BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                                         :
 
         PEG NORLIN,                     :
 
                                         :
 
              Claimant,                  :
 
                                         :
 
         vs.                             :
 
                                         :        File No. 889857
 
         BOBALEE, INC.,                  :
 
                                         :          A P P E A L
 
              Employer,                  :
 
                                         :        D E C I S I O N
 
         and                             :
 
                                         :
 
         THE HARTFORD,                   :
 
                                         :
 
              Insurance Carrier,         :
 
              Defendants.                :
 
         _________________________________________________________________
 
         
 
              The record, including the transcript of the hearing before 
 
         the deputy and all exhibits admitted into the record, has been 
 
         reviewed de novo on appeal.  The decision of the deputy filed 
 
         February 4, 1994 is affirmed and is adopted as the final agency 
 
         action in this case.
 
         
 
              Claimant shall pay the costs of the appeal, including the 
 
         preparation of the hearing transcript.
 
         
 
              Signed and filed this ____ day of October, 1994.
 
         
 
         
 
         
 
         
 
                                       ________________________________
 
                                                BYRON K. ORTON
 
                                           INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Steve Hamilton
 
         Attorney at Law
 
         P.O. Box l88
 
         Storm Lake, Iowa 50588
 
         
 
         Mr. Frank T. Harrison
 
         Attorney at Law
 
         2700 Grand Ave., Ste 111
 
         Des Moines, Iowa 50312
 
         
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                                       1109.50; 1803.1; 1803;
 
                                       2209; 2900
 
                                       Filed October 18, 1994
 
                                       Byron K. Orton
 
         
 
         
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                                         :
 
         PEG NORLIN,                     :
 
                                         :
 
              Claimant,                  :
 
                                         :
 
         vs.                             :
 
                                         :        File No. 889857
 
         BOBALEE, INC.,                  :
 
                                         :          A P P E A L
 
              Employer,                  :
 
                                         :        D E C I S I O N
 
         and                             :
 
                                         :
 
         THE HARTFORD,                   :
 
                                         :
 
              Insurance Carrier,         :
 
              Defendants.                :
 
         _________________________________________________________________
 
         
 
         1108.50; 1803.1; 1803; 2209; 2900
 
         
 
              Claimant's bilateral thoracic outlet syndrome found to  
 
         causally relate to a specific injury in which claimant had caught 
 
         her right ring finger in vise with pulling of the right upper 
 
         extremity and per claimant's testimony her whole trunk into the 
 
         left side.  David Roos, M.D., a renown thoracic and vascular 
 
         surgeon who treated claimant, supported causation.  Claimant had 
 
         asserted cumulative injury in claimant's original notice and 
 
         petition where claimant's symptoms and conditions manifested 
 
         themselves over time and subsequent to the original work incident 
 
         which occurred on claimant's second day at work.  Claimant's 
 
         condition not found to be a cumulative injury but rather a 
 
         condition resulting from a specific work incident which condition 
 
         manifested itself over time and likely was aggravated by 
 
         claimant's continuing work activities after the incident.  That 
 
         claimant had pled cumulative trauma in her original notice and 
 
         petition was not found to be prejudicial to defendants in that 
 
         defendants had notice of the medical conditions for which 
 
         claimant sought compensation.  Claimant's thoracic outlet 
 
         syndrome bilaterally and resulting restrictions including a five 
 
         pound lifting restriction and restrictions from heavy or 
 
         strenuous work with the upper extremities including keyboarding 
 
         and typing as well as restrictions on pushing and pulling and 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
         lifting over and working overhead or forward with the arms found 
 
         to establish a permanent industrial disability of 50 percent of 
 
         the body as a whole.
 
         
 
 
            
 
            
 
            
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                      
 
            PEGGY NORLIN,  
 
                      
 
                 Claimant, 
 
                      
 
            vs.       
 
                                              File No. 889857
 
            BOBALEE HYDRAULICS, INC.,     
 
                                            A R B I T R A T I O N
 
                 Employer, 
 
                                              D E C I S I O N
 
            and       
 
                      
 
            HARTFORD INSURANCE, 
 
                      
 
                 Insurance Carrier,  
 
                 Defendants.    
 
            ___________________________________________________________
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by the 
 
            claimant, Peggy Norlin, against her employer, Bobalee 
 
            Hydraulics Inc., and its insurance carrier, Hartford 
 
            Insurance, to recover benefits under the Iowa Workers' 
 
            Compensation Act as a result of an injury sustained on June 
 
            22, 1988.  This matter came on for hearing before the 
 
            undersigned deputy industrial commissioner at Fort Dodge, 
 
            Iowa, on December 13, 1993.  A first report of injury has 
 
            been filed.  The record consists of the testimony of 
 
            claimant and of joint exhibits 1 through 31 and defendants' 
 
            exhibits A through E.  
 
            
 
                                     ISSUES
 
            
 
                 Pursuant to the hearing report and the oral 
 
            stipulations of the parties at hearing, the parties agree to 
 
            the following:
 
            
 
                 1.  An employer-employee relationship existed between 
 
            claimant and Bobalee Hydraulics on June 22, 1988;
 
            
 
                 2.  Claimant was single and entitled to two exemptions 
 
            on June 22, 1988 and had a gross weekly wage of $255 
 
            resulting in a weekly compensation rate of $164.16;
 
            
 
                 3.  Claimant did receive an injury arising out of and 
 
            in the course of her employment on June 22, 1988;
 
            
 
                 4.  Defendants are entitled to a credit for 163.714 
 
            weeks of benefits paid claimant at the stipulated rate;
 
            
 
                 5.  Claimant seeks healing period or temporary total 
 
            disability benefits intermittently from June 22, 1988 
 
            through November 8, 1993; and
 
            
 
                 6.  Medical fees were fair and reasonable fees for 
 
            treatment received and treatment received was reasonable and 
 
            necessary treatment for the condition treated.
 

 
            
 
            Page   2
 
            
 
            
 
                 Issues remaining to be decided are:
 
            
 
                 1.  Whether a causal relationship existed between the 
 
            injury and claimed disability;
 
            
 
                 2.  Whether claimant is entitled to additional 
 
            temporary total or healing period disability and the extent 
 
            of any such entitlement; 
 
            
 
                 3.  The nature and extent of any permanent disability 
 
            entitlement, including the question of whether claimant has 
 
            a scheduled member disability or an industrial disability to 
 
            the body as a whole; and
 
            
 
                 4.  Whether claimant is entitled to payment of certain 
 
            medical costs as causally related to her work injury and as 
 
            costs defendants authorized.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The deputy, having heard the testimony and considered 
 
            the evidence, finds:
 
            
 
                 Claimant is a 42-year-old woman who completed tenth 
 
            grade and obtained a GED in approximately 1973.  She has 
 
            also taken approximately one semester of community college 
 
            courses in commercial art.  Claimant does not believe that 
 
            she currently has the physical capacities to work as a 
 
            commercial artist.  
 
            
 
                 Claimant began work with the employer on June 21, 1988.  
 
            Prior to that claimant had had a variety of skilled and 
 
            unskilled jobs ranging from waitressing, factory assembly 
 
            work, construction work, janitorial services and school bus 
 
            driving and meat packing.  Claimant also worked briefly as a 
 
            lead worker in a meat packing plant.  Claimant's salary at 
 
            Bobalee Hydraulics was $4.50 per hour when injured.  
 
            Employees work nine-hour days on a five or six day work week 
 
            basis.  Claimant had generally earned from $4.25 to $6.00 
 
            per hour in her pre-Bobalee employments.  
 
            
 
                 On June 22, 1988, claimant's second day of work at 
 
            Bobalee, claimant caught her right third finger in a vise.  
 
            She reported that the vise twisted and pulled her right arm 
 
            through to the next station and that she had pain that "went 
 
            all the way over to the left hand" as well as in the back, 
 
            neck and arm.  James Gannon, M.D., examined claimant on the 
 
            date of injury.  He took a history of the right third finger 
 
            having been caught in a vise with contusions and abrasions 
 
            on the lower arm and numbness and aching of the distal third 
 
            finger.  His impression was of a probable muscle tear of the 
 
            right lower biceps as a result of the extremity having been 
 
            pulled into the vise and rotated.  Dr. Gannon again saw 
 
            claimant on June 23, 1988.  He noted that she then had 
 
            improved right hand motion with increased right elbow 
 
            discoloration and with a restriction of extension.  Claimant 
 
            was tender over the right hand joint and tender posterially 
 
            and slightly medial to the right shoulder.  On June 27, 
 
            1988, Dr. Gannon reported that claimant had more movement 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            and strength in the shoulder and quite good wrist movement.
 
            
 
                 Claimant returned to work on June 30, 1988, apparently 
 
            to the same duties she had on June 22, 1988.  
 
            
 
                 Claimant next saw Dr. Gannon on September 22, 1988 with 
 
            complaints in the [left] arm.  Dr. Gannon diagnosed probable 
 
            left carpal tunnel syndrome.  On October 5, 1988, Dr. Gannon 
 
            stated that claimant had "got better with a different job 
 
            and Motrin."  He released her to return to work on 
 
            apparently the same machine she had worked at from her start 
 
            date through September 22, 1988.  Dr. Gannon, nonetheless, 
 
            referred claimant to William Follows, M.D.  
 
            
 
                 Dr. Follows initially saw claimant on October 28, 1988.  
 
            He recorded a three month history of pain and numbness in 
 
            the left hand initially in the third, fourth and fifth 
 
            fingers but at that point also involving the index finger 
 
            and thumb which problems activity aggravated.  On 
 
            examination claimant had good range of motion of the neck; 
 
            good strength and reflexes in the left upper extremity but 
 
            for decreased sensation in all but the ring finger.  
 
            Claimant had a positive Phalen's sign and a slightly 
 
            positive Tinel's sign.  Claimant was also tender over the 
 
            ulnar nerve and the cubital tunnel with positive Tinel's 
 
            sign there as well.  Dr. Follows' initial impression was of 
 
            left carpal tunnel syndrome with possible cubital tunnel 
 
            [syndrome].  Dr. Follows referred claimant to Sant M. S. 
 
            Hayreh, M.D., for electromyography studies.  On October 3, 
 
            1988, Dr. Hayreh opined that per electromyography studies, 
 
            claimant had normal left median and ulnar nerve activity.  
 
            Dr. Follows is an orthopedic surgeon; Dr. Hayreh, a 
 
            neurologist.  
 
            
 
                 On November 17, 1988, Dr. Follows referred claimant to 
 
            Thomas F. DeBartolo, M.D., an orthopedic hand specialist for 
 
            evaluation as regard to whether an ulnar nerve transposition 
 
            was warranted.  On December 2, 1988, Dr. DeBartolo reported 
 
            finding no localized pathology relative to claimant's left 
 
            upper extremity.  He felt there was no "hard" motor or 
 
            sensory involvement of the left ulnar nerve and no evidence 
 
            of localized pathology in either claimant's neck or 
 
            shoulder.  He "fairly strongly recommended" against upper 
 
            extremity surgery.  
 
            
 
                 Per Drs. DeBartolo and Hayreh, claimant underwent a 
 
            Minnesota Multiphasic Personality Inventory and psychiatric 
 
            evaluation with M. Peltan, Ph.D., on December 23, 1988.  On 
 
            January 5, 1989, Dr. Peltan interpreted claimant's MMPI as 
 
            being valid without evidence of serious acute 
 
            psychopathology or personality disorder.  He believed 
 
            claimant might have low self-esteem and chronic vague, very 
 
            mild dysphoria.  He believed there was a slight possibility 
 
            that claimant had a low level depression which exacerbated 
 
            her pain experience.
 
            
 
                 On January 11, 1989, Scott B. Neff, D.O., an orthopedic 
 
            surgeon, examined claimant.  On examination, Dr. Neff found 
 
            claimant to be exquisitely tender with palpation of the 
 
            cubital tunnel and to have an essentially negative Roos sign 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            for thoracic outlet syndrome as well as a negative Phalen's 
 
            sign at the wrist for distribution into the median nerve.  
 
            Dr. Neff expressly disagreed with Dr. Follows' diagnosis of 
 
            carpal tunnel syndrome and diagnosed cubital tunnel 
 
            syndrome.  He recommend decompression and possible 
 
            transposition of the ulnar nerve.  Dr. Neff did not believe 
 
            claimant could return to heavy work activity as of that 
 
            date.  He believed claimant's symptoms and problems related 
 
            to repetitive elbow, hand, and wrist activity.  
 
            
 
                 Dr. Neff referred claimant to Alexander Matthews, M.D., 
 
            a thoracic and vascular surgeon.  Dr. Matthews also saw 
 
            claimant on January 11, 1989 and diagnosed "very marked" 
 
            left thoracic outlet compression syndrome.  On February 6, 
 
            1989, Dr. Matthews performed a transaxillary resection of 
 
            claimant's left first rib.  On March 15, 1989, Dr. Matthews 
 
            released claimant to return to work on March 20, 1989.  On 
 
            March 29, 1989, Dr. Matthews opined that claimant had no 
 
            permanent partial impairment on account of her [left] 
 
            thoracic outlet decompression surgery.  He characterized 
 
            claimant as asymptomatic with excellent grip strength 
 
            bilaterally and a negative Roos test.  On April 3, 1989, 
 
            claimant reported to Dr. Matthews that her left fourth and 
 
            fifth fingers tingled and were "numb" after returning to 
 
            work washing lights, equipment and walls.  Dr. Matthews then 
 
            placed claimant off work until April 7, 1989.
 
            
 
                 Claimant again saw Dr. Neff on June 9, 1989.  Claimant 
 
            then gave a history of returning to work with ladder 
 
            climbing, wall scrubbing and other activities which required 
 
            her right arm to be "in the air a lot" especially in the 
 
            first two weeks subsequent to returning to work.  Claimant 
 
            then reported numbness and tingling of the right long, ring 
 
            and fifth fingers.  She had a positive Tinel's sign at the 
 
            right elbow and a negative Phalen's sign.  Dr. Neff 
 
            recommended that claimant be restricted from work at or 
 
            above shoulder level.  On July 10, 1989, Dr. Neff reported 
 
            that a MRI of claimant's cervical spine was essentially 
 
            normal.  He then believed claimant was developing ulnar 
 
            nerve entrapment at the cubital tunnel bilaterally.  He did 
 
            not recommend any surgical treatment of that condition until 
 
            electromyography studies were positive.  
 
            
 
                 Claimant was referred to the University of Iowa 
 
            Hospitals and Clinics.  W. John Sharp, M.D., vascular 
 
            surgeon, reported on December 15, 1989 that 
 
            electromyographic studies, nerve conduction studies and 
 
            ulnar somatosensory evoked potentials were all normal.  He 
 
            indicated that as of December 14, 1989, claimant was having 
 
            increasing numbness over her entire [left] hand, arm and 
 
            shoulder and had started to have similar symptoms on the 
 
            right.  Dr. Sharp reported that a physiologic cause for 
 
            claimant's symptoms could not be found.  He did not think 
 
            claimant had thoracic outlet syndrome; nevertheless, he 
 
            offered claimant a referral to David B. Roos, M.D., a 
 
            national expert on thoracic outlet syndrome.  
 
            
 
                 Robert T. Sessions, M.D., apparently also a vascular 
 
            surgeon, reviewed a letter and clinical data on claimant 
 
            which claimant's attorney had supplied him.  Based on that 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            information, Dr. Sessions opined that there was "a good 
 
            chance that a significant portion of [claimant's] problem 
 
            may be recurrent thoracic outlet syndrome."  
 
            
 
                 David B. Roos, M.D., initially saw claimant on or about 
 
            April 8, 1991.  Claimant in April 1991 had complaints of 
 
            neck and shoulder pain, headaches and of both arms feeling 
 
            dead.  Dr. Roos took claimant off work and prescribed 
 
            physical therapy for her.  Dr. Roos' impression by report of 
 
            April 24, 1991 was of cervical and shoulder strain injuries 
 
            resulting in chronic muscle spasm and bilateral thoracic 
 
            outlet syndrome from muscle compression of the brachial 
 
            plexus with the left symptomatically worse than the right.  
 
            The doctor opined that claimant's jerking injury [in June 
 
            1988] no doubt affected her neck, shoulders, and bilateral 
 
            upper extremities and was a direct cause of persistent 
 
            symptoms since then.  The doctor further stated that 
 
            claimant apparently had developed scar tissue from her 
 
            February 1989 left thoracic outlet surgery which tissue had 
 
            trapped the C8 and T1 nerves of the left brachial plexus 
 
            causing ulnar nerve pain and paresthesias with radiation 
 
            down the left arm which resulted in numbness, tingling, 
 
            coldness and weakness of that arm and hand.  He stated 
 
            claimant had also developed biceps tendinitis from chronic 
 
            muscle spasms which were causing pain in the anterior 
 
            shoulder area.  Dr. Roos opined that claimant was 
 
            permanently disabled from job activities requiring heavy use 
 
            of her arms and hands bilaterally with frequent reaching, 
 
            lifting and pulling motions.  
 
            
 
                 On August 28, 1991, Dr. Roos recommended that claimant 
 
            have a second surgery on the left; he further opined that 
 
            claimant might require surgery on the right.  
 
            
 
                 On March 5, 1992, Dr. Roos performed a left 
 
            transaxillary neurolysis of the T-1 nerve of the plexus, 
 
            apical pleurectomy, selective T-2 ganglion thoracic 
 
            sympathectomy, axillary fat pedicle interposition, pleural 
 
            flap coverage of the posterior stump of the first rib after 
 
            resection of long stump and chest tube drainage as well as a 
 
            left supraclavicular neurolysis of entire brachial plexus 
 
            with anterior scalenectomy.  In short, he cleaned out 
 
            additional tissue, muscle and scar tissue in the brachial 
 
            plexus area and placed a fatty deposit in the area as a 
 
            means of controlling reformation of scar tissue.
 
            
 
                 On November 3, 1992, Dr. Roos performed a right 
 
            transaxillary decompression of the thoracic outlet with 
 
            first rib resection and a right supraclavicular total 
 
            anterior scalenectomy with neurolysis of the brachial 
 
            plexus.  
 
            
 
                 Dr. Roos is located in Denver, Colorado.  Defendants 
 
            authorized claimant's treatment with Dr. Roos including her 
 
            surgeries.  Claimant had to travel from her home in Iowa to 
 
            Denver, Colorado for her treatment and surgeries.  After 
 
            both surgeries Dr. Roos reported claimant's condition to, 
 
            David Crippin, M.D., claimant's family physician in Storm 
 
            Lake, Iowa.  After both surgeries, Dr. Roos referred 
 
            claimant back to Dr. Crippin for follow-up care relative to 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            her condition.  
 
            
 
                 Claimant saw Dr. Crippin variously from June 23, 1989 
 
            onward.  Given that the various specialists to which 
 
            defendants referred claimant was significant distances from 
 
            her home, claimant reasonably sought primary care for her 
 
            condition from Dr. Crippin.
 
            
 
                 Dr. Roos again saw claimant on March 18, 1993.  His 
 
            impression then was of persistent pain and muscle spasms in 
 
            the neck, shoulders, and arms with intention tremor of the 
 
            hands all as a result of claimant's original injuries.  Dr. 
 
            Roos then restricted claimant from heavy or strenuous use of 
 
            the upper extremities and from lifting greater than five 
 
            pounds on an occasional basis.  He felt claimant should 
 
            avoid frequent reaching up or outward as well as pushing or 
 
            pulling of objects.  He opined that claimant probably would 
 
            not be able to return to the type of work she was doing when 
 
            injured as he felt she was permanently restricted to light 
 
            to moderate activities.  
 
            
 
                 In his March report, Dr. Roos opined that it was too 
 
            early for assignation of a permanent partial impairment 
 
            rating.  He estimated that the rating would be near 15 
 
            percent "permanent partial disability" for "both upper 
 
            extremities together."  Dr. Roos last examined claimant on 
 
            October 26, 1993.  On October 8, 1993, he reported that 15 
 
            percent would be a "working unit" as regard permanent 
 
            partial impairment related to claimant's condition.
 
            
 
                 John A. Vaubel, M.D., board certified ophthalmologist, 
 
            initially saw claimant on May 5, 1992 for symptoms of 
 
            reduced vision and droopiness of the left eyelid.  Dr. 
 
            Vaubel diagnosed claimant as having Horner's syndrome on the 
 
            left side with left lid ptosis and a visual field defect, 
 
            that is, relative scotomas or blind spots in the left eye 
 
            resulting in complete contraction of the visual field.  In 
 
            his deposition of December 11, 1993, Dr. Vaubel opined that 
 
            claimant's visual field defect and claimant's central visual 
 
            acuity defect both related to her thoracic outlet condition 
 
            either directly to the condition or as a result of the 
 
            number of surgeries claimant had had on account of the 
 
            condition.  Dr. Vaubel agreed that claimant had an apparent 
 
            family history of bilateral retinal detachment which 
 
            condition can cause visual field defects.  He noted the no 
 
            retinal detachment was found on claimant's examinations, 
 
            however.
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 Our first concern is whether a causal relationship 
 
            exists between claimant's injury and claimed disability.  
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury is a proximate 
 
            cause of the disability on which the claim is based.  A 
 
            cause is proximate if it is a substantial factor in bringing 
 
            about the result; it need not be the only cause.  A 
 
            preponderance of the evidence exists when the causal 
 
            connection is probable rather than merely possible.  
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            Blacksmith v. All-American, Inc., 290 N.W.2d 348 (Iowa 
 
            1980); Holmes v. Bruce Motor Freight, Inc., 215 N.W.2d 296 
 
            (Iowa 1974).
 
            
 
                 The question of causal connection is essentially within 
 
            the domain of expert testimony.  The expert medical evidence 
 
            must be considered with all other evidence introduced 
 
            bearing on the causal connection between the injury and the 
 
            disability.  The weight to be given to any expert opinion is 
 
            determined by the finder of fact and may be affected by the 
 
            accuracy of the facts relied upon by the expert as well as 
 
            other surrounding circumstances.  The expert opinion may be 
 
            accepted or rejected, in whole or in part.  Sondag v. Ferris 
 
            Hardware, 220 N.W.2d 903 (Iowa 1974); Anderson v. Oscar 
 
            Mayer & Co., 217 N.W.2d 531 (Iowa 1974); Bodish v. Fischer, 
 
            Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).
 
            
 
                 Defendants make much ado about whether claimant's 
 
            condition relates to the June 22, 1988 injury or whether 
 
            claimant's symptoms are such that claimant sustained a 
 
            cumulative injury at some later date.  Defendants also make 
 
            much ado over whether claimant's symptoms and her surgeries 
 
            were actually necessitated by a work-related thoracic outlet 
 
            condition.  In both instances, defendants assertions are 
 
            ill-founded.  Dr. David Roos, M.D., a nationally recognized 
 
            vascular and thoracic surgeon whom defendants authorized to 
 
            treat claimant, has opined that claimant's conditions relate 
 
            back to the original June 1988 injury.  That claimant's 
 
            symptoms manifested themselves over time and that claimant's 
 
            condition itself likely was aggravated by claimant's 
 
            continuing to work after the initial insult to her right 
 
            finger and upper body on June 22, 1988 is insufficient to 
 
            break the causal chain.  Often the full range of symptoms 
 
            and conditions resulting from a single incident injury are 
 
            not fully manifest until some time subsequent to that 
 
            injury.  While it may have been less than artful for 
 
            claimant to characterize her condition as a cumulative 
 
            injury, a term that has a specific meaning in workers' 
 
            compensation law which meaning is not applicable in this 
 
            case, defendants in no matter are prejudiced by that lack of 
 
            artfulness.  Defendants were fully aware of the conditions 
 
            which claimant had developed; the conditions for which they 
 
            had authorized treatment; and of the conditions on which 
 
            claimant based her claim.  
 
            
 
                 Claimant has established a causal relationship between 
 
            her work-injury of June 22, 1988 and her claimed healing 
 
            period and permanent partial disability resulting from her 
 
            bilateral thoracic outlet syndrome and its symptoms and 
 
            sequela.  
 
            
 
                 We consider the question of claimant's healing period 
 
            benefit entitlement.  
 
            
 
                 Section 85.34(1) provides that healing period benefits 
 
            are payable to an injured worker who has suffered permanent 
 
            partial disability until (1) the worker has returned to 
 
            work; (2) the worker is medically capable of returning to 
 
            substantially similar employment; or (3) the worker has 
 
            achieved maximum medical recovery.  The healing period can 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            be considered the period during which there is a reasonable 
 
            expectation of improvement of the disabling condition.  See 
 
            Armstrong Tire & Rubber Co. v. Kubli, 312 N.W.2d 60 (Iowa 
 
            Ct. App. 1981).  Healing period benefits can be interrupted 
 
            or intermittent.  Teel v. McCord, 394 N.W.2d 405 (Iowa 
 
            1986).
 
            
 
                 Claimant returned to work on June 30, 1988 and then was 
 
            off work intermittently from October 1988 until April 1991 
 
            when Dr. Roos again took her off work.  Claimant has not 
 
            returned to work with either the employer or any other 
 
            employer since April 1991.  Claimant's medical restrictions 
 
            make it impossible for her to return to substantially 
 
            similar employment.  Hence, claimant's healing period runs 
 
            to that point where she achieved maximum medical recovery.  
 
            Dr. Roos last examined claimant on October 26, 1993.  In his 
 
            last report of November 8, 1993 he opined claimant had a 
 
            permanent partial impairment of 15 percent.  That impairment 
 
            rating, obviously, relates to claimant's condition as of her 
 
            last examination.  Claimant is entitled to healing period 
 
            benefits for those times claimant was actually off work on 
 
            account of her condition or on account of treatment and 
 
            recovery related to her condition from June 22, 1988 through 
 
            October 26, 1993.  Defendants receive credit for benefits 
 
            previously paid.  
 
            
 
                 We reach the question of permanent partial disability.
 
            
 
                 An injury to a scheduled member may, because of after- 
 
            effects or compensatory change, result in permanent 
 
            impairment of the body as a whole.  Such impairment may in 
 
            turn be the basis for a rating of industrial disability.  It 
 
            is the anatomical situs of the permanent injury or 
 
            impairment which determines whether the schedules in section 
 
            85.34(2)(a) - (t) are applied.  Lauhoff Grain v. McIntosh, 
 
            395 N.W.2d 834 (Iowa 1986); Blacksmith v. All-American, 
 
            Inc., 290 N.W.2d 348 (Iowa 1980); Dailey v. Pooley Lumber 
 
            Co., 233 Iowa 758, 10 N.W.2d 569 (1943).  Soukup v. Shores 
 
            Co., 222 Iowa 272, 268 N.W. 598 (1936).
 
            
 
                 When disability is found in the shoulder, a body as a 
 
            whole situation may exist.  Alm v. Morris Barick Cattle Co., 
 
            240 Iowa 1174, 38 N.W.2d 161 (1949).  In Nazarenus v. Oscar 
 
            Mayer & Co., II Iowa Industrial Commissioner Report 281 
 
            (App. 1982), a torn rotator cuff was found to cause 
 
            disability to the body as a whole.
 
            
 
                 Since 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 
 
            Ry. Co., 219 Iowa 587, 258 N.W.2d 899 (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."
 
            
 
                 Functional impairment is an element to be considered in 
 
            determining industrial disability which is the reduction of 
 
            earning capacity, but consideration must also be given to 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            the injured employee's age, education, qualifications, 
 
            experience, motivation, loss of earnings, severity and situs 
 
            of the injury, work restrictions, inability to engage in 
 
            employment for which the employee is fitted and the 
 
            employer's offer of work or failure to so offer.  Olson v. 
 
            Goodyear Serv. Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963); 
 
            McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980); 
 
            Barton v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 
 
            (1961).
 
            
 
                 Compensation for permanent partial disability shall 
 
            begin at the termination of the healing period.  
 
            Compensation shall be paid in relation to 500 weeks as the 
 
            disability bears to the body as a whole.  Section 85.34.
 
            
 
                 Defendants initially contend that claimant's injury is 
 
            a scheduled member disability and not a body as a whole 
 
            disability to be compensated industrially.  We disagree.  
 
            Claimant's surgical sites are within her trunk and her neck 
 
            area and not within either upper extremity.  Claimant has 
 
            medically confirmed muscle spasms relating to her condition 
 
            in her neck and her shoulders.  Claimant's restriction on 
 
            reaching upward or outward involves physical activity within 
 
            the shoulder girdle itself and not merely within the hands 
 
            or arms.  Claimant has established a body as a whole injury 
 
            for which she is entitled to industrial compensation.  
 
            
 
                 We consider the question of the extent of claimant's 
 
            permanent partial industrial disability.  
 
            
 
                 Dr. Roos has indicated that claimant has a 15 percent 
 
            permanent partial impairment relating to both upper 
 
            extremities.  While it is uncertain whether the doctor's 
 
            rating represents a combined value for the upper extremities 
 
            or conversion of upper extremity ratings into a body as a 
 
            whole rating, it appears that Dr. Roos believes claimant has 
 
            a moderate permanent partial impairment related to her 
 
            condition.  Dr. Roos additionally has substantially 
 
            restricted claimant.  He stated she should lift no more than 
 
            five pounds on an occasional basis and should not attempt 
 
            repetitive heavy or strenuous use of the upper extremities.  
 
            This restriction includes a restriction on typing and 
 
            keyboarding.  That restriction will preclude claimant from 
 
            many light or moderate level positions for which she might 
 
            otherwise be suited.  Likewise, claimant's restrictions on 
 
            use of her extremities and on pushing and pulling make it 
 
            impossible for her to return to work with the employer or to 
 
            substantially similar work or to many of the factory 
 
            assembly, driving and construction duties that she had 
 
            performed previously.  Claimant's visual field defect and 
 
            central visual acuity defect also likely would play a role 
 
            in preventing her from returning to jobs involving driving.  
 
            Despite these limitations, claimant is at a relatively young 
 
            age and appears capable of retraining.  She has obtained a 
 
            GED and has taken community college courses.  Overall, her 
 
            pre-injury earnings range from $4.25 to $6.50 per hour.  
 
            Claimant apparently has not sought vocational rehabilitation 
 
            assistance and defendants have not provided such assistance.  
 
            In that respect, neither claimant nor defendants appears to 
 
            have been well motivated to assist claimant in returning to 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            gainful employment.  Claimant's restrictions and physical 
 
            impairment will no doubt make any return to gainful 
 
            employment difficult.  The record does not suggest that she 
 
            is wholly precluded from doing so, however.  Likewise, the 
 
            record does not suggest that she could not return to 
 
            employments, albeit, fewer than were available prior to her 
 
            injury, at which she could earn hourly wages at or near 
 
            those she earned in the heavier work she did prior to her 
 
            injury.  When all the above is considered, claimant is found 
 
            to have established permanent partial industrial disability 
 
            of 50 percent of the body as a whole.  
 
            
 
                 We reach the question of claimant's entitlement to 
 
            payment of medical costs incurred with Dr. Crippin and Dr. 
 
            Vaubel and to payment of medical mileage costs.  
 
            
 
                 The employer shall furnish reasonable surgical, 
 
            medical, dental, osteopathic, chiropractic, podiatric, 
 
            physical rehabilitation, nursing, ambulance and hospital 
 
            services and supplies for all conditions compensable under 
 
            the workers' compensation law.  The employer shall also 
 
            allow reasonable and necessary transportation expenses 
 
            incurred for those services.  The employer has the right to 
 
            choose the provider of care, except where the employer has 
 
            denied liability for the injury.  Section 85.27.  Holbert v. 
 
            Townsend Engineering Co., Thirty-second Biennial Report of 
 
            the Industrial Commissioner 78 (Review-reopen 1975).
 
            
 
                 When an employer-designated physician sees fit to refer 
 
            a claimant to another physician, the designated physician 
 
            acts as the defendants' agent.  Claimant need not seek 
 
            further authorization from defendants for such referral and 
 
            care.  See Kittrell v. Allen Memorial Hospital, 34 Biennial 
 
            Report Iowa Industrial Commissioner 164 (1979) (Industrial 
 
            Commissioner affirmed.)
 
            
 
                 Where evidence reveals claimant's condition improves as 
 
            a result of care from a physician whom defendants did not 
 
            authorize, that improvement not only helps claimant but may 
 
            also mitigate the employers' ultimate liability.  That 
 
            mitigation, when considered with other relevant factors, may 
 
            result in a finding that the nonauthorized care was 
 
            reasonable and necessary treatment as section 85.27 
 
            contemplates.  Rittgers v. United Parcel Service, III Iowa 
 
            Industrial Commissioner Report 210 (1983).
 
            
 
                 For reasons set forth in the above findings of fact, 
 
            claimant has established entitlement to payment for medical 
 
            care Dr. Crippin provided.  
 
            
 
                 Dr. Vauble has related claimant's vision problems to 
 
            her bilateral thoracic outlet syndrome or her surgeries 
 
            related to those conditions or both.  The record does not 
 
            reflect that defendants had otherwise authorized care for 
 
            claimant relative to her vision problems.  She apparently 
 
            saw Dr. Vauble on referral from Dr. Crippin.  Care related 
 
            to claimant's vision problems was reasonable and necessary 
 
            care.  In the absence of the employer having authorized a 
 
            physician for such care, claimant is entitled to payment of 
 
            medical costs incurred with Dr. Vauble.  
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            
 
                 Section 85.27 requires that defendants appropriately 
 
            reimburse claimant for transportation expenses incurred 
 
            while seeking medical care.  Claimant is entitled to 
 
            reimbursement of mileage costs incurred from November 16, 
 
            1992 through November 26, 1993 as noted on the mileage 
 
            statement filed with the hearing report.
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Defendants pay claimant permanent partial disability 
 
            for an additional two hundred fifty (250) weeks at the rate 
 
            of one hundred sixty-four and 16/100 dollars ($164.16) with 
 
            those payments to commence on October 27, 1993.
 
            
 
                 Defendants pay claimant healing period benefits at the 
 
            rate of one hundred sixty-four and 16/100 dollars ($164.16) 
 
            from June 22, 1988 through October 26, 1993 for those dates 
 
            when claimant was actually off work on account of her 
 
            injury.  
 
            
 
                 Defendants receive credit for amounts previously paid.
 
            
 
                 Defendants pay any accrued amounts in a lump sum.
 
            
 
                 Defendants pay claimant medical expenses incurred with 
 
            Dr. Crippin and Dr. Vauble and actually relating to 
 
            claimant's June 22, 1988 injury.  
 
            
 
                 Defendants pay claimant mileage expenses as set forth 
 
            in the document labeled, "Mileage:  11/16/92 to 11/26/93" 
 
            submitted with the parties' hearing report.  
 
            
 
                 Defendants pay interest pursuant to section 85.30 as 
 
            amended.
 
            
 
                 Defendants pay costs pursuant to rule 343 IAC 4.33.
 
            
 
                 Defendants file claim activity reports as the agency 
 
            orders.
 
            
 
                 Signed and filed this ____ day of February, 1994.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          HELENJEAN M. WALLESER
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Steve Hamilton
 
            Attorney at Law
 
            P.O. Box 188
 
            Storm Lake, IA  50588
 
            
 
            Mr. Frank Harrison
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            Attorney at Law
 
            2700 Grand Ave, Ste. 111
 
            Des Moines, IA  50312
 
            
 
            
 
 
            
 
            
 
            
 
            
 
                                        1108.50; 1803.1; 1803; 2209;
 
                                        2900.
 
                                        Filed February 4, 1994
 
                                        Helenjean M. Walleser
 
            
 
                       BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                      
 
            PEGGY NORLIN,  
 
                      
 
                 Claimant, 
 
                      
 
            vs.       
 
                                                File No. 889857
 
            BOBALEE HYDRAULICS, INC.,     
 
                                              A R B I T R A T I O N
 
                 Employer, 
 
                                                D E C I S I O N
 
            and       
 
                      
 
            HARTFORD INSURANCE, 
 
                      
 
                 Insurance Carrier,  
 
                 Defendants.    
 
            ___________________________________________________________
 
            1108.50; 1803.1; 1803; 2209; 2900.
 
            
 
                 Claimant's bilateral thoracic outlet syndrome found to  
 
            causally relate to a specific injury in which claimant had 
 
            caught her right ring finger in vise with pulling of the 
 
            right upper extremity and per claimant's testimony her whole 
 
            trunk into the left side.  David Roos, M.D., a renown 
 
            thoracic and vascular surgeon who treated claimant, 
 
            supported causation.  Claimant had asserted cumulative 
 
            injury in claimant's original notice and petition where 
 
            claimant's symptoms and conditions manifested themselves 
 
            over time and subsequent to the original work incident which 
 
            occurred on claimant's second day at work.  Claimant's 
 
            condition not found to be a cumulative injury but rather a 
 
            condition resulting from a specific work incident which 
 
            condition manifested itself over time and likely was 
 
            aggravated by claimant's continuing work activities after 
 
            the incident.  That claimant had pled cumulative trauma in 
 
            her original notice and petition was not found to be 
 
            prejudicial to defendants in that defendants had notice of 
 
            the medical conditions for which claimant sought 
 
            compensation.  Claimant's thoracic outlet syndrome 
 
            bilaterally and resulting restrictions including a five 
 
            pound lifting restriction and restrictions from heavy or 
 
            strenuous work with the upper extremities including 
 
            keyboarding and typing as well as restrictions on pushing 
 
            and pulling and lifting over and working overhead or forward 
 
            with the arms found to establish a permanent industrial 
 
            disability of 50 percent of the body as a whole.
 
 
         
 
         
 
         
 
         
 
         
 
         
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                                         :
 
         JERRY RIPPEY,                   :
 
                                         :
 
              Claimant,                  :
 
                                         :
 
         vs.                             :
 
                                         :        File No. 889863
 
         UNIVERSAL ENGINEERING,          :
 
                                         :          A P P E A L
 
              Employer,                  :
 
                                         :        D E C I S I O N
 
         and                             :
 
                                         :
 
         FIDELITY & CASUALTY,            :
 
                                         :
 
              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.
 
         
 
                                      ISSUE
 
         
 
              Defendants state the following issue on appeal:  "Whether 
 
         there is substantial evidence in the record to support the 
 
         Deputy's conclusion."
 
         
 
                                 FINDINGS OF FACT
 
         
 
              The findings of fact contained in the proposed agency 
 
         decision filed February 17, 1994 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.  Segments designated by brackets ([ ]) indicate 
 
         language that is in addition to the language of the proposed 
 
         agency decision.
 
         
 
              Claimant is a 45-year-old high school graduate who did not 
 
         do very well in high school.  Claimant began working for 
 
         defendant employer in 1971 and last actually worked for the 
 
         company on August 8, 1988.  Claimant actually retained his status 
 
         with the company as an employee until April 1991, at which time 
 
         he received a termination letter.  At the time of claimant's 
 
         injury he was making $11.75 per hour.  Claimant had no other 
 
         formal post-high school education and actually learned his skills 
 

 
         
 
         Page   2
 
         
 
         
 
         
 
         
 
         
 
         on the job.
 
         
 
              Claimant is divorced and has two children and stated that he 
 
         is a custodial parent for one child and his ex-wife has custodial 
 
         care of the other child.  Claimant contends he pays his child 
 
         support and under his arrangement with his ex-wife, he can claim 
 
         one exemption and the wife claims the other exemption.  He 
 
         indicated the children now are 19 and 22 years of age.
 
         
 
              Claimant testified as to his work history prior to beginning 
 
         work for the defendant employer in 1971.  After high school 
 
         claimant played semi-professional baseball as a pitcher and 
 
         developed arm trouble and then the next year began working for 
 
         the Atlanta Braves team as equipment team manager.  Claimant then 
 
         worked for Wilson Foods and described his work as a meat 
 
         processor which involved approximately two and one-half years 
 
         prior to going to work for defendant employer.
 
         
 
              Claimant described the nature of his work with defendant 
 
         employer.  He began as an apprentice machinist and then trained 
 
         and eventually learned to weld, took a test, was certified and 
 
         was a welder for most of the time he was employed with defendant 
 
         employer.  He described the nature of his work and what he did 
 
         for defendant employer.
 
         
 
              Claimant described how he was injured on June 20, 1988, 
 
         which resulted in claimant having his left knee pinned and 
 
         twisted and which resulted in his knee and low back injury.  
 
         There is no dispute that claimant was injured. *****
 
         
 
              Claimant testified that he had two prior left knee injuries 
 
         which resulted in two prior surgeries.  He also had two prior 
 
         right knee injuries which resulted in two surgeries.
 
         
 
              Claimant had surgery on his left knee in November 2, 1988 
 
         which was the third surgery on that knee.  He had his fourth 
 
         surgery on that knee June 2, 1989.  Claimant explained he 
 
         understood that on the third surgery the doctor took a shortcut 
 
         and it was inadequate, thereby, resulting in the fourth surgery.
 
         
 
              Regarding his pre-June 1988 knee injuries, claimant said his 
 
         last surgery prior to that time to his left knee was in 1986.  
 
         His right knee problem and prior surgery was two years before and 
 
         he said it was successful and his right leg was very good.
 
         
 
              Claimant said he wore a knee sleeve prior to June 20, 1988, 
 
         in which he slid it over his left foot and knee to get support 
 
         but he had not had any braces before his June 1988 injury.
 
         
 
              Claimant said that since the June 1988 injury he has had a 
 
         left knee brace prescribed in 1989 which stabilized the knee from 
 
         the outside to the inside.  He said he wore it either inside his 
 
         pants or outside, but wore it mostly when he had to walk, stand 
 
         or sit.  He did not wear it when he went to bed.
 
         
 
              Claimant said he obtained a new brace in 1993.  He said he 
 
         was wearing it on his left knee at the time of the hearing.  He 
 

 
         
 
         Page   3
 
         
 
         
 
         
 
         
 
         
 
         said it was a lighter brace and it weighed one or two pounds 
 
         wherein his older brace weighed four or five pounds.  Therefore, 
 
         he can wear the newer brace more often as it is a lighter brace 
 
         and is easier to tolerate.  He did not expose his brace at the 
 
         hearing.
 
         
 
              Claimant said he also had two pair of shoes with built-in 
 
         lifts.
 
         
 
              Claimant described the swelling that he gets and it depends 
 
         on the extent of his walking and activity.  He said he has given 
 
         up bowling and water skiing.  He indicated he goes to the center 
 
         for swimming, to use the Jacuzzi, for bicycle use and building up 
 
         his upper body.
 
         
 
              Claimant said that prior to June 20, 1988, he basically had 
 
         no back problem even though he indicated he had seen a 
 
         chiropractor prior to that time on occasion for a back and neck 
 
         adjustment.  He indicated he first experienced low back problems 
 
         two or three weeks after his injury and indicated that the doctor 
 
         told him there was nothing he could do to help his back until his 
 
         knee situation was fixed and that the doctor could not put in a 
 
         new knee until claimant was 50 years old as it otherwise would 
 
         not last.
 
         
 
              Claimant acknowledged that the defendant employer authorized 
 
         him to see a chiropractor five times and claimant said it helped 
 
         him.  Claimant indicated that he continued to see the 
 
         chiropractor on occasion later for his low back and that he paid 
 
         for these.  He last saw a chiropractor on September 19, 1993.
 
         
 
              Claimant wears a Velcro back brace around his back and 
 
         stomach which helps support his back and which was recommended by 
 
         the doctor.
 
         
 
              Claimant said he uses a cane on different occasions and more 
 
         often he doesn't use it and indicated Christmas was the last time 
 
         he used the cane.
 
         
 
              Claimant described how a pinched nerve in his back gets so 
 
         bad that it literally paralyzes him and he cannot get up for two 
 
         days and is in constant pain.
 
         
 
              Claimant acknowledged he is a good athlete and that he 
 
         started playing golf in 1971 and that he had met Darrell 
 
         Augustine in 1972.  Claimant plays in the city tournament and 
 
         usually places in the top 10 every year.  He indicated the doctor 
 
         told him he could play golf and he sits a lot and drives a cart 
 
         when he goes now wherein prior to that he often carried his own 
 
         clubs.  He emphasized golf was his only outlet in life now and he 
 
         golfs once or twice a week weather permitting.  He indicated his 
 
         handicap prior to his June 1988 injury was 7 or 8 where now it is 
 
         15 or 16.  He said he used to carry more clubs when he golfed 
 
         prior to his injury.
 
         
 
              Claimant described and showed how he now swings the golf 
 
         club and hits the ball.  He emphasized that he now must use his 
 

 
         
 
         Page   4
 
         
 
         
 
         
 
         
 
         
 
         upper body and arms and uses his lower body and legs very little 
 
         and puts very little pressure on his left leg as it hurts him 
 
         when he plays.  Claimant indicated he lost 40 or 50 yards at 
 
         least off his drives since his injury.
 
         
 
              Claimant contends he now plays with others on a best ball 
 
         basis and lets the partners he plays with do the driving of the 
 
         ball.
 
         
 
              Claimant was asked concerning his dancing and he indicates 
 
         he now does slow dancing and goes sometimes three times a week at 
 
         night and may dance three or four dances a night depending on how 
 
         his knee feels.  Claimant said that his knee gets sore when he 
 
         stands or walks and that sitting affects his back.  He said that 
 
         if he drives over three hours he gets stiff and sore.
 
         
 
              Claimant acknowledged that three vocational consultants have 
 
         not found employment for him except for a company named Quelex in 
 
         which he worked five days delivering processed film.  He 
 
         indicated he made several stops per day and received minimum 
 
         wages.  He said he carried a lot of weight doing this job and his 
 
         knee would hurt and swell up and he would have to soak it in the 
 
         tub when he got off work.
 
         
 
              He acknowledged that he goes and picks up a car for Bob 
 
         Zimmerman Ford to drive up to Cedar Rapids, Des Moines or Omaha.  
 
         He receives minimum wages.  He indicated he does this once a 
 
         month, sometimes every four months, and has no trouble doing this 
 
         particular activity.  He said it is never full time.
 
         
 
              Claimant was then asked regarding numerous types of jobs 
 
         that was suggested to him by Mr. Proctor, rehabilitation 
 
         consultant, and indicated his reasons he wasn't able to do the 
 
         job or some particular that may have prevented his employment to 
 
         comply with his restrictions, etc.
 
         
 
              Claimant said he isn't afraid to work and acknowledged that  
 
         Dr. James N. Weinstein and Richard F. Neiman, M.D., encouraged 
 
         him to get a job.  Claimant said there is no job he feels he can 
 
         do.  He has applied for social security but hasn't gotten it.  
 
         His last application was in 1992.  He said he was put through a 
 
         functional capacity evaluation and social security felt he could 
 
         do other jobs.  He was referred to defendants' exhibit A.
 
         
 
              On cross-examination, claimant indicated he gets in and out 
 
         of his golf cart but he doesn't stop to pick up his ball but he 
 
         does stop and mark the ball.  He used to go to the practice 
 
         greens and shoot 10 to 15 balls but now he warms up with about 10 
 
         balls at practice.
 
         
 
              Claimant acknowledged that his additional chiropractic 
 
         treatments were not authorized but indicated the chiropractor 
 
         advised him he needed more treatment.  He indicated the 
 
         chiropractor prescribed the back brace but no doctor prescribed 
 
         the use of a cane.
 
         
 
              The claimant was extensively cross-examined concerning his 
 

 
         
 
         Page   5
 
         
 
         
 
         
 
         
 
         
 
         work with the rehabilitation consultants and his attempts to look 
 
         for jobs or following up on job leads or references concerning 
 
         jobs.  Claimant had told a rehabilitation specialist that he 
 
         didn't want to relocate.  He also indicated that in one 
 
         particular instance the distance driving time expense was not 
 
         worth the effort if he even got the job because of the low hourly 
 
         wage he was offered.  Claimant then was asked concerning the 
 
         functional capacity test that indicated claimant was capable of 
 
         sedentary work.  Claimant was referred to exhibit A, page 22, 
 
         which was his June 1992 social security disability application in 
 
         which he indicated he couldn't stand more than five minutes and 
 
         indicated he must wear the leg brace all the time.  It is obvious 
 
         from the testimony as a whole that claimant did not wear it all 
 
         the time.
 
         
 
              Claimant related that he had hepatitis B for two to four 
 
         months in September 1993, but acknowledged that during this 
 
         period of time he was at the Roosevelt Hotel at a dance even 
 
         though he was supposedly confined because of his hepatitis B.  
 
         Claimant acknowledged that he was a professional dancer in the 
 
         past in 1983 to 1985.  It seems like claimant's testimony as to 
 
         how much he dances per week varies from one time a week up to 
 
         three times a week.  He indicated that when he does dance, he 
 
         pays for it physically.  He also indicated that when he plays 
 
         golf it is usually 18 holes and it takes him four and one-half to 
 
         five and one-half hours to play.
 
         
 
              Claimant said he has made no job search since 1993 but is 
 
         ready to do so now.  Although claimant earlier testified as to 
 
         lifts in his shoes, he indicated that when he goes dancing he 
 
         wears cowboy boots that do not have lifts.
 
         
 
              Claimant was asked concerning his June 9, 1993 visit with 
 
         his lawyer in which he had his braces on his leg and that after 
 
         the meeting, he went home and approximately one hour later he 
 
         left the house without the braces and cane and went to the golf 
 
         course.  Claimant was video taped on this day.
 
         
 
              Darrell Augustine testified that he is self-employed and 
 
         operates two Laundromats and that he knows claimant and plays 
 
         golf and has played golf with claimant since the early 1970s.  He 
 
         said he played golf with the claimant in 1992 and 1993 but that 
 
         there was one year in the 1990s that claimant disappeared.  He 
 
         acknowledged that otherwise he has played every year with the 
 
         claimant.
 
         
 
              He acknowledged that claimant has a bad left knee and that 
 
         claimant was a very good golfer and still is.  He has observed a 
 
         change in claimant's swing and indicated claimant does not use 
 
         his legs but uses his upper body.  He said claimant always uses 
 
         the cart and used to always walk before his injury.  He said 
 
         claimant drags his club now if he doesn't carry the clubs in a 
 
         cart.
 
         
 
              He said that prior to claimant's injury claimant used to 
 
         have a normal swing and now uses his arms instead of his whole 
 
         body.  He said he and the claimant play in two-men tournaments.  
 

 
         
 
         Page   6
 
         
 
         
 
         
 
         
 
         
 
         He said if he particularly had a good shot then claimant would 
 
         not stroke the ball but instead would use his partner's best ball 
 
         as the best ball.  He said the tournaments are 18 holes played in 
 
         one day and some are several days tournaments (weekends).
 
         
 
              He said claimant played less golf in 1993 because his back 
 
         hurt and claimant got hepatitis.
 
         
 
              He acknowledged he saw the videos of claimant (represented 
 
         by defendants' exhibit L).  He said they accurately represent 
 
         claimant's game at Twin Pines on that particular day in which 
 
         claimant had no cart.  He said that the claimant didn't play 
 
         there a lot.  He indicated that the reason no carts were used 
 
         that day was that the course was wet and they didn't allow the 
 
         carts on the course.  He indicated it was in 1993 that he first 
 
         knew claimant had a back problem.  He said that claimant plays a 
 
         lot of golf but that he is not necessarily his usual partner.  He 
 
         understands claimant plays once or twice a week now.
 
         
 
              He was referred to certain exhibits or newspaper articles as 
 
         to claimant's golfing ability.  Mr. Augustine said that he does 
 
         not usually make it to the last day but claimant does as he is a 
 
         very good golfer.  He indicated that claimant is usually among 
 
         the final leaders and that these tournaments are usually four day 
 
         tournaments in which play is two days each weekend, a week apart.
 
         
 
              He indicated that most golfers shift their weight to the 
 
         left leg but that claimant doesn't.  He emphasized again that 
 
         claimant plays a good game of golf even with his problems and 
 
         that he is a good putter and can also get to the green.
 
         
 
              Kent Jayne, a vocational rehabilitation counselor, testified 
 
         he did an assessment on claimant and the report is dated April 
 
         26, 1993, represented by claimant's exhibit 6.  He said that 
 
         since this report was given he has obtained additional 
 
         information, psychological evaluations, doctor reports and has 
 
         reviewed the video tapes.  He said that he has changed his 
 
         opinion since his original assessment.  The original assessment 
 
         indicated that claimant was employable.  He now indicates that 
 
         claimant's employability has decreased and that his earning 
 
         capacity decrease is based on claimant's test scores.  He opined 
 
         that claimant had an 85 to 95 percent reduced earning capacity.  
 
         *****  [It is] presumed that when this witness is using the word 
 
         "earning capacity," he is strictly referring to loss of income 
 
         and not determining industrial disability, [and that 
 
         determination is the province of this agency.]
 
         
 
              He testified as to claimant's functional capacity, the 
 
         psychologist report done by the state.  He addressed the question 
 
         of why claimant did not go to Kirkwood College to take another 
 
         psychological assessment test.  He indicated that it was 
 
         inappropriate at that time as claimant had already done that type 
 
         of test and it would have been redundant.  He said claimant was 
 
         not a candidate for retraining and, therefore, the Kirkwood Skill 
 
         Center program would have been worthless.  He again opined that 
 
         he didn't think claimant was employable in the open labor market 
 
         and that he is restricted to sedentary work.  He indicated a 
 

 
         
 
         Page   7
 
         
 
         
 
         
 
         
 
         
 
         sedentary job usually takes more intelligence and that the 
 
         employers do not want one with severe disabilities.  He indicated 
 
         that in the entry level position if one misses work, the 
 
         employers do not like it.  Also, there is usually no fringe 
 
         benefits such as claimant had at defendant employer.
 
         
 
              He indicated he watched two of the video tapes and that he 
 
         did not see anything inconsistent regarding claimant's complaints 
 
         and activities in the tape.
 
         
 
              He was asked questions as to certain jobs or job contacts 
 
         and in each instance he indicated that the job requirements are 
 
         not consistent with claimant's physical restrictions.  He said 
 
         claimant is motivated and made 200 contacts.  He said that 
 
         claimant returned to the welding job and asked for light duty and 
 
         couldn't get it.  He said he has not written claimant off as to 
 
         his being employable and added that claimant might be able to 
 
         work temporarily but not able to retain a job.
 
         
 
              He said his first contact was with claimant in claimant's 
 
         attorney's office on April 26, 1993, and that he saw him for a 
 
         total of two times, the second time being one month before the 
 
         hearing.  
 
         
 
              Mr. Jayne indicated that claimant's attorney asked him to do 
 
         a vocational assessment and not to provide placement of the 
 
         claimant.  He was only to make recommendations.  He indicated he 
 
         did a job search and indicated that at the bottom of page 8 of 
 
         claimant's exhibit 6 (a geographical census) but he did not 
 
         contact individual employers.  He said he disagreed with Mr. 
 
         Hughes as to the recommendation of retraining claimant and, also, 
 
         as to Mr. Hughes' recommendation for potential retraining 
 
         program.  He disagreed with Mr. Proctor if he said claimant can 
 
         be placed in a permanent job.  Mr. Jayne indicated he hadn't 
 
         initially read the department of vocational rehabilitation letter 
 
         but had received it two months later.  He also did not see the 
 
         functional capacity test of William Minks, M.D., of August 4, 
 
         1992, represented by defendant's exhibit K.  Mr. Augustine said 
 
         he was given no social security record.  He said claimant did not 
 
         tell him he applied for social security.
 
         
 
              This witness was extensively questioned on 
 
         cross-examination.  He acknowledged that claimant was told he was 
 
         capable of sedentary work but Mr. Jayne said that did not 
 
         necessarily mean a sedentary job.  He also acknowledged that he 
 
         relies on medical opinions of the doctors and further 
 
         acknowledged that three doctors had claimed claimant was capable 
 
         of sedentary work and that he was released for sedentary work.  
 
         He indicated the doctor said claimant cannot return as a welder 
 
         and that Mr. Jayne indicated he would not place claimant in 
 
         anything but a sedentary-type job.
 
         
 
              *****
 
         
 
              Mr. Jayne's report, represented by claimant's exhibit 6, 
 
         pages 1 through 10, basically concludes that claimant has a 
 
         reduction in present and future earning capacity of between 85 
 

 
         
 
         Page   8
 
         
 
         
 
         
 
         
 
         
 
         and 95 percent at his current levels and if he experiences 
 
         further complications or reduction of capacity, claimant would 
 
         approach 100 percent.  Mr. Jayne also emphasized that he was not 
 
         given a rating of industrial disability as that is within the 
 
         sole purview of the industrial commissioner.  It is apparent that 
 
         Mr. Jayne did not seek a job for claimant or make contacts for 
 
         him.  It appears that Mr. Jayne was strictly trying to determine 
 
         claimant's vocational potential and earning capacity in light of 
 
         his injuries without doing the real test or real effort of 
 
         getting claimant a job or making contacts or leading claimant to 
 
         certain definite contacts.  This latter effort would seem ***** 
 
         to be more important in light of the Americans With Disabilities 
 
         Act in which claimant would usually not have to disclose his 
 
         disability before being offered a job. As will be addressed 
 
         later, claimant did, as shown on the video tapes, go to his 
 
         attorney's office in a very crippled or limping-type situation 
 
         but within an hour or hour and a half later on the golf course 
 
         and as shown by the videos, this claimant became suddenly cured 
 
         or not affected by his knee as far as any visible outward 
 
         indications.  It would be presumed that he would make the same 
 
         effort presenting himself to a job as he did trying to golf on a 
 
         golf course.
 
         
 
              Larry Lang testified that he works for defendant employer 
 
         and is a human resource manager and handles workers' compensation 
 
         matters.  He was somewhat familiar with claimant's claim, the 
 
         nature of his work and the requirements of the job.  He 
 
         acknowledged that claimant last worked on August 8, 1988 for the 
 
         company but retained his status with the company until April 1991 
 
         at which time there was a termination letter.
 
         
 
              Mr. Lang testified that there was a discussion in March of 
 
         1991 with claimant as to his health and condition.  They 
 
         discussed the doctor's recommendation and his final physical 
 
         report recommendations and the recommendations from the 
 
         vocational rehabilitation consultant.  It was agreed or 
 
         understood that claimant could not return to his former job as a 
 
         welder and he said claimant also indicated he didn't think he 
 
         could return so he explained to the claimant the benefits if he 
 
         terminated his rights under Cobra, etc.
 
         
 
              Mr. Lang said he did not discuss other positions claimant 
 
         could bid into at this time but indicated claimant did have a 
 
         right to bid into other jobs.  Mr. Lang said they were ready to 
 
         let Mr. Lang return to his full-time work but they couldn't 
 
         accommodate him as to a welder under the doctor's restrictions 
 
         and that there was not enough work part-time versus full-time for 
 
         him to do some of that type of work on a lighter basis even 
 
         though they were able to accommodate him for awhile.
 
         
 
              He said the reason they had this discussion with claimant 
 
         was that they felt a reasonable time had passed to see if 
 
         claimant could return to his regular full-time job and, also, 
 
         they had a letter around April 1991 showing claimant had reached 
 
         maximum improvement.
 
         
 
              Mr. Lang said there was no union action taken as a result of 
 

 
         
 
         Page   9
 
         
 
         
 
         
 
         
 
         
 
         claimant's termination.
 
         
 
              Mr. Lang indicated at the time of claimant's injury he was 
 
         making $11.75 per hour and that now after a raise, the hourly 
 
         wage would be $14.14.  He also indicated there would be the same 
 
         full-time benefits, pensions and rights to overtime.  He 
 
         acknowledged that there was a pay raise about one month after 
 
         claimant was injured.
 
         
 
              Thomas Werning testified he works as a controller for 
 
         defendant employer and knew claimant had hurt his back and left 
 
         knee in June 1988.  He said that he had seen claimant in bars at 
 
         Roosevelt Singlefest in October of 1993 and claimant was doing a 
 
         line dance and seemed to have no problem dancing.
 
         
 
              Patricia Aten testified she is a nurse and rehabilitation 
 
         consultant with Karr Rehabilitation Service, Inc.  Her first 
 
         contact with claimant was August 31, 1992, when she was asked to 
 
         make contact with him and find him a job.  She indicated claimant 
 
         had told her he still hurt, his back still hurt and he had 
 
         problems.  They discussed the claimant's vocational goals and 
 
         positions he would like and claimant indicated he would like to 
 
         do welding.  She said she provided claimant with leads and 
 
         contacts and was looking for sedentary work.
 
         
 
              She said she referred claimant to 30 jobs and that claimant 
 
         was to follow up and make contacts.  She indicated some of these 
 
         jobs requested resumes or applications and that claimant did not 
 
         consistently follow up on job leads.  She indicated he followed 
 
         up on three in 13 days and some are on the same day.
 
         
 
              She related an incident in which claimant went for an 
 
         interview and talked about being paid money under the table and 
 
         not reporting it and that he wanted to take his girlfriend with 
 
         him.  Claimant later explained that that was not what happened 
 
         but that he wanted to be paid cash for one week to see if he 
 
         liked the job.  She had mixed feelings as to claimant's 
 
         motivation.
 
         
 
              Ms. Aten concluded that based on claimant's background, she 
 
         believed he was employable in a competitive job market on a 
 
         full-time basis.  She said claimant's attorney knew she was 
 
         trying to place claimant in a competitive job.  Ms. Aten then 
 
         said that Karr Rehabilitation transferred this case to Larry 
 
         Proctor.  As of that time, she had not found claimant a job.
 
         
 
              She said she was aware that claimant played golf and that 
 
         there was a psychological report. (Cl. Ex. 5, p. 1-15)  She did 
 
         not do any independent testing and worked with the claimant from 
 
         August 1992 to February 7, 1993.
 
         
 
              Larry Proctor testified he is a rehabilitation consultant 
 
         working with Karr Rehabilitation Services since May 1993.  He 
 
         said his first contact with claimant's attorney was June 9, 1993, 
 
         at the attorney's office and that the attorney understood he was 
 
         trying to place claimant in a job.
 
         
 

 
         
 
         Page  10
 
         
 
         
 
         
 
         
 
         
 
              He related that he was sitting in the reception room at 
 
         claimant's attorney when the claimant came into the law office 
 
         and was walking slowly and in distress and was in apparent 
 
         obvious pain, shuffling along and looking as though he was 
 
         experiencing a lot of pain.  He said he introduced himself and 
 
         then went into the conference room.  Mr. Proctor said he had the 
 
         initial report of Ms. Aten.  He said claimant told him he was 
 
         having a lot of pain in his left knee and right knee and gave him 
 
         the impression it was debilitating and wanted Mr. Proctor to wait 
 
         a couple of weeks so he could recover.
 
         
 
              Mr. Proctor testified he was surprised to know that claimant 
 
         went to the golf course that afternoon.  He felt that was 
 
         impossible taking into consideration how claimant looked at the 
 
         time he was in the attorney's office a short time earlier.
 
         
 
              He said claimant told him he was using the YMCA for water 
 
         exercises and doing sedentary activities.  Claimant never told 
 
         him he was going golfing and dancing.
 
         
 
              Mr. Proctor said he tried to place claimant in a sedentary 
 
         job classification and called local employers weekly and provided 
 
         job leads to the claimant.  He said claimant would also make 
 
         calls.
 
         
 
              He said he called a Mr. Hughes of the Iowa Division of 
 
         Vocational Rehabilitation as claimant had told him he was working 
 
         with the state.  Mr. Proctor said that after talking with Mr. 
 
         Hughes, claimant met the state qualifications and a time was set 
 
         up for claimant to go to the Kirkwood College for a test 
 
         evaluation which would be paid for by the state.
 
         
 
              Mr. Proctor said claimant did not show and Mr. Hughes did 
 
         not know why [claimant] ***** did not show up, especially since 
 
         the state would pay for it.
 
         
 
              Mr. Proctor also had mixed feelings as to claimant's desire 
 
         to work as he considered how the claimant appeared to employers.  
 
         He said claimant is friendly but in both instances he knew of, 
 
         claimant wore the knee brace outside his pants and he wondered 
 
         what impression claimant made on any future employer.
 
         
 
              He was asked concerning a report of a Dr. Bryant, a 
 
         psychologist.  Mr. Proctor said that in reviewing it, claimant 
 
         scored three points below average range and that this is not a 
 
         low level in his opinion.  He said claimant is not mentally 
 
         disabled.  He also said the doctor questioned the validity of the 
 
         test and that it might be valid.
 
         
 
              He said he had barely gotten started with claimant 
 
         concerning job placement when claimant came down with hepatitis B 
 
         which put things on hold as claimant did not have any energy 
 
         during this time.  Mr. Proctor then said that on November 1, 
 
         1993, claimant said he couldn't follow up with any leads so he 
 
         ended his working with the claimant on January 4, 1994.  He gave 
 
         claimant no leads then as claimant said he couldn't follow up.  
 
         In his further testimony, he questioned claimant's motivation.  
 

 
         
 
         Page  11
 
         
 
         
 
         
 
         
 
         
 
         He said he is still willing to assist claimant in finding work.  
 
         He said the Americans With Disabilities Act is making a big 
 
         difference in how one is hired and retained.
 
         
 
              ***** Claimant's exhibit 7 is numerous pages of various 
 
         contacts that claimant made or that he was referred to. *****
 
         
 
              Claimant's exhibit 5 is a psychological report.  It reflects 
 
         on page 3 that areas of this test indicate that 
 
         psychological/emotional features have become intertwined in 
 
         claimant's thinking and secondary gain is present.  It further 
 
         shows some exaggeration of physical symptoms is probably present.
 
         
 
              Claimant's exhibit 5, pages 5 through 13, is the report from 
 
         John Hughes, counselor, who is with the State Rehabilitation 
 
         Department.  Taking this report as a whole, ***** [there is] a 
 
         concern as to claimant's motivation and willingness to try 
 
         certain things.  It seems like in 1992, he also had some personal 
 
         problems not connected with any injury.  It also appears around 
 
         May 1992, he seemed interested in participating in a program of 
 
         vocational evaluation at the Kirkwood Skill Center and the file 
 
         was being transferred to that end.  As shown on page 13 of said 
 
         exhibit, there is authorization to pay for this evaluation which 
 
         was to be given July 9, 1992.  As the evidence shows, claimant 
 
         did not go to this and actually refused and indicated this was a 
 
         duplication or he thought he already had enough evaluation.  
 
         *****
 
         
 
              Claimant' exhibit 1 covers claimant's medical records at the 
 
         University of Iowa.  These reflect claimant had a third surgery 
 
         on his left knee on November 2, 1988 and a fourth surgery on June 
 
         7, 1989. (Cl. Ex. 1, p. 4; Cl. Ex. 1, p. 11)
 
         
 
              Page 32 of said exhibit is a report of John P. Albright, 
 
         M.D., Department of Orthopaedic Surgery, in which he opined 
 
         claimant had a 60 percent permanent impairment of his left lower 
 
         extremity under the AMA Guides to the Evaluation of Permanent 
 
         Impairment.  He deferred the impairment rating for claimant's 
 
         back to the spine team and Dr. Weinstein.  Page 33 of said 
 
         exhibit is a September 26, 1991 report of Dr. Weinstein in which 
 
         he opined claimant had a 3 percent permanent partial impairment 
 
         to his body as a whole as a result of claimant's June 20, 1988 
 
         injury to claimant's back in which he aggravated a degenerative 
 
         condition in his S1 joint.  There is no dispute that claimant 
 
         incurred an injury to his left knee and back and, therefore, 
 
         ***** [there is] no need to go into any more detail on claimant's 
 
         medical records at the University of Iowa as represented by 
 
         claimant's exhibit 1.
 
         
 
              On March 24, 1992, Dr. Albright wrote a report (page 34 of 
 
         said exhibit) and it emphasizes a 60 percent rating includes the 
 
         prior 34 percent rating that he made on claimant's preexisting 
 
         left knee condition.  Therefore, he is opining that claimant had 
 
         an additional 26 percent permanent impairment as a result of his 
 
         June 1988 injury to his left knee.  He then indicated that 
 
         claimant's back impairment should be combined under the Guides to 
 
         the 60 percent.
 

 
         
 
         Page  12
 
         
 
         
 
         
 
         
 
         
 
         
 
              Claimant's exhibit 1, page 35, is a report from Kevin M. 
 
         Carpenter, M.D., concerning claimant's hearing loss.  Any hearing 
 
         loss claimant incurred at work is not an issue in this case.  
 
         This January 21, 1993 report indicates that claimant will need a 
 
         hearing aid for communication.  There is no indication claimant 
 
         has followed that advise or has a hearing aid or feels he needs 
 
         one.  The evidence shows that claimant is golfing and dancing and 
 
         not working and that may have made a difference as far as whether 
 
         claimant thinks he now has a need for a hearing aid.
 
         
 
              On page 3 of claimant's exhibit 2, Dr. Neiman issued a 
 
         report pursuant to an independent medical exam he made on 
 
         February 5, 1992.  His figures are confusing and appears to be in 
 
         error as far as math is concerned.  It appears that he would 
 
         relate a 24 percent permanent partial impairment to claimant's 
 
         left knee based on his prior injuries and an additional 36 
 
         percent based on his June 1988 injury.  It appears that he has 
 
         opined that claimant has a 14 percent body as a whole injury 
 
         after converting the impairment he gave to claimant's left lower 
 
         extremity.  He opined a 10 percent body as a whole impairment to 
 
         claimant's low back.  He then opined a 24 percent combined 
 
         permanent body as a whole impairment to claimant as a result of 
 
         claimant's June 20, 1988 injury.  Claimant was referred by Dr. 
 
         Neiman to St. Luke's Hospital for a functional capacity 
 
         evaluation represented by claimant's exhibit 2, pages 6 through 
 
         12. ***** After looking at the videos, a person questions the 
 
         total validity of claimant's activity in these particular 
 
         functions.  It would seem ***** that in watching the videos and 
 
         how claimant golfed, he would be able to do better at some of 
 
         these functional capacity tests, at least now.  This test was 
 
         given in April of 1993 and the videos were shot in May, June and 
 
         August of 1993.
 
         
 
              Claimant's exhibit 4 contains a May 14, 1992 report of 
 
         Bradley P. Kristiansen, D.C..  Page 1 of said report is dated May 
 
         14, 1993 and page 2 is dated May 14, 1992. ***** [Presumably,] it 
 
         is to be 1993.  It is of interest ***** that page 2 of the report 
 
         indicates that claimant has had to give up all sports activities.  
 
         It appears throughout claimant's medical that he has not 
 
         disclosed his actual sports activities and that he played golf 
 
         quite often, goes dancing, etc. *****
 
         
 
              There is a dispute as to medical bills in the amount of 
 
         $1,456.67 with Dr. Kristiansen and his chiropractic office.  The 
 
         defendants indicate that they authorized five visits.  It appears 
 
         that claimant was aware that the additional chiropractic 
 
         treatments were not authorized.  The ***** $1,456.67 in 
 
         chiropractic bills were not authorized and are not the 
 
         responsibility of defendants.  Pages 4 through 7 of claimant's 
 
         exhibit 4 are the itemization of said chiropractic bills.
 
         
 
              Defendants' exhibit J is the reports from Mr. Proctor, the 
 
         rehabilitation consultant, who testified in person.
 
         
 
              There is no question claimant has a serious injury with his 
 
         left knee and low back resulting from his June 20, 1988 work 
 

 
         
 
         Page  13
 
         
 
         
 
         
 
         
 
         
 
         injury.  Claimant, likewise, had left knee problems that 
 
         preexisted said 1988 injury.  The medical evidence is unanimous 
 
         that claimant is not able to return to his job as a welder 
 
         because of his 1988 injury.  It does not appear that there would 
 
         be any job similar to claimant's job he had with defendant 
 
         employer on said date that he would be able to do.  That job 
 
         required claimant to do heavy strenuous work and put himself in 
 
         difficult positions.
 
         
 
              Claimant contends he is totally disabled and is an odd-lot 
 
         candidate.  [It is found] ***** that claimant is not totally 
 
         disabled and is not an odd-lot candidate.  ***** According to the 
 
         videos that are represented by defendants' exhibit L, ***** 
 
         claimant went to his attorney's office on or around June 9, 1993, 
 
         at around 10:14 a.m., and as shown on the video could hardly 
 
         walk, walked slowly, held onto the rail, used a cane.  He also 
 
         apparently exhibited that type of condition while in the 
 
         attorney's office waiting when one of the rehabilitation 
 
         consultants happened to come upon him in the office also.  
 
         Claimant left his home on said date around 11:10 a.m. and reached 
 
         the golf course around noon on that day.  Claimant testified in 
 
         court and demonstrated that he has a unique swing in which he 
 
         does not have to use his legs because of his upper body strength 
 
         and he is able to play golf several times a week without it 
 
         apparently bothering him. *****
 
         
 
              *****Claimant ***** [appears to have been] overstating his 
 
         medical situation and was, in fact, faking the extent of his 
 
         disability and inability to do things. ***** Claimant did not 
 
         disclose his full activities to the doctor.  In fact, the medical 
 
         reports show that he told them he had to discontinue all sports 
 
         activities.  Although ***** claimant was injured on June 20, 
 
         1988, he is using that injury to enable him through his 
 
         exaggeration of his condition to again become active in his 
 
         golfing game and lead a life of golfing enjoyment without 
 
         working. ***** Claimant can do sedentary work and the medical 
 
         evidence supports that.  Claimant offered into evidence exhibits 
 
         showing substantial contacts have been made. ***** He may have 
 
         given the impression to employers who might be hiring that he 
 
         either didn't want the job or may have visibly through openly 
 
         wearing a brace on the outside rather than the inside of his 
 
         pants or gave some other impression that did not help in 
 
         obtaining a job.  It is believed that claimant does not want to 
 
         work for substantially less income than he was making at the time 
 
         of his injury.  If claimant desires to play on the golf course 
 
         the rest of his life, that is his privilege, but defendants 
 
         should not be stuck with claimant's overexaggeration of his 
 
         inability or claim that he cannot work at all.  It is strange 
 
         that claimant needed to use his cane when he went to his 
 
         attorney's office obviously knowing there would be others there 
 
         to see him and yet when he went on the golf course, he suddenly 
 
         did not need a cane and did not even use his golf club to support 
 
         himself.  He obviously did not expect to be video taped that day.
 
         
 
              In viewing all of the tapes, ***** [it is found] that 
 
         claimant is able to do some work even though not the type of work 
 
         he did at the time he was injured.  Claimant should seek work and 
 

 
         
 
         Page  14
 
         
 
         
 
         
 
         
 
         
 
         attempt to earn a living rather than convincing himself that he 
 
         should play golf during the day and dance during the evening.
 
         
 
              ***** [It is noted] that a motion for continuance was filed 
 
         on September 9, 1993, indicating that claimant wanted a 
 
         continuance of his arbitration hearing scheduled for September 
 
         16, 1993, because he was then currently physically incapacitated 
 
         as he had contacted hepatitis B and there was a letter from the 
 
         doctor requiring claimant to have bedrest until the acute stage 
 
         is resolved.  
 
         
 
              Mr. Werning testified that on October 8, 1993, claimant was 
 
         at a dance at the Roosevelt Hotel doing the line dance and seemed 
 
         to have no problems dancing.  Not only was claimant able to dance 
 
         contrary to his physical complaints, but he was there at a dance 
 
         carrying a highly contagious disease from which he had his case 
 
         continued so he could rest and recover. *****
 
         
 
              ***** Claimant has a substantial loss of income.  He would 
 
         be making now approximately $14 plus an hour plus benefits if he 
 
         was still working for the defendant employer.  At the time of his 
 
         injury, claimant was making about $11.75 per hour.  It would 
 
         appear that the sedentary jobs which might be available would be 
 
         paying anything from minimum wage up to around $6.75 per hour and 
 
         there would be a question as to whether there would be any fringe 
 
         benefits which can be a substantial amount of one's salary or 
 
         actual monetary benefit from employment.
 
         
 
              Claimant has substantial restrictions and also a substantial 
 
         permanent impairment in addition to the permanent impairment he 
 
         had prior to this injury.  Claimant has had four surgeries to his 
 
         left knee, two as a result of his June 20, 1980 injury and two 
 
         from prior injuries.  He has also had two surgeries to his right 
 
         knee.  *****  [However, claimant's physical activities 
 
         demonstrate that his impairment is not greatly disabling.  This 
 
         ability to dance and to not only play golf, but to play 
 
         exceptionally well, indicates an ability to tolerate various 
 
         physical activities involved in various occupations.
 
         
 
              Although this is not to say that claimant does not have a 
 
         disability as a result of his injury, it does cast doubt on 
 
         claimant's description of the extent of his disability.  His 
 
         physical ability to engage in these activities can be readily 
 
         translated to an ability to engage in various occupations 
 
         involving similar movements.  
 
         
 
              Claimant's failure to attend the vocational rehabilitation 
 
         services offered to him reflects adversely on claimant's 
 
         motivation to return to work.  The services were authorized and 
 
         would not have represented any cost to claimant, yet claimant 
 
         decided on his own they were not needed or were duplicative.  
 
         Claimant cannot maximize his award by failing to reduce his 
 
         disability through reasonable vocational rehabilitation efforts.
 
         
 
              Claimant's psychological evaluation shows that he is of 
 
         reasonable intelligence.  Claimant therefore is a good candidate 
 
         for retraining in another field within his physical limitations.  
 

 
         
 
         Page  15
 
         
 
         
 
         
 
         
 
         
 
         The vocational rehabilitation testing that was completed shows 
 
         that claimant is eligible for a variety of jobs, but that 
 
         claimant made less than a complete effort to apply for those jobs 
 
         identified for him.  In addition, he appeared to be intentionally 
 
         sabotaging the interview process by wearing his brace outside his 
 
         clothing.  Claimant has been medically released to engage in 
 
         sedentary work.  Claimant is restricted from returning to his job 
 
         as a welder.
 
         
 
              Claimant was 45 years old at the time of the hearing, and 
 
         had completed high school.  Claimant had no education beyond high 
 
         school except on the job training.  Claimant has experienced a 
 
         loss of wages as a result of his work injury.]
 
         
 
              Taking into consideration claimant's work experience and 
 
         medical and work history prior to his June 20, 1988 injury and 
 
         after said injury; his age; intelligence; location and severity 
 
         of his injury; his permanent restrictions and impairment; his 
 
         motivation; the employer's attempt to accommodate but the 
 
         employer's acknowledgment that claimant is unable to do the work 
 
         he was doing at the time of his injury and the apparent inability 
 
         to find work for the claimant within his restrictions at 
 
         defendant employer's place of business; and, ***** all other 
 
         factors that are considered in determining industrial disability, 
 
         ***** it is found that claimant has incurred a ***** [35] percent 
 
         industrial disability.
 
         
 
              There is a dispute as to the number of exemptions to which 
 
         claimant is entitled.  Claimant claims he is entitled to three 
 
         exemptions (himself and two children).  Defendants contend that 
 
         claimant is entitled to himself and one dependent child.  
 
         Claimant testified that for income tax purposes, he and his 
 
         ex-wife have an agreement that he takes one child and she takes 
 
         one child.  It is not clear whether this was done in the divorce 
 
         decree and whether an IRS agreement signed by the parties is on 
 
         file. ***** It is found that claimant, himself, is taking only 
 
         one dependent and not two for income tax purposes and, therefore, 
 
         is entitled to take only one child as a dependent herein.  There 
 
         is no other evidence that he is paying support for two children 
 
         other than he seems to indicate he was supporting two children.  
 
         Actually, there is no evidence he is supporting any child other 
 
         than his relating to an agreement in which he is entitled to one 
 
         and his ex-wife entitled to one. ***** [It is found] that 
 
         claimant is entitled to two exemptions (himself and one child) 
 
         and that his rate of weekly benefits is $278.93.
 
         
 
              Claimant is seeking payment of $1,456.57 in medical benefits 
 
         under the provisions of 85.27.  These appear to be solely 
 
         chiropractic bills.  There appears to be no dispute that these 
 
         were not authorized. ***** There is no evidence that these 
 
         chiropractic treatments which were unauthorized were beneficial 
 
         to the claimant.  It could also be very well true that contrary 
 
         to claimant's contention, he is unable to do sports activities 
 
         and that these bills were the result of claimant's golfing.  
 
         Defendants did authorize five visits and those have apparently 
 
         been paid for.
 
         
 

 
         
 
         Page  16
 
         
 
         
 
         
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              The conclusions of law contained in the proposed agency 
 
         decision filed February 17, 1994 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.  Segments designated by brackets ([ ]) indicate 
 
         language that is in addition to the language of the proposed 
 
         agency decision.
 
         
 
              In Guyton v. Irving Jensen Co., 373 N.W.2d 101 (Iowa 1985), 
 
         the Iowa court formally adopted the "odd-lot doctrine."  Under 
 
         that doctrine a worker becomes an odd-lot employee when an injury 
 
         makes the worker incapable of obtaining employment in any 
 
         well-known branch of the labor market.  An odd-lot worker is thus 
 
         totally disabled if the only services the worker can perform are 
 
         "so limited in quality, dependability, or quantity that a 
 
         reasonably stable market for them does not exist."  Guyton, 373 
 
         N.W.2d at 105.
 
         
 
              The burden of persuasion on the issue of industrial 
 
         disability always remains with the worker.  When a worker makes a 
 
         prima facie case of total disability by producing substantial 
 
         evidence that the worker is not employable in the competitive 
 
         labor market, the burden to produce evidence of suitable 
 
         employment shifts to the employer, however.  If the employer 
 
         fails to produce such evidence and if the trier of fact finds the 
 
         worker does fall in the odd-lot category, the worker is entitled 
 
         to a finding of total disability.  Guyton, 373 N.W.2d at 106.  
 
         Even under the odd-lot doctrine, the trier of fact is free to 
 
         determine the weight and credibility of evidence in determining 
 
         whether the worker's burden of persuasion has been carried, and 
 
         only in an exceptional case would evidence be sufficiently strong 
 
         as to compel a finding of total disability as a matter of law.  
 
         Guyton, 373 N.W.2d at 106.
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which the employee is 
 
         fitted.  Olson v. Goodyear Serv. Stores, 255 Iowa 1112, 125 
 
         N.W.2d 251 (1963); Barton v. Nevada Poultry, 253 Iowa 285, 110 
 
         N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  
 
         Impairment and disability are not synonymous.  The degree of 
 
         industrial disability can be much different than the degree of 
 
         impairment because industrial disability references to loss of 
 
         earning capacity and impairment references to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 

 
         
 
         Page  17
 
         
 
         
 
         
 
         
 
         
 
         
 
              Factors to be considered in determining industrial dis
 
         ability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of the healing period; 
 
         the work experience of the employee prior to the injury and after 
 
         the injury and the potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         Likewise, an employer's refusal to give any sort of work to an 
 
         impaired employee may justify an award of disability.  McSpadden 
 
         v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980).  These are 
 
         matters which the finder of fact considers collectively in 
 
         arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  Neither does a rating of 
 
         functional impairment directly correlate to a degree of 
 
         industrial disability to the body as a whole.  In other words, 
 
         there are no formulae which can be applied and then added up to 
 
         determine the degree of industrial disability.  It therefore 
 
         becomes necessary for the deputy or commissioner to draw upon 
 
         prior experience as well as general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Christensen v. Hagen, Inc., Vol. 1 No. 3 State of Iowa 
 
         Industrial Commissioner Decisions 529 (App. March 26, 1985); 
 
         Peterson v. Truck Haven Cafe, Inc., Vol. 1 No. 3 State of Iowa 
 
         Industrial Commissioner Decisions 654 (App. February 28, 1985).
 
         
 
              Compensation for permanent partial disability shall begin at 
 
         the termination of the healing period.  Compensation shall be 
 
         paid in relation to 500 weeks as the disability bears to the body 
 
         as a whole.  Section 85.34.
 
         
 
              The employer shall furnish reasonable surgical, medical, 
 
         dental, osteopathic, chiropractic, podiatric, physical 
 
         rehabilitation, nursing, ambulance and hospital services and 
 
         supplies for all conditions compensable under the workers' 
 
         compensation law.  The employer shall also allow reasonable and 
 
         necessary transportation expenses incurred for those services.  
 
         The employer has the right to choose the provider of care, except 
 
         where the employer has denied liability for the injury.  Iowa 
 
         Code section 85.27.  Holbert v. Townsend Engineering Co., 
 
         Thirty-second Biennial Report of the Industrial Commissioner 78 
 
         (Review-reopen 1975).
 
         
 
              It is further concluded that:
 
         
 
              Claimant incurred a ***** 35 percent industrial disability 
 
         as a result of his June 20, 1988 work injury.
 
         
 
              Claimant has substantial restrictions and additional 
 

 
         
 
         Page  18
 
         
 
         
 
         
 
         permanent impairment as a result of his June 20, 1988 injury.
 
         
 
              Claimant is entitled to only two exemptions and that his 
 
         rate of weekly benefits is $278.93 based on exemptions of himself 
 
         and one dependent child at the time of his injury.
 
         
 
              Claimant is not an odd-lot candidate.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed and 
 
         modified.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants shall pay unto claimant one hundred 
 
         seventy-five (175) weeks of permanent partial disability benefits 
 
         at the weekly rate of two hundred seventy-eight and 93/100 
 
         dollars ($278.93) beginning September 6, 1990.
 
         
 
              That defendants shall pay accrued weekly benefits in a lump 
 
         sum and shall receive credit against the award for weekly 
 
         benefits previously paid.  The parties have stipulated that 
 
         defendants have previously paid one hundred seventy-five (175) 
 
         weeks of permanent partial disability at a weekly rate of two 
 
         hundred eighty-six and 69/100 dollars ($286.69).  Defendants have 
 
         previously paid healing period but healing period benefits are 
 
         not in dispute.
 
         
 
              That defendants shall pay interest on benefits awarded 
 
         herein as set forth in Iowa Code section 85.30.
 
         
 
              That defendants shall pay the costs of this action, pursuant 
 
         to rule 343 IAC 4.33.
 
         
 
              That defendants shall file an activity report upon payment 
 
         of this award as required by this agency, pursuant to rule 343 
 
         IAC 3.1.
 
         
 
              Signed and filed this ____ day of October, 1994.
 
         
 
         
 
         
 
                                       ________________________________
 
                                                BYRON K. ORTON
 
                                           INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Thomas M. Wertz
 
         Attorney at Law
 
         4089 21st Ave. SW, Ste 114
 
         Cedar Rapids, IA 52404
 
         
 
         Ms. Dorothy L. Kelley
 
         Attorney at Law
 
         500 Liberty Bldg
 
         Des Moines, IA 50309
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
                                       5-1803; 5-1900; 5-2500; 5-4100
 
                                       Filed October 31, 1994
 
                                       Byron K. Orton
 
         
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                                         :
 
         JERRY RIPPEY,                   :
 
                                         :
 
              Claimant,                  :
 
                                         :
 
         vs.                             :
 
                                         :        File No. 889863
 
         UNIVERSAL ENGINEERING,          :
 
                                         :          A P P E A L
 
              Employer,                  :
 
                                         :        D E C I S I O N
 
         and                             :
 
                                         :
 
         FIDELITY & CASUALTY,            :
 
                                         :
 
              Insurance Carrier,         :
 
              Defendants.                :
 
         _________________________________________________________________
 
         5-1803
 
         
 
              Found claimant is entitled to 35 percent industrial 
 
         disability.
 
         
 
         5-2500
 
         
 
              Claimant is not entitled to have some chiropractic bills 
 
         reimbursed because they were unauthorized.
 
         
 
         5-1900
 
         
 
              Found claimant entitled to one child, not two, as an 
 
         exemption.
 
         
 
         5-4100
 
         
 
              Found claimant was not an odd-lot candidate.