BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
           
 
            IRENE HUSS,      
 
                        
 
                 Claimant,   
 
                        
 
            vs.         
 
                                            File No. 890904
 
            TLS COMPANY,     
 
                                             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.
 
            
 
                                      ISSUES
 
            
 
                 Claimant states the following issue on appeal:
 
            
 
                 The claimant proved by a preponderance of the 
 
                 evidence that she sustained an injury to the body 
 
                 as a whole entitling her to industrial disability 
 
                 benefits.
 
            
 
                 Defendants state the following issues on cross-appeal:
 
            
 
                 Whether the deputy industrial commissioner 
 
                 correctly held that claimant had sustained a 23% 
 
                 permanent partial disability to her right upper 
 
                 extremity entitling claimant to permanent partial 
 
                 disability benefits for 57.5 weeks; and
 
            
 
                 Whether the deputy industrial commissioner 
 
                 correctly held that defendants denied in their 
 
                 answer to claimant's petition liability for the 
 
                 injury found to be compensable and thereby holding 
 
                 that defendants are liable for medical services 
 
                 rendered to claimant after April 3, 1991
 
            
 
                                FINDINGS OF FACT
 
            
 
                 The findings of fact contained in the proposed agency 
 
            decision filed September 15, 1992 are adopted as final 
 
            agency action.
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 The conclusions of law contained in the proposed agency 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            decision filed September 15, 1992 are adopted as set forth 
 
            below.  Segments designated by brackets ([ ]) indicate 
 
            language that is in addition to the language of the proposed 
 
            agency decision.
 
            
 
                 The first issue to be addressed is the nature and 
 
            extent of claimant's disability.
 
            
 
                 If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
            
 
                 Claimant argues that she has sustained a body as a 
 
            whole injury in that she continues to have persistent 
 
            shoulder problems as well as problems in the forearm and 
 
            wrist.
 
            
 
                 Defendants argue that claimant's disability is limited 
 
            only to the upper extremity, and that she has sustained a 
 
            scheduled member injury and impairment.
 
            
 
                 If claimant has sustained an injury to the shoulder, 
 
            then an evaluation of her industrial disability is 
 
            warranted.  If, however, claimant has sustained an injury 
 
            only to the upper extremity, she is entitled to benefits 
 
            under the scheduled member portion of Iowa Code section 85.
 
            
 
                 The right of an employee to receive compensation for 
 
            injuries sustained is statutory. The statute conferring this 
 
            right can also fix the amount of compensation payable for 
 
            different specific injuries.  The employee is not entitled 
 
            to compensation except as the statute provides.  Soukup v. 
 
            Shores Co., 222 Iowa 272, 268 N.W. 598 (1936).
 
            
 
                 Compensation for permanent partial disability begins at 
 
            termination of the healing period.  Section 85.34(2).  
 
            Permanent partial disabilities are classified as either 
 
            scheduled or unscheduled.  A specific scheduled disability 
 
            is evaluated by the functional method; the industrial method 
 
            is used to evaluate an unscheduled disability. Simbro v. 
 
            Delong's Sportswear, 332 N.W.2d 886 (Iowa 1983); Graves v. 
 
            Eagle Iron Works, 331 N.W.2d 116 (Iowa 1983); Martin v. 
 
            Skelly Oil Co., 252 Iowa 128, 106 N.W.2d 95 (1960).
 
            
 
                 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, 222 Iowa 
 
            272, 268 N.W. 598.
 
            
 
                 Almost all of the medical examinations and tests 
 
            performed have concentrated on claimant's fingers, wrists, 
 
            forearm and elbow.  Other than the recent injections from 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            Dr. Jacobs, claimant has never received any treatment to the 
 
            right shoulder.  The two impairment ratings have been 
 
            confined to the right upper extremity.  The record implies 
 
            that claimant may have tendinitis in her shoulder, but this 
 
            condition has not been shown to be causally related to the 
 
            cumulative injury sustained by claimant or that her 
 
            condition is permanent.  Although she does complain of pain 
 
            in the shoulder area, all of the impairment ratings have 
 
            been based on disability to the upper extremity, not the 
 
            shoulder or body as a whole.  Claimant stated that she 
 
            continues to have pain in the shoulder, it has been noted by 
 
            the agency that pain which is not substantiated by clinical 
 
            findings is not a substitute for impairment.  See, Waller v. 
 
            Chamberlain Mfg. Co., II Iowa Ind. Comm'r Rep. 419, 425 
 
            (1981).  The record does not indicate any substantial, 
 
            significant clinical findings which correlate with the 
 
            objective pain expressed by claimant.  In fact, most of the 
 
            medical records indicate that there is no pathology for 
 
            claimant's complaints of shoulder pain.
 
            
 
                 As a result, it is found that claimant's disability is 
 
            limited to the right upper extremity and is a scheduled 
 
            member injury.
 
            
 
                 The next issue then is to become the extent of her 
 
            disability.  Two doctors have rendered opinions regarding 
 
            the impairment.  Dr. Neff and Mr. Bower collectively gave 
 
            claimant a 9 percent permanent partial impairment to the 
 
            upper extremity.  Dr. Grant was of the opinion that claimant 
 
            had sustained a 23 percent impairment to the right upper 
 
            extremity.
 
            
 
                 Both physicians are highly qualified, and base their 
 
            ratings on objective findings.  There is evidence in the 
 
            record of animosity between Dr. Neff and the claimant, and 
 
            as a result, Dr. Neff's disbeliefs of claimant's complaints 
 
            and his skepticism of her efforts are suspicious.  Although 
 
            Dr. Neff was one of claimant's treating physicians, his 
 
            opinion is not automatically afforded more weight than that 
 
            opinion from Dr. Grant.  Dr. Grant followed claimant's 
 
            condition for approximately one year.  It seems from the 
 
            record that he provided more clinical help than Dr. Neff.  
 
            As a result, Dr. Grant's opinion is considered to be more 
 
            applicable to claimant's disability.
 
            
 
                 [Claimant's impairment from the injury is confined to 
 
            the arm and does not extend to the body as a whole.  
 
            However, Dr. Grant's rating of 23 percent impairment of the 
 
            upper extremity included 12 percent impairment of the 
 
            shoulder.  As previously determined, claimant's shoulder 
 
            complaints are not causally related to her work injury.  Dr. 
 
            Grant rated claimant's shoulder, elbow and loss of strength 
 
            of the extremity separately.  Thus, the 12 percent assigned 
 
            to impairment of the shoulder should not be considered.  Dr. 
 
            Grant's rating of claimant's elbow impairment of 8 percent 
 
            and loss of strength of 5 percent convert, under the AMA 
 
            Guides, to 13 percent.  Claimant's impairment of her right 
 
            arm as a result of her work injury is 13 percent.
 
            
 
                 Therefore, claimant has sustained a 13 percent 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            permanent partial disability to her right arm.  She is 
 
            entitled to 32.5 weeks of permanent partial disability 
 
            benefits (250 weeks times 13 percent equals 32.5).]
 
            
 
                 The next issue to be addressed is whether claimant is 
 
            entitled to medical benefits as governed by Iowa Code 
 
            section 85.27.
 
            
 
                 Iowa Code section 85.27 provides, in relevant part:
 
            
 
                    The employer, for all injuries compensable 
 
                 under this chapter or chapter 85A, shall furnish 
 
                 reasonable surgical, medical, dental, osteopathic, 
 
                 chiropractic, podiatric, physical rehabilitation, 
 
                 nursing, ambulance and hospital services and 
 
                 supplies therefor and shall allow reasonably 
 
                 necessary transportation expense incurred for such 
 
                 services....
 
            
 
                    For purposes of this section the employer is 
 
                 obliged to furnish reasonable services and 
 
                 supplies to treat an injured employee, and has the 
 
                 right to choose the care.
 
            
 
                 Generally, the employer has the right to control the 
 
            medical treatment, unless the employer denies liability for 
 
            the injury.  The agency has consistently held that where the 
 
            employer, or defendants, authorize medical treatment, and 
 
            later deny liability in their answer, claimant will be 
 
            responsible for unauthorized treatment rendered before the 
 
            answer has been filed, and an injury requiring medical 
 
            treatment is found to have arisen out of and in the course 
 
            of employment.  See Mason v. Thermo-Gas, Appeal decision 
 
            filed July 28, 1989.
 
            
 
                 [Defendants denied in their answer that claimant's 
 
            injury arose out of and was in the course of her employment.  
 
            Although by the time of the hearing this issue was 
 
            stipulated, the answer was never amended.  The answer denied 
 
            paragraphs of the petition alleging that an injury occurred 
 
            as well as paragraphs indicating the resulting disability 
 
            was to the body as a whole.  Defendants are therefore not 
 
            entitled to control the course of claimant's medical 
 
            treatment when at the same time liability for the injury is 
 
            denied.
 
            
 
                 As a result of the foregoing, any medical treatment 
 
            rendered by unauthorized physicians before defendants denied 
 
            liability in their answer is to be paid by claimant.  
 
            Medical treatment after the denial of liability shall be 
 
            paid by defendants.  From the record, it appears that 
 
            treatment from Dr. Jacobs, Dr. McGuire and Dr. Grant was 
 
            unauthorized.]
 
            
 
                 WHEREFORE, the decision of the deputy is affirmed and 
 
            modified.
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, it is ordered:
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            
 
                 That defendants shall pay claimant permanent partial 
 
            disability benefits for thirty-two point five (32.5) weeks 
 
            at the rate of two hundred forty-nine and 02/100 dollars 
 
            ($249.02) commencing on June 1, 1989.
 
            
 
                 That defendants shall pay accrued amounts in a lump sum 
 
            and shall receive credit against the award for weekly 
 
            benefits previously paid.
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            
 
                 That defendants shall pay for medical services rendered 
 
            after April 3, 1991.
 
            
 
                 That defendants shall file an activity report upon 
 
            payment of this award as required by this agency, pursuant 
 
            to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of September, 1993.
 
            
 
            
 
            
 
                                          
 
                                      ________________________________
 
                                                   BYRON K. ORTON
 
                                              INDUSTRIAL COMMISSIONER
 
            
 
            
 
            Copies To:
 
            
 
            Mr. David D. Drake
 
            Attorney at Law
 
            1200 35th Street  Suite 500
 
            West Des Moines, Iowa  50265
 
            
 
            Mr. George H. Capps
 
            Attorney at Law
 
            P O Box 971
 
            Des Moines, Iowa  50304
 
            
 
 
            
 
 
 
                
 
 
 
                                           5-1800
 
                                           Filed September 30, 1993
 
                                           BYRON K. ORTON
 
                      
 
                       BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
            
 
            IRENE HUSS,      
 
                        
 
                 Claimant,   
 
                        
 
            vs.         
 
                                               File No. 890904
 
            TLS COMPANY,     
 
                                                A P P E A L
 
                 Employer,   
 
                                               D E C I S I O N
 
            and         
 
                        
 
            THE HARTFORD,    
 
                        
 
                 Insurance Carrier,    
 
                 Defendants.      
 
            ____________________________________________________________
 
            
 
            
 
            5-1800
 
            Claimant failed to prove that her wrist/forearm problems 
 
            caused disability to the shoulder.
 
            Claimant awarded compensation based on disability to the 
 
            arm.
 
            
 
 
            
 
            
 
            
 
            
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                                          :
 
            IRENE HUSS,                   :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 890904
 
            TLS COMPANY,                  :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            THE HARTFORD,                 :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by 
 
            claimant, Irene Huss, against TLS, employer, and the 
 
            Hartford Insurance Company, insurance carrier, both as 
 
            defendants.  Claimant filed her petition based on a 
 
            work-related injury which occurred on March 24, 1988.
 
            
 
                 A hearing was held on August 24, 1992, at Des Moines, 
 
            Iowa.  the record consists of the testimony from claimant; 
 
            and, joint exhibits 1 through 10.
 
            
 
                                      ISSUES
 
            
 
                 The following issues were presented for resolution:
 
            
 
                 1.  The nature and extent of claimant's disability; 
 
            and,
 
            
 
                 2.  Whether claimant is entitled to medical benefits as 
 
            governed by Iowa Code section 85.27.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The undersigned deputy, having reviewed all of the 
 
            evidence received, finds the following facts:
 
            
 
                 Claimant, Irene Huss, has lived in Maxwell, Iowa for 
 
            the past 18 years.  She was born on October 16, 1939, and 
 
            was 52 years of age at the time of the hearing.
 
            
 
                 Claimant graduated from Cincinnati High School in 1957, 
 
            and maintained a low B average.  Some of the courses taken 
 
            by claimant included typing, shorthand and "commercial" 
 
            subjects.  Claimant has received no further training or 
 
            formal education.
 
            
 
                 Since October of 1957, claimant has held numerous 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            positions as a data entry and/or keypunch operator.  These 
 
            jobs required claimant to use extensively her right arm, 
 
            hand and shoulder while performing her job duties at a 
 
            keyboard.  Claimant was responsible for entering all types 
 
            of information into the machines.
 
            
 
                 Claimant began working for the defendant, TLS, in July 
 
            of 1983.  She was hired as a data entry operator, a position 
 
            she held until July of 1988, when she left her employment.  
 
            Claimant began working on a new machine in January of 1988 
 
            and began to experience physical problems with her right 
 
            hand, wrist and forearm.  Within one or two months, claimant 
 
            stated that the pain traveled to her upper arm and shoulder.
 
            
 
                 In March of 1988, claimant sought treatment from 
 
            Orville Jacobs, D.O., although his records indicate that 
 
            claimant's main complaint was that of low back pain (Joint 
 
            Exhibit 1, page 27).
 
            
 
                 In April of 1988, claimant was sent to Martin S. 
 
            Rosenfeld, D.O., with chief complaints of pain in both hands 
 
            and arms, the right side greater than the left side.  
 
            Claimant's patient history states that she had these 
 
            complaints for more than two years.  Upon examination, Dr. 
 
            Rosenfeld noted tenderness over the extensors at the wrists 
 
            and elbows, although the Phalen and Tinel signs were 
 
            negative, and the results of an EMG were normal.  He 
 
            diagnosed extensor tendinitis in the wrists and possibly the 
 
            elbow, and gave claimant a wrist brace and a prescription 
 
            for Indocin.  She was to return in three weeks (Jt. Ex. 1, 
 
            p. 52).
 
            
 
                 After several months of conservative treatment, 
 
            including injections to the right elbow and right and left 
 
            wrists, claimant underwent a later elbow extensor release 
 
            and lateral arthrotomy.  The surgery was performed at Des 
 
            Moines General Hospital on July 8, 1988 (Jt. Ex. 1, pp. 42-
 
            54; 80-83).
 
            
 
                 During the next several months, claimant continued to 
 
            received follow-up treatment from Dr. Rosenfeld, and 
 
            underwent physical therapy to increase the range of motion 
 
            in her right elbow.  Claimant continued to complain of 
 
            forearm pain, and expressed some discomfort in the shoulder 
 
            which Dr. Rosenfeld felt was "possibly from the use of the 
 
            sling." (Jt. Ex. 1, p. 40).
 
            
 
                 Claimant continued to see Dr. Rosenfeld until December 
 
            of 1988.  His final note indicates that claimant had not 
 
            responded as well or as quickly to the treatment, but that 
 
            he anticipated she would continue to make progress.  He also 
 
            anticipated a small degree of impairment due to the lack of 
 
            range of motion (Jt. Ex. 1, p. 36).
 
            
 
                 Next, claimant was sent to Scott B. Neff, D.O.  He 
 
            ordered a bone scan of both of her arms with a tomogram of 
 
            the right elbow.  He also ordered EMG studies of the radial 
 
            nerve, and stated that the Roos sign for the thoracic outlet 
 
            was equivocal (Jt. Ex. 1, p. 79).
 
            
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
                 Claimant returned to Dr. Neff in January of 1989.  
 
            After reviewing the results of the tomograms and bone scan, 
 
            he detected a large bone spur on the lateral aspect of the 
 
            radial neck of claimant's elbow.  He recommended that 
 
            claimant undergo excision of the bone spur, a resection of 
 
            the annular ligament and decompression of the radial nerve.  
 
            Claimant was admitted for surgery at Iowa Lutheran Hospital 
 
            on January 19, 1989 (Jt. Ex. 1, pp. 78, 85-88).  In January 
 
            of 1989, claimant also began physical therapy with Thomas 
 
            Bower, L.P.T.  Initial treatment consisted of whirlpool 
 
            therapy and phonophoresis three times a week (Jt. Ex. 1, p. 
 
            70).
 
            
 
                 Claimant returned to Dr. Neff in February of 1989, and 
 
            his notes indicate that claimant was to work on the 
 
            extension and range of motion in her elbow.  He recommended 
 
            an intensive range of motion and exercise home program, 
 
            including "milk jug, weights and thousands and thousands of 
 
            repetitions to wrist and elbow exercises every day." (Jt. 
 
            Ex. 1, p. 77).  He released claimant to return to data entry 
 
            work involving use of a keyboard, but no heavy or repetitive 
 
            manual labor (Jt. Ex. 1, p. 77).
 
            
 
                 Dr. Neff's notes dated March 1989 reveal that claimant 
 
            had a persistent numbness over the dorsum of the forearm, 
 
            but that her dorsal extensors were strong and radial motor 
 
            activity was excellent.  Several references concerning 
 
            claimant's "negative mindset" about returning to work and 
 
            her job are contained in Dr. Neff's entry.  He recommended a 
 
            two hour data entry position with a gradual increase during 
 
            the next several weeks (Jt. Ex. 1, p. 76).
 
            
 
                 Claimant returned to Dr. Neff on March 29, 1989.  He 
 
            released her to return to work on April 17, 1989, noting 
 
            that claimant lacked 10 degrees of her elbow extension but 
 
            showed full extension of the thumb and fingers, and full 
 
            pronation and suppination of the wrist.  Dr. Neff believed 
 
            claimant could continue her rehabilitation at home with a 
 
            practice keyboard, and he instructed her to begin practicing 
 
            for various intervals during the next several weeks (Jt. Ex. 
 
            1, p. 76).
 
            
 
                 Dr. Neff's subsequent notes dated May 24, 1989 
 
            summarize his final examination.  After using her practice 
 
            keyboard for 15 to 20 minutes, claimant experienced aching 
 
            and soreness in her right forearm and wrist.  Apparently, 
 
            the company was unwilling to accommodate claimant, as she 
 
            needed a full release to return to work on an eight hour per 
 
            day basis and claimant was terminated.  Although Dr. Neff's 
 
            notes indicate that claimant was able to perform a variety 
 
            of gardening activities, during direct examination claimant 
 
            explained that she performed limited work in the yard.  His 
 
            examination revealed that extension of the fingers on the 
 
            right hand was normal, and that elbow motion was "almost 
 
            normal." (Jt. Ex. 1, p. 75).
 
            
 
                 In June of 1989, both Dr. Neff and Mr. Bower rendered 
 
            opinions regarding claimant's permanent impairment.  After 
 
            administering several range of motion studies to the right 
 
            elbow, both felt that claimant had sustained a 9 percent 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            impairment to the right upper extremity (Jt. Ex. 1, p. 68).
 
            
 
                 In July of 1989, claimant was seen by W. Blair, M.D., 
 
            at the University of Iowa Hospitals and Clinics.  He noted 
 
            diffuse pain at the elbow, and full range of motion of the 
 
            right shoulder, elbow, wrist and fingers.  His impression 
 
            was that of chronic industrial pain syndrome of the right 
 
            upper extremity, etiology unclear.  No additional surgery 
 
            was recommended (Jt. Ex. 1, pp. 31-32).
 
            
 
                 In March of 1992, Dr. Neff was asked to convert the 
 
            rating to the body as a whole.  He refused to do so and made 
 
            the following statements:
 
            
 
                    Clearly a situation such as this cannot be 
 
                 migratory or progressive following injury, 
 
                 assuming that the activity which caused the 
 
                 problem is no longer occurring.  Consequently in 
 
                 my opinion there is no possible way whereby this 
 
                 injury and its subsequent sequela can go from an 
 
                 upper extremity circumstance to a body as a whole 
 
                 circumstance.  Your request is not medically 
 
                 sensible and not possible.
 
            
 
            (Jt. Ex. 1, p. 74)
 
            
 
                 Dr. Neff refused to see claimant, but recommended she 
 
            return to the University of Iowa Hospitals and Clinics (Jt. 
 
            Ex. 1, p. 74).
 
            
 
                 In January 1991, claimant was examined by Daniel 
 
            McGuire, M.D., who noted no obvious neurological deficit in 
 
            the right upper extremity.  Claimant exhibited almost full 
 
            active range of motion, but stated that the pain was 
 
            "incapacitating."  Objective findings showed some loss of 
 
            strength (Jt. Ex. 1, pp. 34-35).
 
            
 
                 Finally, as of February 28, 1992, claimant continued to 
 
            undergo trigger point injections of cortisone to the right 
 
            shoulder and right elbow to decrease inflammation and pain, 
 
            with treatment being rendered by Dr. Jacobs (Jt. Ex. 1, pp. 
 
            1-2).
 
            
 
                 Claimant returned to Mr. Bower in April of 1992.  
 
            Claimant continued to complain of pain throughout the entire 
 
            right upper extremity, felt a squeezing sensation around her 
 
            elbow and shoulder, some parathesia in the forearm, and 
 
            stated that at times her fingers would not move.  Claimant 
 
            participated in a test designed to determine her maximum 
 
            lifting ability with the right upper extremity.  Claimant 
 
            would not use her right arm to perform the tests, and Mr. 
 
            Bower was unable to determine the functional capacity of her 
 
            right upper extremity due to this refusal.  Claimant also 
 
            underwent testing for determining her dexterity.  Claimant 
 
            demonstrated a very slow pace of work while performing 
 
            repetitive activities, and complained of pain, numbness and 
 
            burning sensations in her fingers, forearm, elbow and 
 
            shoulder of her right upper extremity.  Mr. Bower was unable 
 
            to establish proper work restrictions or lifting 
 
            restrictions due to her lack of activity or use of the right 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            upper extremity.  He felt claimant was demonstrating a 
 
            shoulder/hand type syndrome, and recommended she seek 
 
            medical attention to determine whether ganglion blocks or 
 
            other types of treatment would be beneficial (Jt. Ex. 1, pp. 
 
            65-67).
 
            
 
                 Claimant returned to Dr. Neff in May of 1992.  His 
 
            report contains numerous references to what he describes as 
 
            "inappropriate" responses during his examination, such as 
 
            magnification of her symptoms, facial grimaces, grunts and 
 
            teeth gritting, which were actions he believed were made to 
 
            impress him with a degree of pain she was suffering.  He 
 
            emphatically stressed his belief that claimant was 
 
            demonstrating an industrial pain syndrome in the right hand, 
 
            wrist and forearm, and was not experiencing any impairment 
 
            or pathology in the right shoulder.  He did state that x-
 
            rays of the right shoulder showed acromioclavicular 
 
            degenerative joint disease which was not caused by the data 
 
            entry work.  He stressed that claimant could return to 
 
            office-type work.  He had nothing further to offer claimant, 
 
            and did not recommend any further orthopedic treatment (Jt. 
 
            Ex. 1, pp. 72-73).
 
            
 
                 From October 1989 through October 1990, claimant 
 
            received various treatments from several physicians at the 
 
            McFarland Clinic in Ames, Iowa.  Nerve conduction velocity 
 
            tests and EMG's performed on the right arm were normal, and 
 
            there was no evidence of interosseous nerve syndrome nor of 
 
            a radial nerve injury, ulnar nerve injury or median nerve 
 
            injury.  She was given a TENS unit which provided some 
 
            relief, and in October of 1990, underwent an evaluation for 
 
            a permanent impairment rating.  The report contains several 
 
            references to claimant's symptoms of shoulder pain and 
 
            restricted range of motion in the right arm.
 
            
 
                 She underwent tests to measure her grip which showed 
 
            that claimant's right arm was weaker than her left arm.  
 
            John Grant, M.D., indicated that based on his examination, 
 
            was of the opinion that claimant had a 12 percent impairment 
 
            due to the shoulder problems; an 8 percent impairment due to 
 
            elbow problems; and, a 5 percent impairment based on limited 
 
            strength.  He used the combined value charts, and issued a 
 
            permanent partial disability limited to the right upper 
 
            extremity of 23 percent (Jt. Ex. 1, pp. 55-63).  His 
 
            previous notes had recognized that if the shoulder was 
 
            involved, claimant's impairment would be to the body as a 
 
            whole (Jt. Ex. 1, p. 56).
 
            
 
                         ANALYSIS AND CONCLUSIONS OF LAW
 
            
 
                 The first issue to be addressed is the nature and 
 
            extent of claimant's disability.
 
            
 
                 If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
            
 
                 Claimant argues that she has sustained a body as a 
 
            whole injury in that she continues to have persistent 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            shoulder problems as well as problems in the forearm and 
 
            wrist.
 
            
 
                 Defendants argue that claimant's disability is limited 
 
            only to the upper extremity, and that she has sustained a 
 
            scheduled member injury and impairment.
 
            
 
                 If claimant has sustained an injury to the shoulder, 
 
            then an evaluation of her industrial disability is 
 
            warranted.  If, however, claimant has sustained an injury 
 
            only to the upper extremity, she is entitled to benefits 
 
            under the scheduled member portion of Iowa Code section 85.
 
            
 
                 The right of an employee to receive compensation for 
 
            injuries sustained is statutory. The statute conferring this 
 
            right can also fix the amount of compensation payable for 
 
            different specific injuries.  The employee is not entitled 
 
            to compensation except as the statute provides.  Soukup v. 
 
            Shores Co., 222 Iowa 272, 268 N.W. 598 (1936).
 
            
 
                 Compensation for permanent partial disability begins at 
 
            termination of the healing period.  Section 85.34(2).  
 
            Permanent partial disabilities are classified as either 
 
            scheduled or unscheduled.  A specific scheduled disability 
 
            is evaluated by the functional method; the industrial method 
 
            is used to evaluate an unscheduled disability. Simbro v. 
 
            Delong's Sportswear, 332 N.W.2d 886 (Iowa 1983); Graves v. 
 
            Eagle Iron Works, 331 N.W.2d 116 (Iowa 1983); Martin v. 
 
            Skelly Oil Co., 252 Iowa 128, 106 N.W.2d 95 (1960).
 
            
 
                 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, 222 Iowa 
 
            272, 268 N.W. 598.
 
            
 
                 Almost all of the medical examinations and tests 
 
            performed have concentrated on claimant's fingers, wrists, 
 
            forearm and elbow.  Other than the recent injections from 
 
            Dr. Jacobs, claimant has never received any treatment to the 
 
            right shoulder.  The two impairment ratings have been 
 
            confined to the right upper extremity.  The record implies 
 
            that claimant may have tendinitis in her shoulder, but this 
 
            condition has not been shown to be causally related to the 
 
            cumulative injury sustained by claimant or that her 
 
            condition is permanent.  Although she does complain of pain 
 
            in the shoulder area, all of the impairment ratings have 
 
            been based on disability to the upper extremity, not the 
 
            shoulder or body as a whole.  Claimant stated that she 
 
            continues to have pain in the shoulder, it has been noted by 
 
            the agency that pain which is not substantiated by clinical 
 
            findings is not a substitute for impairment.  See, Waller v. 
 
            Chamberlain Mfg. Co., II Iowa Ind. Comm'r Rep. 419, 425 
 
            (1981).  The record does not indicate any substantial, 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            significant clinical findings which correlate with the 
 
            objective pain expressed by claimant.  In fact, most of the 
 
            medical records indicate that there is no pathology for 
 
            claimant's complaints of shoulder pain.
 
            
 
                 As a result, it is found that claimant's disability is 
 
            limited to the right upper extremity and is a scheduled 
 
            member injury.
 
            
 
                 The next issue then is to become the extent of her 
 
            disability.  Two doctors have rendered opinions regarding 
 
            the impairment.  Dr. Neff and Mr. Bower collectively gave 
 
            claimant a 9 percent permanent partial impairment to the 
 
            upper extremity.  Dr. Grant was of the opinion that claimant 
 
            had sustained a 23 percent impairment to the right upper 
 
            extremity.
 
            
 
                 Both physicians are highly qualified, and base their 
 
            ratings on objective findings.  There is evidence in the 
 
            record of animosity between Dr. Neff and the claimant, and 
 
            as a result, Dr. Neff's disbeliefs of claimant's complaints 
 
            and his skepticism of her efforts are suspicious.  Although 
 
            Dr. Neff was one of claimant's treating physicians, his 
 
            opinion is not automatically afforded more weight than that 
 
            opinion from Dr. Grant.  Dr. Grant followed claimant's 
 
            condition for approximately one year.  It seems from the 
 
            record that he provided more clinical help than Dr. Neff.  
 
            As a result, Dr. Grant's opinion is considered to be more 
 
            applicable to claimant's disability.
 
            
 
                 Therefore, claimant has sustained a 23 percent 
 
            permanent partial disability to her right arm.  She is 
 
            entitled to 57.5 weeks of permanent partial disability 
 
            benefits (250 weeks times 23 percent equals 57.5).
 
            
 
                 The next issue to be addressed is whether claimant is 
 
            entitled to medical benefits as governed by Iowa Code 
 
            section 85.27.
 
            
 
     
 
            
 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            Iowa Code section 85.27 provides, in relevant part:
 
            
 
                    The employer, for all injuries compensable 
 
                 under this chapter or chapter 85A, shall furnish 
 
                 reasonable surgical, medical, dental, osteopathic, 
 
                 chiropractic, podiatric, physical rehabilitation, 
 
                 nursing, ambulance and hospital services and 
 
                 supplies therefor and shall allow reasonably 
 
                 necessary transportation expense incurred for such 
 
                 services....
 
            
 
                    For purposes of this section the employer is 
 
                 obliged to furnish reasonable services and 
 
                 supplies to treat an injured employee, and has the 
 
                 right to choose the care.
 
            
 
                 Generally, the employer has the right to control the 
 
            medical treatment, unless the employer denies liability for 
 
            the injury.  The agency has consistently held that where the 
 
            employer, or defendants, authorize medical treatment, and 
 
            later deny liability in their answer, claimant will be 
 
            responsible for unauthorized treatment rendered before the 
 
            answer has been filed, and an injury requiring medical 
 
            treatment is found to have arisen out of and in the course 
 
            of employment.  See Mason v. Thermo-Gas, Appeal decision 
 
            filed July 28, 1989.
 
            
 
                 As a result of the foregoing, any medical treatment 
 
            rendered by unauthorized physicians before defendants denied 
 
            liability is to be paid by claimant.  From the record, it 
 
            appears that treatment from Dr. Jacobs, Dr. McGuire and Dr. 
 
            Grant was unauthorized.
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay claimant permanent partial 
 
            disability benefits for fifty-seven point five (57.5) weeks 
 
            at the rate of two hundred forty-nine and 02/100 dollars 
 
            ($249.02) commencing on June 1, 1989.
 
            
 
                 That defendants shall pay accrued amounts in a lump sum 
 
            and shall receive credit against the award for weekly 
 
            benefits previously paid.
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            
 
                 That defendants shall pay the costs of this action, 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 That defendants shall pay for medical services rendered 
 
            after April 3, 1991.
 
            
 
                 That defendants shall file an activity report upon 
 
            payment of this award as required by this agency, pursuant 
 
            to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of September, 1992.
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            
 
            
 
            
 
            
 
                                          
 
                                      ________________________________
 
                                          PATRICIA J. LANTZ
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr David D Drake
 
            Attorney at Law
 
            1200 35th St  Ste 500
 
            West Des Moines IA 50265
 
            
 
            Mr George H Capps
 
            Attorney at Law
 
            P O Box 971
 
            Des Moines IA 50304
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                            5-1800
 
                                            Filed September 15, 1992
 
                                            Patricia J. Lantz
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                                          :
 
            IRENE HUSS,                   :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 890904
 
            TLS COMPANY,                  :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            THE HARTFORD,                 :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            5-1800
 
            Claimant failed to prove that her wrist/forearm problems 
 
            caused disability to the shoulder.
 
            Claimant awarded compensation based on disability to the 
 
            arm.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            CHARLENE HILDA SCHEITLER,     :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  890947
 
            TIMMYS RESTAURANT & CATERING, :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            UNITED FIRE AND CASUALTY,     :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Charlene 
 
            Hilda Scheitler as a result of injuries to her back which 
 
            occurred on March 12, 1988.  Defendants denied 
 
            compensability for the injury and paid no benefits.
 
            
 
                 The case was heard and fully submitted at Sioux City, 
 
            Iowa, on June 21, 1991.  The record in the proceeding 
 
            consists of joint exhibits A through G; claimant's exhibits 
 
            H, I and K through R; and testimony from Karen Drum and Jean 
 
            Herren.
 
            
 
                                      issues
 
            
 
                 The issues presented for determination are as follows:
 
            
 
                 1.  Arising out of and in the course of employment;
 
            
 
                 2.  Temporary total disability or healing period and 
 
            causation;
 
            
 
                 3.  Permanent partial disability and causation;
 
            
 
                 4.  Commencement date for permanent partial disability;
 
            
 
                 5.  Rate of weekly compensation; and 
 
            
 
                 6.  Entitlement to Iowa Code section 85.27 benefits.
 
            
 
                                        
 
            
 
                                        
 
            
 
                                 findings of fact
 
            
 
                 Having considered all the evidence received the 
 
            following findings of fact are made:
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
                 Claimant, Charlene Hilda Scheitler, now age 60, is a 
 
            resident of Le Mars, Iowa.  Claimant started to work for 
 
            employer on May 23, 1987, as a catering server or catering 
 
            crew person.  Her duties were to load and unload a catering 
 
            van with food and equipment.  She would assist in setting up 
 
            a buffet line, set tables, prepare beverages, serve guests, 
 
            clear tables and wash dishes.  Claimant's hours were 
 
            irregular and she generally worked on an as needed basis.
 
            
 
                 Claimant testified that prior to March 12, 1988, she 
 
            often experienced low back pain after a day of work for 
 
            employer.
 
            
 
                 On March 12, 1988, claimant had been called to work to 
 
            assist with catering a meal.  After the vehicle had been 
 
            unloaded, a break in work took place just before serving was 
 
            to begin.  Claimant was not experiencing any low back 
 
            discomfort at that point in time.  While standing and not 
 
            holding or carrying anything, claimant unexpectedly sneezed.  
 
            The sneeze was not precipitated by anything in the work 
 
            environment and happened spontaneously.  At the time of the 
 
            sneeze, claimant incurred a sudden and severe onset of pain 
 
            in the low back with radiation into her legs.  Claimant has 
 
            not worked since that time.
 
            
 
                 The first issue to be decided concerns whether claimant 
 
            sustained an injury on March 12, 1988, arising out of and in 
 
            the course of employment.
 
            
 
                 Claimant has clearly established that she was "in the 
 
            course of employment" when the injury occurred in that she 
 
            was performing work for employer during normal work hours.
 
            
 
                 The next issue is whether the injury "arose out of" the 
 
            employment situation.  In other words, there must be a 
 
            connection between the injury and something peculiar to the 
 
            employment situation.  Claimant has the burden of proving 
 
            this element by a preponderance of the evidence.
 
            
 
                 Claimant contends that the low back injury is 
 
            cumulative in nature and the sneeze simply brought it to its 
 
            zenith.  This theory is rejected from a factual standpoint.  
 
            The evidence is uncontradicted that claimant had not sought 
 
            medical care for her low back pain caused by work prior to 
 
            the March 12, 1988, injury.  It is also found that 
 
            claimant's prior low back complaints resolved with rest.  
 
            Furthermore, claimant did not previously experience severe 
 
            low back pain and pain into the legs.  Based upon the 
 
            temporal relationship of the new and distinct symptoms which 
 
            occurred on March 12, 1988, it is found that the injury of 
 
            March 12, 1988, had no relationship to the prior episodes of 
 
            low back pain.  It is also found that the sole proximate 
 
            cause of the March 12, 1988, low back pain is the unexpected 
 
            sneeze.  
 
            
 
                 Having found the sneeze to be the cause of the injury, 
 
            the next question is whether the injury is the result of a 
 
            hazard connected with the employment.
 
            
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
                 No evidence was presented which established that the 
 
            sneeze was caused by the employment situation.  Nor did 
 
            claimant establish that a sneeze is made more dangerous by 
 
            the employment situation than when not at work.
 
            
 
                 It is found that claimant has failed to establish by a 
 
            preponderance of the evidence that her low back injury of 
 
            March 12, 1988, resulted from a rational consequence of a 
 
            hazard connected with her employment situation in that a 
 
            sneeze is equally dangerous at home as it is at work.  See 
 
            Klodt v. Hillside Manor Care Center, file number 855422 
 
            Appeal Decision (1989), where benefits were denied when 
 
            claimant swallowed a chicken bone because eating chicken is 
 
            equally hazardous whether performed at work or elsewhere.
 
            
 
                 This issue is dispositive of the entire case and 
 
            further analysis is unnecessary.
 
            
 
                                conclusions of law
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that she received an injury on March 12, 
 
            1988, which arose out of and in the course of her 
 
            employment.  McDowell v. Town of Clarksville, 241 N.W.2d 904 
 
            (Iowa 1976); Musselman v. Central Telephone Co., 261 Iowa 
 
            352, 154 N.W.2d 128 (1967). 
 
            
 
                 The injury must both arise out of and be in the course 
 
            of the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 
 
            Iowa 402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 
 
            of the Iowa Report.  See also Sister Mary Benedict v. St. 
 
            Mary's Corp., 255 Iowa 847, 124 N.W.2d 548 (l963) and Hansen 
 
            v. State of Iowa, 249 Iowa 1147, 91 N.W.2d 555 (1958).
 
            
 
                 The words "out of" refer to the cause or source of the 
 
            injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63. 
 
            
 
                 The words "in the course of" refer to the time and 
 
            place and circumstances of the injury.  McClure v. Union 
 
            et al. Counties, 188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 
 
            402, 68 N.W.2d 63.
 
            
 
                 Claimant has failed to prove by a preponderance of the 
 
            evidence that she sustained a low back injury on March 12, 
 
            1988, that arose out of her employment with employer.
 
            
 
                                        
 
            
 
                                        
 
            
 
                                      order
 
            
 
                 IT IS THEREFORE, ORDERED:
 
            
 
                 That claimant's petition is dismissed.
 
            
 
                 That claimant take nothing from this proceeding.
 
            
 
                 That the parties pay their own respective costs 
 
            pursuant to rule 343 IAC 4.33.
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            
 
                 Signed and filed this ____ day of July, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          MARLON D. MORMANN
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Roger Carter
 
            Attorney at Law
 
            303 Terra Centre
 
            PO Box 912
 
            Sioux City, Iowa  51102
 
            
 
            Mr. Thomas M. Plaza
 
            Attorney at Law
 
            701 Pierce St. STE 200
 
            PO Box 3086
 
            Sioux City, Iowa  51102
 
            
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                      1101
 
                      Filed July 2, 1991
 
                      Marlon D. Mormann
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            CHARLENE HILDA SCHEITLER,     :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No.  890947
 
            TIMMYS RESTAURANT & CATERING, :
 
                      :  A R B I T R A T I O N
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            UNITED FIRE AND CASUALTY,     :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            1101
 
            Claimant, while at work experienced an unexpected sneeze 
 
            which caused a severe low back injury.  The sneeze was not 
 
            caused by anything peculiar to the employment situation.  
 
            Benefits denied as a sneeze is as dangerous at work as it is 
 
            as home.  Citing to the chicken bone case where it is held 
 
            that eating chicken is equally dangerous at work as 
 
            elsewhere.  Klodt v. Hillside Manor Care Center, file number 
 
            855422 Appeal Decision (1989).