteen and 95/100 dollars ($218.95), beginning 
 
         May 1, 1988.
 
         
 
              That defendants shall pay the accrued weekly benefits in a 
 
         lump sum.
 
         
 
              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 requested by the Division of Industrial 
 
         Services.
 
         
 
              That this case is to be placed back into the rotation for 
 
         later disposition of the 86.13 penalty issue bifurcated from 
 
         these proceedings.
 
         
 
              Signed and filed this 22nd day of September, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                                
 
                                                         
 
                                             BERNARD J. O'MALLEY
 
                                             DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. Donald G. Beattie
 
         Attorney at Law
 
         204 8th St SE
 
         Altoona, IA  50009
 
         
 
         Mr. Larry D. Spaulding
 
         Attorney at Law
 
         1100 Des Moines Bldg
 
         Des Moines, IA  50309
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                            5-1100; 5-1108.50
 
                                            5-1803; 2209; 4000
 
                                            Filed September 22, 1989 
 
                                            Bernard J. O'Malley
 
         
 
                 BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LINDA LITTLE,
 
         
 
              Claimant,
 
                                                 File No. 873368
 
         vs.
 
         
 
         BONDURANT-FARRAR COMMUNITY            A R B I T R A T I 0 N
 
         SCHOOLS,
 
                                                 D E C I S I 0 N
 
              Employer,
 
         
 
         and
 
         
 
         EMPLOYERS MUTUAL INSURANCE COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         5-1100
 
         
 
              Claimant's injury found to have arose out of and in the 
 
         course of claimant's employment.
 
         
 
         5-1108.50
 
         
 
              Claimant's disability was causally connected to claimant's 
 
         work-related injury.
 
         
 
         2209
 
         
 
              Claimant was head custodian at an elementary school where 
 
         she was doing some heavy work involving moving furniture and 
 
         stripping floors on August 1, 1987.  Deputy found that this event 
 
         on August 1, 1987 triggered a resulting cumulative injury on 
 
         October 27, 1987.
 
         
 
         5-1803
 
         
 
              Permanent disability can be found despite the absence of a 
 
         permanent impairment rating.
 
         
 
              This 42-year-old claimant was a custodian for 14 years for 
 
         defendant employer.  She relied on her back and shoulders for her 
 
         livelihood.  The doctor advised her to get a sedentary type job. 
 
         Claimant found a sales representative job at approximately 30% 
 
         less income.
 
                                                
 
                                                         
 
         
 
              Defendant employer offered claimant an assistant custodian 
 
         job at over 30 percent less income.  This job also required some 
 
         heavy duty work.
 
         
 
              Claimant found to have a 30% industrial disability.
 
         
 
         5-4000
 
         
 
              86.13 Penalty issued was bifurcated from this proceeding.
 
 
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                                          :
 
            GLENN S. NUCKOLLS,            :
 
                                          :
 
                 Claimant,                :      File No. 873510
 
                                          :
 
            vs.                           :        A P P E A L
 
                                          :
 
            AMERICAN FREIGHT SYSTEM, INC.,:      D E C I S I O N
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ____________________________________________________________
 
            _____
 
            The record has been reviewed de novo on appeal.  The order 
 
            of dismissal of the deputy filed September 27, 1991 is 
 
            affirmed and is adopted as the final agency action in this 
 
            case.
 
            Signed and filed this ____ day of February, 1992.
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                               BYRON K. ORTON
 
                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Dennis L. Hanssen
 
            Attorney at Law
 
            2700 Grand Ave., Ste 111
 
            Des Moines, Iowa 50312
 
            
 
            Mr. Jon K. Hoffmann
 
            Attorney at Law
 
            500 Liberty Bldg.
 
            Des Moines, Iowa 50309
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
            9998
 
            Filed February 24, 1992
 
            Byron K. Orton
 
            HJW
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                                          :
 
            GLENN S. NUCKOLLS,            :
 
                                          :
 
                 Claimant,                :      File No. 873510
 
                                          :
 
            vs.                           :        A P P E A L
 
                                          :
 
            AMERICAN FREIGHT SYSTEM, INC.,:      D E C I S I O N
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ____________________________________________________________
 
            _____
 
            
 
            9998
 
            
 
                 Summary affirmance of deputy's order filed September 
 
            27, 1992.
 
            
 
 
            
 
            
 
            
 
            
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
            BRIAN REYNOLDS,                 :
 
                                            :
 
                 Claimant,                  :
 
                                            :
 
            vs.                             :
 
                                            :       File No. 873552
 
            AMANA REFRIGERATION, INC.,      :
 
                                            :          A P P E A L
 
                 Employer,                  :
 
                                            :        D E C I S I O N
 
            and                             :
 
                                            :
 
            LIBERTY MUTUAL INSURANCE        :
 
            COMPANY,                        :
 
                                            :
 
                 Insurance Carrier,         :
 
                 Defendants.                :
 
            ____________________________________________________________
 
            
 
                 The record, including the transcript of the hearing 
 
            before the deputy and all exhibits admitted into the record, 
 
            has been reviewed de novo on appeal.
 
            
 
                                      ISSUES
 
            
 
                 Claimant states the following issues on appeal:
 
            
 
                 I.  Is the conclusion by the Deputy Commissioner 
 
                 that Claimant does not have an occupational 
 
                 disease supported by substantial evidence in the 
 
                 record?
 
            
 
                 II. Is the conclusion by the Deputy Commissioner 
 
                 that Claimant has no industrial disability or 
 
                 compensable permanent partial disability supported 
 
                 by substantial evidence in the record?
 
            
 
                                 FINDINGS OF FACT
 
 
 
            The findings of fact contained in the proposed agency 
 
            decision filed November 26, 1990 are adopted as set forth 
 
            below.  Segments designated by asterisks (*****) indicate 
 
            portions of the language from the proposed agency decision 
 
            that have been intentionally deleted and do not form a part 
 
            of this final agency decision.
 
            
 
                 *****
 
            
 
                 Claimant is a 25-year-old who finished the tenth grade 
 
            and later obtained a GED.  He has no other formal education.
 
            Claimant related his work history beginning when he was 14 
 
            years of age up to sometime in 1987 when he began working 
 
            for defendant employer.  This prior history involved 
 
            claimant working as a mattress assembler and a truck 
 
            mechanic limited to changing oil, tires and washing 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            vehicles.  Claimant went to work for defendant employer in 
 
            1987 because of the $9.60 per hour pay versus the $7.00 per 
 
            hour at his previous employment.  Claimant described his 
 
            work with defendant employer.  After approximately six 
 
            months, claimant was assigned to a job placing fiberglass 
 
            insulation in refrigerator walls.  He described the 
 
            procedure of cutting, handling and eventually installing the 
 
            fiberglass in the refrigerator walls.  He indicated there 
 
            was one strip per unit and he would have a 500 per night 
 
            quota.  He said this was not a physical job.
 
            
 
                 Claimant said he played junior high football and 
 
            wrestled and had no asthma or breathing problems prior to 
 
            working for defendant employer.
 
            
 
                 Claimant testified defendant employer had a safety 
 
            class but there was no requirement that an employee wear a 
 
            mask or gloves when handling the fiberglass.  He also 
 
            indicated he never saw any warning on the plastic bag of 
 
            fiberglass.  Claimant said his first symptoms of having 
 
            congestion, trouble breathing and coughing up stuff and 
 
            becoming ill began in October of 1987.  He first saw Richard 
 
            D. Louvar, D.O., the family doctor, in December 1987 who 
 
            referred claimant to Darrell R. Dennis, M.D., whose 
 
            specialty is pulmonary disease and critical care.
 
            
 
                 Dr. Louvar notified defendant employer to take claimant 
 
            off the insulation work.  Defendant employer then assigned 
 
            claimant to a tray assembly area.  Claimant contends there 
 
            was still exposure to fiber in the area and the insulation 
 
            was stacked on a table in front of him even though he wasn't 
 
            handling it in this tray job.  Claimant said the factory is 
 
            open with no dividing walls.
 
            
 
                 Claimant was then moved to an injection molding 
 
            department because his condition became worse.  This new 
 
            move removed claimant from the insulation exposure but his 
 
            pay was reduced to $7.14 per hour.  Claimant contends he was 
 
            still bothered by the symptoms and that when it got hot, 
 
            defendant employer used fans which stirred up the dust.
 
            
 
                 Claimant worked one month in the injection molding 
 
            department.  He was on medication.  He related the medicine 
 
            made him irritable, nervous and light headed.  He said the 
 
            employer did not place him in another job and his mother 
 
            discouraged him from applying for a job in the crate 
 
            department, boxing complete refrigerators.  Claimant quit 
 
            working for defendant employer in May 1988.  He explained he 
 
            won unemployment benefits over defendant employer's 
 
            resistance.
 
            
 
                 Claimant related the jobs he did after leaving 
 
            defendant employer, which included assembling hoses at 
 
            Apache Hose and Belt Company.  He went back and forth, in 
 
            other words, quitting and returning at this place of 
 
            employment.  Ultimately, in April 1990, he was laid off at 
 
            Apache and thereafter worked hanging Sheetrock on the walls 
 
            and nailing it.  Prior to this, and after leaving defendant 
 
            employer, claimant was basically free of his severe symptoms 
 
            and took medication.  Claimant said his asthma symptoms did 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            return at this dry wall job.
 
            
 
                 Claimant testified as to how the asthmatic condition 
 
            effects him when he is doing certain activities.  He said 
 
            Amana Refrigeration had a health plan but he opted out.
 
            
 
                 Connie Reynolds, claimant's mother, testified she has 
 
            worked at St. Luke's Hospital a year and previously worked 
 
            for defendant employer for eleven years.  She indicated she 
 
            was also affected while working for defendant employer and 
 
            was disqualified from working with the insulation.  She 
 
            indicated she knew of no family-inherited trait for asthma, 
 
            but said she was also disqualified from working with 
 
            fiberglass insulation as it bothered her.  She said she left 
 
            defendant employer because she could not take it any longer 
 
            as she had hands, elbow and carpal tunnel problems.  She 
 
            indicated she has paid for some of claimant's medication and 
 
            the doctor has given claimant samples as claimant could not 
 
            afford to pay for the medicine.  She related claimant is not 
 
            taking his medicine on an every day basis.  She acknowledged 
 
            claimant's condition improved after he left defendant 
 
            employer.  She also said the medication helped claimant.  
 
            She said claimant's symptoms returned after he started 
 
            working for the Sheetrock company.
 
            
 
                 Audrey Brickman was claimant's supervisor in 1987 and 
 
            1988.  She said claimant never asked to use a dust mask 
 
            which was available.  She said claimant was eventually moved 
 
            from an area of possible fiber exposure to the injection 
 
            molding department which is in a different building where 
 
            there is no fiberglass exposure.  She doesn't recall 
 
            claimant cutting any fiberglass but said he would have 
 
            handled fiberglass in his earlier job with the company.
 
            
 
                 Cynthia Baldwin, director of occupational health for 
 
            defendant employer, testified she conducted a test on March 
 
            10, 1988, and used an air pump to pick up the fiber and 
 
            dust.  She said the nuisance dust level was very low.  She 
 
            acknowledged the test was basically for asbestos and not 
 
            fiberglass.  She said she considers herself to be an expert 
 
            in this type of testing.
 
            
 
                 Darrell R. Dennis, M.D., a board certified pulmonary 
 
            disease specialist and a private practitioner since July of 
 
            1986, testified by way of his deposition on August 10, 1990.  
 
            He first consulted with claimant on January 20, 1988, after 
 
            being referred to him by claimant's family doctor, Richard 
 
            Louvar, D.O.
 
            
 
                 Dr. Dennis said claimant's pulmonary function test 
 
            dated January 6, 1988 substantiated that claimant did have 
 
            hyperreactive airway disease or asthma.  He agreed with this 
 
            diagnosis and also said he felt that claimant's occupational 
 
            exposure was either a cause or contributing factor to 
 
            claimant's upper respiratory and pulmonary systems.  Dr. 
 
            Dennis said claimant had not seen him between April 6, 1988 
 
            until September 1989 and claimant had missed a May 1988 
 
            follow-up appointment.  The doctor indicated further that:  
 
            "Based on his history, he dated the onset of his symptoms 
 
            with the onset of his employment with Amana Refrigeration.  
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            Because of that I thought that his occupational exposure 
 
            could be a contributing or causal factor." (Jt. Ex. 2, p. 
 
            26)  Earlier in his testimony, the doctor said, "I think 
 
            that his occupational exposures were a possible contributing 
 
            factor to his pulmonary symptoms." (Jt. Ex. 2, p. 24 and 25)  
 
            On October 3, 1990, Dr. Dennis wrote a letter to claimant's 
 
            attorney stating:  "[I]t is my opinion that Mr. Reynolds' 
 
            occupational exposures are a possible causal factor and a 
 
            probable exacerbating factor for the development of his 
 
            hyperreactive airway disease (asthma).  It is distinctly 
 
            unlikely that chronic bronchitis is a viable diagnosis in 
 
            this patient." (Jt. Ex. 1(10))
 
            
 
                 The doctor acknowledged he wrote defendant employer 
 
            saying it would be preferable not to have claimant employed 
 
            in this situation or environment where he would be exposed 
 
            to potentially significant exposure such as heavy dust, 
 
            fumes and odors (Jt. Ex. 2, p. 30 and 31).  The doctor 
 
            defined asthma as "variable airway obstruction which is 
 
            aggravated by either specific allergens or by nonspecific 
 
            irritants, and which remits either spontaneously or with 
 
            therapy." (Jt. Ex. 2, p. 41)  The doctor said it can be 
 
            reversible.  It can be aggravated by viral infection, 
 
            exercise, allergens, irritants, cold air, strong odor, 
 
            smoke, air pollutants and aspirin.  Dr. Dennis said 
 
            fiberglass or dust from fiberglass itself is not an 
 
            allergenic.  The doctor acknowledged that he wrote a letter 
 
            on September 14, 1989, to claimant's attorney, that 
 
            indicated:
 
            
 
                    It is not possible to say with absolute 
 
                 certainty that the patient's pulmonary 
 
                 symptomatology are secondary to his occupational 
 
                 exposures.  However, the onset of his upper 
 
                 respiratory and pulmonary symptomatology coincide 
 
                 with his significant occupational exposure to 
 
                 asbestos.  The patient does not have a history of 
 
                 prior pulmonary disease and he does not have a 
 
                 personal or family history of atopic disease.
 
            
 
            (Jt. Ex. 1, (5))
 
            
 
                 The doctor said his reason was that asthma can come on 
 
            at any time (Jt. Ex. 2, p. 43).  He further stated that the 
 
            symptoms of occupational asthma should subside after 
 
            changing jobs and avoiding the initial irritants (Jt. Ex. 2, 
 
            p. 46).  It appears the doctor relied heavily on the history 
 
            given to him by the claimant.  Many tests were not given.  
 
            It seems as if the doctor presumed early in the game that 
 
            claimant had an occupational disease and thereafter treated 
 
            it as such.  Dr. Dennis testified that asthma can be well 
 
            controlled with medication and with the avoidance of 
 
            nonexacerbating factors.  He indicated that the majority of 
 
            people with asthma do not have a physical limitation in 
 
            their work capacity and he did not think claimant had a 
 
            limitation in his work capacity, but that he does have a 
 
            limitation in his environmental condition (Jt. Ex. 2, p. 
 
            48).  Dr. Dennis said he could not be certain when claimant 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            would have developed asthma regardless of his occupation 
 
            (Jt. Ex. 2, p. 56).  Although Dr. Dennis indicates asthmas 
 
            can be medically managed, he said claimant wasn't given the 
 
            proper dosages and that the underdosages came because 
 
            claimant's asthma was not being medically managed.  The 
 
            doctor then increased claimant's dosage.  Dr. Dennis was 
 
            then asked and answered as follows:
 
            
 
                 Q.  Doctor Dennis, did you perform a lung function 
 
                 study in your visit with him in 1989, September 
 
                 and October?
 
            
 
                 A.  No.
 
            
 
                 Q.  Are the environmental restrictions that you 
 
                 have imposed upon Mr. Reynolds related to his -- 
 
                 related to his exposure of fiberglass at Amana 
 
                 Refrigeration?
 
            
 
                 A.  That's one thing we have not addressed yet and 
 
                 we made a brief reference to it.  It is not clear 
 
                 to me that necessarily it was the fiberglass 
 
                 exposure that was responsible for his problems.  
 
                 It sounded as if, based on his history, it was an 
 
                 occupational exposure.  Fiberglass is not the 
 
                 typical agent that will cause this kind of 
 
                 problem.  Any dust, any kind of particulate matter 
 
                 is a possibility.  But other thoughts that I had 
 
                 was that he was being exposed to some other 
 
                 nonspecific irritants, something else causing the 
 
                 problems.
 
            
 
                 Q.  Are the environmental restrictions that you 
 
                 have imposed now related to his occupational 
 
                 exposure at Amana Refrigeration?
 
            
 
                 A.  The recommendations are because of his 
 
                 diagnosis of hyperreactive airway disease or 
 
                 asthma and not specifically related to his 
 
                 occupational exposures at Amana Refrigeration.
 
            
 
            (Jt. Ex. 2, pp. 57 and 58)
 
            
 
                 Dr. Dennis indicated claimant told him fiberglass was 
 
            the only occupational agent he could identify.  Claimant 
 
            also told him the factory was very dusty.  It is obvious 
 
            that the doctor is solely relying on what claimant is 
 
            telling him.  The doctor did not, in fact, go out to the 
 
            plant.  The doctor's final comment in his testimony was "His 
 
            need for continued medication, continued medical management, 
 
            is related to his occupational exposure at Amana 
 
            Refrigeration only in the fact that there is a possibility 
 
            that his occupational exposures are responsible for his 
 
            asthma." (Jt. Ex. 2, p. 59)
 
            
 
                 Richard D. Louvar, D.O., has treated claimant since 
 
            1973.  He said claimant had complaints in 1987 of trouble 
 
            breathing and related he was working with fiberglass.  Since 
 
            the doctor had no prior history for treatment of claimant 
 
            for this type of complaint, he opined that claimant's 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            problems probably were related to his exposure at work (Jt. 
 
            Ex. 3, pp. 10 and 18).  He said claimant was not wearing a 
 
            dust respirator.  The doctor then wrote a letter to 
 
            defendant employer on March 7, 1988 (Jt. Ex. 1, p. 11), 
 
            indicating claimant should be transferred to another area 
 
            where he will not be exposed to insulation.  Dr. Louvar last 
 
            saw claimant for an upper respiratory tract infection in 
 
            January 1989.  He prescribed antibiotics and antihistamine.  
 
            It doesn't appear that this had anything to do with his 
 
            alleged fiberglass exposure.  The doctor saw claimant in May 
 
            1990 for poison ivy and there was no mention of any 
 
            pulmonary problems (Jt. Ex. 3, p. 10).  Dr. Louvar 
 
            emphasized claimant should avoid noxious stimuli and protect 
 
            himself from asbestos, dust and fiberglass.  He said there 
 
            was no specific allergen or substance that was identified as 
 
            being responsible for claimant's pulmonary condition.  Dr. 
 
            Louvar could not determine any degree of permanent 
 
            impairment but he opined that claimant may have a 
 
            semi-permanent or permanent condition caused from fiberglass 
 
            fibers in his lungs which would make him prone to have 
 
            chronic bronchitis which could trigger asthma or restrict 
 
            airway disease.
 
            
 
                 Dr. Louvar acknowledged he sent claimant to Dr. Dennis 
 
            because he is a specialist in pulmonary care.  He admitted 
 
            no studies were performed that confirmed the presence of 
 
            glass in claimant's lungs.  He agreed asthma is triggered by 
 
            many things such as viral infection, exercise, cold air, 
 
            noxious odors, smoke, air pollution, sulphur dioxide and 
 
            aspirin.  Dr. Louvar agreed that symptoms of occupational 
 
            asthma should subside after changing jobs and avoiding the 
 
            initial irritants unless permanent damage is done.
 
            
 
                 Paul From, M.D., certified in internal medicine, 
 
            testified on September 12, 1990 by way of his deposition 
 
            (Jt. Ex. 4).  He said he had claimant's medical records and 
 
            Dr. Dennis' and Louvar's depositions to review.  He saw 
 
            claimant on October 13, 1989 upon referral from defendant 
 
            insurance company.  Dr. From's notes that certain tests were 
 
            not given which could actually determine the root of 
 
            claimant's problem and restrictions, if any, in the flow of 
 
            air.
 
            
 
                 Dr. From performed a spirometry test on claimant and 
 
            found the volume of air and speed with which the air was 
 
            moved in and out of claimant's lungs was normal (Jt. Ex. 4, 
 
            p. 17).  Claimant also had a normal pulmonary function study 
 
            done.  Dr. From did a very thorough examination on claimant 
 
            and performed various other tests.  The doctor noted 
 
            claimant's complaints "have persisted in spite of his no 
 
            longer working at his previous occupation, and I believe his 
 
            condition could best be described at this time as a chronic 
 
            bronchitis." (Jt. Ex. 4, p. 27)  He concluded that this 
 
            ruled out occupational asthma and indicated claimant had 
 
            chronic bronchitis.  Dr. From opined that claimant's work 
 
            was not the cause of his present complaints (Jt. Ex. 4, p. 
 
            28) and that claimant did not suffer any medical impairment.  
 
            He did not think the exposure to fiberglass caused any of 
 
            claimant's problems.  The doctor also explained claimant's 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            forced vital capacity was 104 percent of normal and this is 
 
            inconsistent with claimant's breathing complaints.  
 
            Claimant's maximum volume ventilation was 102 percent of 
 
            predicted normal.  This is often seen in "healthy" people 
 
            (Jt. Ex. 4, p. 31).
 
            
 
                 Dr. From indicated that when he examined claimant in 
 
            October 1989, he couldn't even find any asthma.  Dr. From 
 
            did not believe claimant had occupational asthma.  He said 
 
            there is a possibility something at work aggravated 
 
            claimant's chronic bronchitis but he did not think it was 
 
            the proximate cause of it.  He also said he couldn't rule 
 
            out the proximate cause of the irritation of claimant's 
 
            chronic bronchitis.  He admitted the other doctors treated 
 
            claimant at an acute phase whereas Dr. From did not.  Dr. 
 
            From wrote a report on November 7, 1989 (Dep. Ex. 2 of From 
 
            Deposition; Jt. Ex. 4) and affirmed many of the things to 
 
            which the doctor testified. 
 
            
 
                 The other doctors also made written reports which 
 
            confirmed or supported their testimony.  There is no need to 
 
            further duplicate their written opinions in addition to 
 
            their deposition testimony.
 
            
 
                 There is obviously a disagreement among the medical 
 
            doctors.  It is obvious claimant relies heavily on Dr. 
 
            Dennis' testimony.  Dr. Dennis relies heavily on the history 
 
            related to him by claimant.  It is evident that Dr. Dennis 
 
            feels there was no prior family history of evidence of 
 
            asthma or symptoms of which claimant was complaining and yet 
 
            the claimant's mother indicated she was disqualified from 
 
            being in a fiberglass environment during part of the time 
 
            she was employed with defendant employer.  She testified she 
 
            had worked for a total of eleven years for defendant 
 
            employer until she finally quit because of carpal tunnel 
 
            problems.  Dr. Dennis couched many of his opinions with the 
 
            word "possible" rather than "probable."
 
            
 
                 The greater weight of medical evidence, which is 
 
            additionally supported by the claimant and his mother's 
 
            testimony, shows that when claimant was removed from the 
 
            fiberglass department or area of defendant employer, and 
 
            especially when the claimant quit the employment with 
 
            defendant employer, his symptoms eased and by the time he 
 
            saw Dr. From in October 1989, there was basically no 
 
            symptoms for which the claimant complained or that the 
 
            doctor could objectively find.  Dr. From testified that 
 
            tests were normal and did not even find any evidence of 
 
            asthma.  The testimony is clear that there could be many 
 
            factors causing an allergy reaction or an irritant to 
 
            claimant which could result in some hyperreactive airway 
 
            problems.  It appears that claimant again started having 
 
            some problems when he began a job of hanging Sheetrock.
 
            
 
                 Dr. Dennis' letter of September 14, 1989 (Jt. Ex. 1(5) 
 
            to claimant's attorney indicated that "it is not possible to 
 
            say with absolute certainty that the patient's pulmonary 
 
            symptomatology are secondary to his occupational exposures."  
 
            It is clear that his reasoning at that time was that asthma 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            can come on at any time.  Dr. Dennis had not seen claimant 
 
            between April 6, 1988, which was shortly before claimant 
 
            quit his job with defendant employer, until September 1989.  
 
            Claimant had missed a May 1988 follow-up appointment with 
 
            the doctor.
 
            
 
                 Dr. Louvar testified that he last saw claimant for an 
 
            upper respiratory tract infection in January 1989.  It is 
 
            clear from his testimony that claimant had an upper 
 
            respiratory tract infection and bronchitis and he prescribed 
 
            some antibiotics.  This was a cold infection and not as a 
 
            result of any alleged occupational disease or exposure.
 
            
 
                 The greater weight of evidence shows that claimant's 
 
            work place or alleged work injury on January 4, 1988 did not 
 
            cause claimant to have any permanent impairment.  There 
 
            isn't a doctor who contends claimant has any permanent 
 
            impairment.  Claimant contends that the alleged occupational 
 
            disease caused his asthma. Also, claimant seems to contend 
 
            that since he had to be removed from jobs and ultimately 
 
            claims he left employment because of the alleged irritants 
 
            at defendant employer, this is also compensable under the 
 
            Iowa Workers' Compensation Laws.  Claimant refused to 
 
            continue working at defendant employer or even seek another 
 
            position crating refrigerators that in no way, it appears, 
 
            would expose him to fiberglass or any other irritants.  At 
 
            least, he did not try.  *****
 
            
 
                 *****
 
            
 
                 The greater weight of evidence shows that claimant 
 
            first suffered his hyperreactive airway respiratory and 
 
            breathing problems and asthmatic symptoms as a result of 
 
            working at defendant employer with fiberglass.  There is no 
 
            evidence of any other causation of claimant's problems 
 
            except in the work place.  The parties agreed that claimant 
 
            was off work beginning March 9, 1988 up to and not including 
 
            May 1, 1988.  It is found that during this period of time 
 
            claimant was temporary totally disabled as a result of his 
 
            working in the plant of defendant employer and being exposed 
 
            to an irritant, most likely fiberglass.  It is further found 
 
            that once claimant was removed from that environment, he 
 
            recovered and was found to have no asthma or hyperreactive 
 
            airway disease or impairment resulting from any work 
 
            experience at defendant employer.  The undersigned finds 
 
            claimant does not have an occupational disease and that 
 
            claimant did not incur an occupational disease which arose 
 
            out of and in the course of his employment, nor was any such 
 
            disease causally connected to any alleged January 4, 1988 
 
            injury.  It is also found that claimant does not have an 
 
            impairment resulting from any occupational disease or injury 
 
            on January 4, 1988.
 
            
 
                 Iowa Code section 85.27 benefits was only an issue 
 
            based on the fact that defendants contend the medical was 
 
            not causally connected as a result of an alleged injury or 
 
            occupational disease occurring on January 4, 1988.  There 
 
            was no issue of authorization.  It is obvious authorization 
 
            would not be an issue in light of the fact that defendants 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            denied liability.  It appears claimant went to the company 
 
            doctor anyway.  Defendants are responsible for all 
 
            claimant's medical bills that are exhibits and in dispute 
 
            herein under 85.27.
 
            
 
                                CONCLUSIONS OF LAW
 
 
 
            The conclusions of law contained in the proposed agency 
 
            decision filed November 26, 1990 are adopted as set forth 
 
            below.  Segments designated by brackets ([ ]) indicate 
 
            language that is in addition to the language of the proposed 
 
            agency decision.
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that he received an injury on January 4, 
 
            1988 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 claimant has the burden of proving by a preponderance of 
 
            the evidence that the injury of January 4, 1988 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). 
 
            
 
                 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.
 
            
 
                 Iowa Code section 85.32 provides:
 
            
 
                    Except as to injuries resulting in permanent 
 
                 partial disability, compensation shall begin on 
 
                 the fourth day of disability after the injury.
 
            
 
                    If the period of incapacity extends beyond the 
 
                 fourteenth day following the date of injury, then 
 
                 the compensation due during the third week shall 
 
                 be increased by adding thereto an amount equal to 
 
                 three days of compensation.
 
            
 
                 Iowa Code section 85.33 provides, in part:
 
            
 
                    Except as provided in subsection 2 of this 
 
                 section, the employer shall pay to an employee for 
 
                 injury producing temporary total disability weekly 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
                 compensation benefits, as provided in section 
 
                 85.32, until the employee has returned to work or 
 
                 is medically capable of returning to employment 
 
                 substantially similar to the employment in which 
 
                 the employee was engaged at the time of injury, 
 
                 whichever occurs first.
 
            
 
     
 
            
 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            It is further concluded that:
 
            
 
                 Claimant did not receive an occupational disease on 
 
            January 4, 1988.
 
            
 
                 Claimant incurred an injury on January 4, 1988 as a 
 
            result of exposure to an irritant at defendant employer, 
 
            which irritant caused claimant to be off work beginning 
 
            March 9, 1988 to and not including May 1, 1988 which 
 
            resulted in claimant incurring 7.571 weeks of temporary 
 
            total disability at the rate of $212.63.
 
            Claimant's exposure to an irritant at defendant employer's 
 
            place of business did not cause claimant to incur an 
 
            occupational disease or any [permanent] impairment.  It only 
 
            caused claimant to have temporary breathing hyperreactive 
 
            airway restrictions.
 
            
 
                 Defendants are responsible for claimant's medical bills 
 
            which were causally related to claimant's temporary total 
 
            disability resulting from claimant's exposure to an irritant 
 
            at defendant employer's place of business.
 
            
 
                 Claimant is not entitled to any further disability 
 
            benefits.
 
            
 
                 WHEREFORE, the decision of the deputy is affirmed.
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay unto claimant seven point 
 
            five seven one (7.571) weeks of temporary total disability 
 
            benefits at the rate of two hundred twelve and 63/100 
 
            dollars ($212.63) per week beginning March 9, 1988.
 
            
 
                 That defendants shall pay accrued weekly benefits in a 
 
            lump sum.  There is no credit as defendants have not paid 
 
            any benefits.
 
            
 
                 That defendants shall pay claimant's medical expenses.  
 
            Claimant failed to abide by the hearing assignment order 
 
            item No. 3 and failed to itemize the medical expenses.  
 
            Because of the status of such records, the undersigned is 
 
            not attempting to determine the total amount.
 
            
 
                 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 matter 
 
            including the transcription of the hearing.  
 
            
 
     
 
            
 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            That defendant shall file claim activity reports as required 
 
            by this agency pursuant to rule 343 IAC 3.1(2).
 
            
 
                 Signed and filed this ____ day of November, 1992.
 
            
 
            
 
            
 
            
 
                                          
 
                                       ________________________________
 
                                                   BYRON K. ORTON
 
                                              INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Wm Dennis Currell
 
            Attorney at Law
 
            465 Brenton Financial Center
 
            150 1st Ave NE
 
            Cedar Rapids, IA 52401
 
            
 
            Mr. Greg A. Egbers
 
            Attorney at Law
 
            600 Union Arcade Bldg
 
            111 E 3rd St
 
            Davenport, IA 52801
 
            
 
 
            
 
 
 
 
 
 
 
 
 
                                              1801; 2203 
 
                                              Filed November 19, 1992
 
                                              Byron K. Orton
 
            
 
            
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
            BRIAN REYNOLDS,                 :
 
                                            :
 
                 Claimant,                  :
 
                                            :
 
            vs.                             :
 
                                            :       File No. 873552
 
            AMANA REFRIGERATION, INC.,      :
 
                                            :          A P P E A L
 
                 Employer,                  :
 
                                            :        D E C I S I O N
 
            and                             :
 
                                            :
 
            LIBERTY MUTUAL INSURANCE        :
 
            COMPANY,                        :
 
                                            :
 
                 Insurance Carrier,         :
 
                 Defendants.                :
 
            ____________________________________________________________
 
            
 
            1801, 2203
 
            Claimant who suffered asthma and hyperactive airway disease 
 
            after exposure to irritant at work, most likely fiberglass, 
 
            found not to have suffered an occupational disease.  
 
            Claimant's condition was not permanent, and resolved once 
 
            claimant removed himself from exposure.  Claimant awarded 
 
            temporary total disability benefits.  Deputy affirmed. 
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            BRIAN REYNOLDS,               :
 
                                          :
 
                 Claimant,                :
 
                                          :        File No. 873552
 
            vs.                           :
 
                                          :
 
            AMANA REFRIGERATION, INC.,    :     A R B I T R A T I O N
 
                                          :
 
                 Employer,                :        D E C I S I O N
 
                                          :
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INSURANCE      :
 
            COMPANY,                      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This case came on for hearing on October 3, 1990, in 
 
            Cedar Rapids, Iowa.  This is a proceeding in arbitration 
 
            wherein claimant seeks compensation for healing period 
 
            benefits and permanent partial disability benefits as a 
 
            result of an alleged occupational disease on January 4, 
 
            1988.  The record in the proceeding consists of the 
 
            testimony of the claimant, claimant's mother, Connie 
 
            Reynolds, Audrey Brichman, and Cynthia Baldwin; joint 
 
            exhibits 1, 2, 3 and 4; and defendants' exhibits A and B.
 
            
 
                                      issues
 
            
 
                 The issues for resolution are:
 
            
 
                 1.  Whether claimant's January 4, 1988 occupational 
 
            disease arose out of and in the course of his employment;
 
            
 
                 2.  Whether claimant's alleged occupational disease is 
 
            causally connected to his alleged injury on January 4, 1988;
 
            
 
                 3.  The nature and extent of claimant's disability and 
 
            entitlement to disability benefits; and,
 
            
 
                 4.  Whether claimant is entitled to 85.27 medical 
 
            benefits with the issue only being causal connection of said 
 
            medical benefits to the alleged January 4, 1988 occupational 
 
            disease injury.
 
            
 
                     
 
            
 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            findings of fact
 
            
 
                 The undersigned deputy having heard the testimony and 
 
            considered all the evidence, finds that:
 
            
 
                 Claimant is a 25-year-old who finished the tenth grade 
 
            and later obtained a GED.  He has no other formal education.
 
            Claimant related his work history beginning when he was 14 
 
            years of age up to sometime in 1987 when he began working 
 
            for defendant employer.  This prior history involved 
 
            claimant working as a mattress assembler and a truck 
 
            mechanic limited to changing oil, tires and washing 
 
            vehicles.  Claimant went to work for defendant employer in 
 
            1987 because of the $9.60 per hour pay versus the $7.00 per 
 
            hour at his previous employment.  Claimant described his 
 
            work with defendant employer.  After approximately six 
 
            months, claimant was assigned to a job placing fiber glass 
 
            insulation in refrigerator walls.  He described the 
 
            procedure of cutting, handling and eventually installing the 
 
            fiber glass in the refrigerator walls.  He indicated there 
 
            was one strip per unit and he would have a 500 per night 
 
            quota.  He said this was not a physical job.
 
            
 
                 Claimant said he played junior high football and 
 
            wrestled and had no asthma or breathing problems prior to 
 
            working for defendant employer.
 
            
 
                 Claimant testified defendant employer had a safety 
 
            class but there was no requirement that an employee wear a 
 
            mask or gloves when handling the fiber glass.  He also 
 
            indicated he never saw any warning on the plastic bag of 
 
            fiber glass.  Claimant said his first symptoms of having 
 
            congestion, trouble breathing and coughing up stuff and 
 
            becoming ill began in October of 1987.  He first saw Richard 
 
            D. Louvar, D.O., the family doctor, in December 1987 who 
 
            referred claimant to Darrell R. Dennis, M.D., whose 
 
            specialty is pulmonary disease and critical care.
 
            
 
                 Dr. Louvar notified defendant employer to take claimant 
 
            off the insulation work.  Defendant employer then assigned 
 
            claimant to a tray assembly area.  Claimant contends there 
 
            was still exposure to fiber in the area and the insulation 
 
            was stacked on a table in front of him even though he wasn't 
 
            handling it in this tray job.  Claimant said the factory is 
 
            open with no dividing walls.
 
            
 
                 Claimant was then moved to an injection molding 
 
            department because his condition became worse.  This new 
 
            move removed claimant from the insulation exposure but his 
 
            pay was reduced to $7.14 per hour.  Claimant contends he was 
 
            still bothered by the symptoms and that when it got hot, 
 
            defendant employer used fans which stirred up the dust.
 
            
 
                 Claimant worked one month in the injection molding 
 
            department.  He was on medication.  He related the medicine 
 
            made him irritable, nervous and light headed.  He said the 
 
            employer did not place him in another job and his mother 
 
            discouraged him from applying for a job in the crate 
 
            department, boxing complete refrigerators.  Claimant quit 
 
            working for defendant employer in May 1988.  He explained he 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            won unemployment benefits over defendant employer's 
 
            resistance.
 
            
 
                 Claimant related the jobs he did after leaving 
 
            defendant employer, which included assembling hoses at 
 
            Apache Hose and Belt Company.  He went back and forth, in 
 
            other words, quitting and returning at this place of 
 
            employment.  Ultimately, in April 1990, he was laid off at 
 
            Apache and thereafter worked hanging Sheetrock on the walls 
 
            and nailing it.  Prior to this, and after leaving defendant 
 
            employer, claimant was basically free of his severe symptoms 
 
            and took medication.  Claimant said his asthma symptoms did 
 
            return at this dry wall job.
 
            
 
                 Claimant testified as to how the asthmatic condition 
 
            effects him when he is doing certain activities.  He said 
 
            Amana Refrigeration had a health plan but he opted out.
 
            
 
                 Connie Reynolds, claimant's mother, testified she has 
 
            worked at St. Luke's Hospital a year and previously worked 
 
            for defendant employer for eleven years.  She indicated she 
 
            was also affected while working for defendant employer and 
 
            was disqualified from working with the insulation.  She 
 
            indicated she knew of no family-inherited trait for asthma, 
 
            but said she was also disqualified from working with fiber 
 
            glass insulation as it bothered her.  She said she left 
 
            defendant employer because she could not take it any longer 
 
            as she had hands, elbow and carpal tunnel problems.  She 
 
            indicated she has paid for some of claimant's medication and 
 
            the doctor has given claimant samples as claimant could not 
 
            afford to pay for the medicine.  She related claimant is not 
 
            taking his medicine on an every day basis.  She acknowledged 
 
            claimant's condition improved after he left defendant 
 
            employer.  She also said the medication helped claimant.  
 
            She said claimant's symptoms returned after he started 
 
            working for the Sheetrock company.
 
            
 
                 Audrey Brickman was claimant's supervisor in 1987 and 
 
            1988.  She said claimant never asked to use a dust mask 
 
            which was available.  She said claimant was eventually moved 
 
            from an area of possible fiber exposure to the injection 
 
            molding department which is in a different building where 
 
            there is no fiber glass exposure.  She doesn't recall 
 
            claimant cutting any fiber glass but said he would have 
 
            handled fiber glass in his earlier job with the company.
 
            
 
                 Cynthia Baldwin, director of occupational health for 
 
            defendant employer, testified she conducted a test on March 
 
            10, 1988, and used an air pump to pick up the fiber and 
 
            dust.  She said the nuisance dust level was very low.  She 
 
            acknowledged the test was basically for asbestos and not 
 
            fiber glass.  She said she considers herself to be an expert 
 
            in this type of testing.
 
            
 
                 Darrell R. Dennis, M.D., a board certified pulmonary 
 
            disease specialist and a private practitioner since July of 
 
            1986, testified by way of his deposition on August 10, 1990.  
 
            He first consulted with claimant on January 20, 1988, after 
 
            being referred to him by claimant's family doctor, Richard 
 
            Louvar, D.O.
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            
 
                 Dr. Dennis said claimant's pulmonary function test 
 
            dated January 6, 1988 substantiated that claimant did have 
 
            hyperreactive airway disease or asthma.  He agreed with this 
 
            diagnosis and also said he felt that claimant's occupational 
 
            exposure was either a causal or contributing factor to 
 
            claimant's upper respiratory and pulmonary systems.  Dr. 
 
            Dennis said claimant had not seen him between April 6, 1988 
 
            until September 1989 and claimant had missed a May 1988 
 
            follow-up appointment.  The doctor indicated further that:  
 
            "Based on his history, he dated the onset of his symptoms 
 
            with the onset of his employment with Amana Refrigeration.  
 
            Because of that I thought that his occupational exposure 
 
            could be a contributing or causal factor." (Jt. Ex. 2, p. 
 
            26)  Earlier in his testimony, the doctor said, "I think 
 
            that his occupational exposures were a possible contributing 
 
            factor to his pulmonary symptoms." (Jt. Ex. 2, p. 24 and 25)  
 
            On October 3, 1990, Dr. Dennis wrote a letter to claimant's 
 
            attorney stating:  "[I]t is my opinion that Mr. Reynolds' 
 
            occupational exposures are a possible causal factor and a 
 
            probable exacerbating factor for the development of his 
 
            hyperreactive airway disease (asthma).  It is distinctly 
 
            unlikely that chronic bronchitis is a viable diagnosis in 
 
            this patient." (Jt. Ex. 1(10))
 
            
 
                 The doctor acknowledged he wrote defendant employer 
 
            saying it would be preferable not to have claimant employed 
 
            in this situation or environment where he would be exposed 
 
            to potentially significant exposure such as heavy dust, 
 
            fumes and odors (Jt. Ex. 2, p. 30 and 31).  The doctor 
 
            defined asthma as "variable airway obstruction which is 
 
            aggravated by either specific allergens or by nonspecific 
 
            irritants, and which remits either spontaneously or with 
 
            therapy." (Jt. Ex. 2, p. 41)  The doctor said it can be 
 
            reversible.  It can be aggravated by viral infection, 
 
            exercise, allergens, irritants, cold air, strong odor, 
 
            smoke, air pollutants and aspirin.  Dr. Dennis said fiber 
 
            glass or dust from fiber glass itself is not an allergenic.  
 
            The doctor acknowledged that he wrote a letter on September 
 
            14, 1989, to claimant's attorney, that indicated:
 
            
 
                    It is not possible to say with absolute 
 
                 certainty that the patient's pulmonary 
 
                 symptomatology are secondary to his occupational 
 
                 exposures.  However, the onset of his upper 
 
                 respiratory and pulmonary symptomatology coincide 
 
                 with his significant occupational exposure to 
 
                 asbestos.  The patient does
 
            
 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            not have a history of prior pulmonary disease and 
 
            he does not have a personal or family history of 
 
            atopic disease.
 
            
 
            (Jt. Ex. 1, (5))
 
            
 
                 The doctor said his reason was that asthma can come on 
 
            at any time (Jt. Ex. 2, p. 43).  He further stated that the 
 
            symptoms of occupational asthma should subside after 
 
            changing jobs and avoiding the initial irritants (Jt. Ex. 2, 
 
            p. 46).  It appears the doctor relied heavily on the history 
 
            given to him by the claimant.  Many tests were not given.  
 
            It seems as if the doctor presumed early in the game that 
 
            claimant had an occupational disease and thereafter treated 
 
            it as such.  Dr. Dennis testified that asthma can be well 
 
            controlled with medication and with the avoidance of 
 
            nonexacerbating factors.  He indicated that the majority of 
 
            people with asthma do not have a physical limitation in 
 
            their work capacity and he did not think claimant had a 
 
            limitation in his work capacity, but that he does have a 
 
            limitation in his environmental condition (Jt. Ex. 2, p. 
 
            48).  Dr. Dennis said he could not be certain when claimant 
 
            would have developed asthma regardless of his occupation 
 
            (Jt. Ex. 2, p. 56).  Although Dr. Dennis indicates asthmas 
 
            can be medically managed, he said claimant wasn't given the 
 
            proper dosages and that the underdosages came because 
 
            claimant's asthma was not being medically managed.  The 
 
            doctor then increased claimant's dosage.  Dr. Dennis was 
 
            then asked and answered as follows:
 
            
 
                 Q.  Doctor Dennis, did you perform a lung function 
 
                 study in your visit with him in 1989, September 
 
                 and October?
 
            
 
                 A.  No.
 
            
 
                 Q.  Are the environmental restrictions that you 
 
                 have imposed upon Mr. Reynolds related to his -- 
 
                 related to his exposure of fiberglass at Amana 
 
                 Refrigeration?
 
            
 
                 A.  That's one thing we have not addressed yet and 
 
                 we made a brief reference to it.  It is not clear 
 
                 to me that necessarily it was the fiberglass 
 
                 exposure that was responsible for his problems.  
 
                 It sounded as if, based on his history, it was an 
 
                 occupational exposure.  Fiberglass is not the 
 
                 typical agent that will cause this kind of 
 
                 problem.  Any dust, any kind of particulate matter 
 
                 is a possibility.  But other thoughts that I had 
 
                 was that he was being exposed to some other 
 
                 nonspecific irritants, something else causing the 
 
                 problems.
 
            
 
                 Q.  Are the environmental restrictions that you 
 
                 have imposed now related to his occupational 
 
                 exposure at Amana Refrigeration?
 
            
 
                 A.  The recommendations are because of his 
 
                 diagnosis of hyperreactive airway disease or 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
                 asthma and not specifically related to his 
 
                 occupational exposures at Amana Refrigeration.
 
            
 
            (Jt. Ex. 2, pp. 57 and 58)
 
            
 
                 Dr. Dennis indicated claimant told him fiber glass was 
 
            the only occupational agent he could identify.  Claimant 
 
            also told him the factory was very dusty.  It is obvious 
 
            that the doctor is solely relying on what claimant is 
 
            telling him.  The doctor did not, in fact, go out to the 
 
            plant.  The doctor's final comment in his testimony was "His 
 
            need for continued medication, continued medical management, 
 
            is related to his occupational exposure at Amana 
 
            Refrigeration only in the fact that there is a possibility 
 
            that his occupational exposures are responsible for his 
 
            asthma." (Jt. Ex. 2, p. 59)
 
            
 
                 Richard D. Louvar, D.O., has treated claimant since 
 
            1973.  He said claimant had complaints in 1987 of trouble 
 
            breathing and related he was working with fiber glass.  
 
            Since the doctor had no prior history for treatment of 
 
            claimant for this type of complaint, he opined that 
 
            claimant's problems probably were related to his exposure at 
 
            work (Jt. Ex. 3, pp. 10 and 18).  He said claimant was not 
 
            wearing a dust respirator.  The doctor then wrote a letter 
 
            to defendant employer on March 7, 1988 (Jt. Ex. 1, p. 11), 
 
            indicating claimant should be transferred to another area 
 
            where he will not be exposed to insulation.  Dr. Louvar last 
 
            saw claimant for an upper respiratory tract infection in 
 
            January 1989.  He prescribed antibiotics and antihistamine.  
 
            It doesn't appear that this had anything to do with his 
 
            alleged fiber glass exposure.  The doctor saw claimant in 
 
            May 1990 for poison ivy and there was no mention of any 
 
            pulmonary problems (Jt. Ex. 3, p. 10).  Dr. Louvar 
 
            emphasized claimant should avoid noxious stimuli and protect 
 
            himself from asbestos, dust and fiber glass.  He said there 
 
            was no specific allergen or substance that was identified as 
 
            being responsible for claimant's pulmonary condition.  Dr. 
 
            Louvar could not determine any degree of permanent 
 
            impairment but he opined that claimant may have a 
 
            semi-permanent or permanent condition caused from fiber 
 
            glass fibers in his lungs which would make him prone to have 
 
            chronic bronchitis which could trigger asthma or restrict 
 
            airway disease.
 
            
 
                 Dr. Louvar acknowledged he sent claimant to Dr. Dennis 
 
            because he is a specialist in pulmonary care.  He admitted 
 
            no studies were performed that confirmed the presence of 
 
            glass in claimant's lungs.  He agreed asthma is triggered by 
 
            many things such as viral infection, exercise, cold air, 
 
            noxious odors, smoke, air pollution, sulphur dioxide and 
 
            aspirin.  Dr. Louvar agreed that symptoms of occupational 
 
            asthma should subside after changing jobs and avoiding the 
 
            initial irritants unless permanent damage is done.
 
            
 
                 Paul From, M.D., certified in internal medicine, 
 
            testified on September 12, 1990 by way of his deposition 
 
            (Jt. Ex. 4).  He said he had claimant's medical records and 
 
            Dr. Dennis' and Louvar's depositions to review.  He saw 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            claimant on October 13, 1989 upon referral from defendant 
 
            insurance company.  Dr. From's notes that certain tests were 
 
            not given which could actually determine the root of 
 
            claimant's problem and restrictions, if any, in the flow of 
 
            air.
 
            
 
                 Dr. From performed a spirometry test on claimant and 
 
            found the volume of air and speed with which the air was 
 
            moved in and out of claimant's lungs was normal (Jt. Ex. 4, 
 
            p. 17).  Claimant also had a normal pulmonary function study 
 
            done.  Dr. From did a very thorough examination on claimant 
 
            and performed various other tests.  The doctor noted 
 
            claimant's complaints "have persisted in spite of his no 
 
            longer working at his previous occupation, and I believe his 
 
            condition could best be described at this time as a chronic 
 
            bronchitis." (Jt. Ex. 4, p. 27)  He concluded that this 
 
            ruled out occupational asthma and indicated claimant had 
 
            chronic bronchitis.  Dr. From opined that claimant's work 
 
            was not the cause of his present complaints (Jt. Ex. 4, p. 
 
            28) and that claimant did not suffer any medical impairment.  
 
            He did not think the exposure to fiber glass caused any of 
 
            claimant's problems.  The doctor also explained claimant's 
 
            forced vital capacity  was 104 percent of normal and this is 
 
            inconsistent with claimant's breathing complaints.  
 
            Claimant's maximum volume ventilation was 102 percent of 
 
            predicted normal.  This is often seen in "healthy" people 
 
            (Jt. Ex. 4, p. 31).
 
            
 
                 Dr. From indicated that when he examined claimant in 
 
            October 1989, he couldn't even find any asthma.  Dr. From 
 
            did not believe claimant had occupational asthma.  He said 
 
            there is a possibility something at work aggravated 
 
            claimant's chronic bronchitis but he did not think it was 
 
            the proximate cause of it.  He also said he couldn't rule 
 
            out the proximate cause of the irritation of claimant's 
 
            chronic bronchitis.  He admitted the other doctors treated 
 
            claimant at an acute phase whereas Dr. From did not.  Dr. 
 
            From wrote a report on November 7, 1989 (Dep. Ex. 2 of From 
 
            Deposition; Jt. Ex. 4) and affirmed many of the things to 
 
            which the doctor testified. 
 
            
 
                 The other doctors also made written reports which 
 
            confirmed or supported their testimony.  There is no need to 
 
            further duplicate their written opinions in addition to 
 
            their deposition testimony.
 
            
 
                 There is obviously a disagreement among the medical 
 
            doctors.  It is obvious claimant relies heavily on Dr. 
 
            Dennis' testimony.  Dr. Dennis relies heavily on the history 
 
            related to him by claimant.  It is evident that Dr. Dennis 
 
            feels there was no prior family history of evidence of 
 
            asthma or symptoms of which claimant was complaining and yet 
 
            the claimant's mother indicated she was disqualified from 
 
            being in a fiber glass environment during part of the time 
 
            she was employed with defendant employer.  She testified she 
 
            had worked for a total of eleven years for defendant 
 
            employer until she finally quit because of carpal tunnel 
 
            problems.  Dr. Dennis couched many of his opinions with the 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            word "possible" rather than "probable."
 
            
 
                 The greater weight of medical evidence, which is 
 
            additionally supported by the claimant and his mother's 
 
            testimony, shows that when claimant was removed from the 
 
            fiber glass department or area of defendant employer, and 
 
            especially when the claimant quit the employment with 
 
            defendant employer, his symptoms eased and by the time he 
 
            saw Dr. From in October 1989, there was basically no 
 
            symptoms for which the claimant complained or that the 
 
            doctor could objectively find.  Dr. From testified that 
 
            tests were normal and did not even find any evidence of 
 
            asthma.  The testimony is clear that there could be many 
 
            factors causing an allergy reaction or an irritant to 
 
            claimant which could result in some hyperreactive airway 
 
            problems.  It appears that claimant again started having 
 
            some problems when he began a job of hanging Sheetrock.
 
            
 
                 Dr. Dennis' letter of September 14, 1989 (Jt. Ex. 1(5) 
 
            to claimant's attorney indicated that "it is not possible to 
 
            say with absolute certainty that the patient's pulmonary 
 
            symptomatology are secondary to his occupational exposures."  
 
            It is clear that his reasoning at that time was that asthma 
 
            can come on at any time.  Dr. Dennis had not seen claimant 
 
            between April 6, 1988, which was shortly before claimant 
 
            quit his job with defendant employer, until September 1989.  
 
            Claimant had missed a May 1988 follow-up appointment with 
 
            the doctor.
 
            
 
                 Dr. Louvar testified that he last saw claimant for an 
 
            upper respiratory tract infection in January 1989.  It is 
 
            clear from his testimony that claimant had an upper 
 
            respiratory tract infection and bronchitis and he prescribed 
 
            some antibiotics.  This was a cold infection and not as a 
 
            result of any alleged occupational disease or exposure.
 
            
 
                 The greater weight of evidence shows that claimant's 
 
            work place or alleged work injury on January 4, 1988 did not 
 
            cause claimant to have any permanent impairment.  There 
 
            isn't a doctor who contends claimant has any permanent 
 
            impairment.  Claimant contends that the alleged occupational 
 
            disease caused his asthma. Also, claimant seems to contend 
 
            that since he had to be removed from jobs and ultimately 
 
            claims he left employment because of the alleged irritants 
 
            at defendant employer, this is also compensable under the 
 
            Iowa Workers' Compensation Laws.  Claimant refused to 
 
            continue working at defendant employer or even seek another 
 
            position crating refrigerators that in no way, it appears, 
 
            would expose him to fiber glass or any other irritants.  At 
 
            least, he did not try.  It appears his mother influenced him 
 
            in not trying to obtain that job.  It is unfortunate that 
 
            his mother had such an influence over claimant under these 
 
            circumstances.
 
            
 
                 The evidence is clear that there can be many causes for 
 
            asthma reactions by various allergens or irritants at home 
 
            and at work.  The employer is not responsible for any 
 
            industrial disability by the mere fact that there may be an 
 
            irritant in a factory to which claimant reacts.  Once the 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            irritant is removed or claimant is removed from the 
 
            environment, claimant no longer has the symptoms or the 
 
            reaction or illness.  The mere fact that one has to leave an 
 
            environment so as to prevent exposure to fiber glass or 
 
            other irritants or allergens, or to prevent a hyperreactive 
 
            airway disease or asthma in its initial stages or from later 
 
            resulting in a possible permanent impairment, does not make 
 
            defendant employer responsible under the workers' 
 
            compensation law when there is no impairment.
 
            
 
                 The greater weight of evidence shows that claimant 
 
            first suffered his hyperreactive airway respiratory and 
 
            breathing problems and asthmatic symptoms as a result of 
 
            working at defendant employer with fiber glass.  There is no 
 
            evidence of any other causation of claimant's problems 
 
            except in the work place.  The parties agreed that claimant 
 
            was off work beginning March 9, 1988 up to and not including 
 
            May 1, 1988.  The undersigned finds that during this period 
 
            of time claimant was temporary totally disabled as a result 
 
            of his working in the plant of defendant employer and being 
 
            exposed to an irritant, most likely fiber glass.  The 
 
            undersigned further finds that once claimant was removed 
 
            from that environment, he recovered and was found to have no 
 
            asthma or hyperreactive airway disease or impairment 
 
            resulting from any work experience at defendant employer.  
 
            The undersigned finds claimant does not have an occupational 
 
            disease and that claimant did not incur an occupational 
 
            disease which arose out of and in the course of his 
 
            employment, nor was any such disease causally connected to 
 
            any alleged January 4, 1988 injury.  It is also found that 
 
            claimant does not have an impairment resulting from any 
 
            occupational disease or injury on January 4, 1988.
 
            
 
                 Iowa Code section 85.27 benefits was only an issue 
 
            based on the fact that defendants contend the medical was 
 
            not causally connected as a result of an alleged injury or 
 
            occupational disease occurring on January 4, 1988.  There 
 
            was no issue of authorization.  It is obvious authorization 
 
            would not be an issue in light of the fact that defendants 
 
            denied liability.  It appears claimant went to the company 
 
            doctor anyway.  Defendants are responsible for all 
 
            claimant's medical bills that are exhibits and in dispute 
 
            herein under 85.27.
 
            
 
                                conclusions of law
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that he received an injury on January 4, 
 
            1988 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 claimant has the burden of proving by a preponderance of 
 
            the evidence that the injury of January 4, 1988 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 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            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.
 
            
 
                 Iowa Code section 85.32 provides:
 
            
 
                    Except as to injuries resulting in permanent 
 
                 partial disability, compensation shall begin on 
 
                 the fourth day of disability after the injury.
 
            
 
                    If the period of incapacity extends beyond the 
 
                 fourteenth day following the date of injury, then 
 
                 the compensation due during the third week shall 
 
                 be increased by adding thereto an amount equal to 
 
                 three days of compensation.
 
            
 
                 Iowa Code section 85.33 provides, in part:
 
            
 
                    Except as provided in subsection 2 of this 
 
                 section, the employer shall pay to an employee for 
 
                 injury producing temporary total disability weekly 
 
                 compensation benefits, as provided in section 
 
                 85.32, until the employee has returned to work or 
 
                 is medically capable of returning to employment 
 
                 substantially similar to the employment in which 
 
                 the employee was engaged at the time of injury, 
 
                 whichever occurs first.
 
            
 
                 It is further concluded that:
 
            
 
                 Claimant did not receive an occupational disease on 
 
            January 4, 1988.
 
            
 
                 Claimant incurred an injury on January 4, 1988 as a 
 
            result of exposure to an irritant at defendant employer, 
 
            which irritant caused claimant to be off work beginning 
 
            March 9, 1988 to and not including May 1, 1988 which 
 
            resulted in claimant incurring 7.571 weeks of temporary 
 
            total disability at the rate of $212.63.
 
            Claimant's exposure to an irritant at defendant employer's 
 
            place of business did not cause claimant to incur an 
 
            occupational disease or any impairment.  It only caused 
 
            claimant to have temporary breathing hyperreactive airway 
 
            restrictions.
 
            
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
                 Defendants are responsible for claimant's medical bills 
 
            which were causally related to claimant's temporary total 
 
            disability resulting from claimant's exposure to an irritant 
 
            at defendant employer's place of business.
 
            
 
                 Claimant is not entitled to any further disability 
 
            benefits.
 
            
 
                                      order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay unto claimant seven point 
 
            five seven one (7.571) weeks of temporary total disability 
 
            benefits at the rate of two hundred twelve and 63/100 
 
            dollars ($212.63) per week beginning March 9, 1988.
 
            
 
                 That defendants shall pay accrued weekly benefits in a 
 
            lump sum.  There is no credit as defendants have not paid 
 
            any benefits.
 
            
 
                 That defendants shall pay claimant's medical expenses.  
 
            Claimant failed to abide by the hearing assignment order 
 
            item No. 3 and failed to itemize the medical expenses.  
 
            Because of the status of such records, the undersigned is 
 
            not attempting to determine the total amount.
 
            
 
                 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.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          BERNARD J. O'MALLEY
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            
 
            Copies to:
 
            
 
            Mr Wm Dennis Currell
 
            Attorney at Law
 
            465 Brenton Financial Center
 
            150 1st Ave NE
 
            Cedar Rapids IA 52401
 
            
 
            Mr Greg A Egbers
 
            Attorney at Law
 
            600 Union Arcade Bldg
 
            111 E 3rd St
 
            Davenport IA 52801
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      2203; 1402.50;
 
                      1402.30; 1801
 
                      Filed November 26, 1990
 
                      Bernard J. O'Malley
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            BRIAN REYNOLDS,               :
 
                                          :
 
                 Claimant,                :
 
                                          :        File No. 873552
 
            vs.                           :
 
                                          :
 
            AMANA REFRIGERATION, INC.,    :     A R B I T R A T I O N
 
                                          :
 
                 Employer,                :        D E C I S I O N
 
                                          :
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INSURANCE      :
 
            COMPANY,                      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            2203; 1402.50; 1402.30
 
            Claimant was found not to have incurred an occupational 
 
            disease.
 
            
 
            1801
 
            Claimant was found to have incurred a temporary total 
 
            disability of 7.571 as a result of a work-related exposure 
 
            to an irritant (fiber glass) which caused claimant to miss 
 
            work.  Once claimant was removed from the irritant and 
 
            environment, claimant was basically recovered.  Claimant was 
 
            never determined by any doctor to have a permanent 
 
            impairment.