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            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            CURTIS NEWSOME,     :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 894197
 
            JERRY J. KOBS, INC. AND PRO,  :
 
            DRIVERS, INC., :
 
                      :     A R B I T R A T I O N
 
                 Employer, :
 
                      :       D E C I S I O N
 
            and       :
 
                      :
 
            AETNA CASUALTY & SURETY  :
 
            COMPANY,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            statement of the case
 
            This is a proceeding in arbitration brought by Curtis 
 
            Newsome, claimant, against Jerry J. Kobs, Inc. and Pro 
 
            Drivers, Inc., employer, and Aetna Casualty & Surety 
 
            Company, insurance carrier, to recover benefits under the 
 
            Iowa Workers' Compensation Act as a result of an injury 
 
            sustained on February 12, 1988.  This matter came on for 
 
            hearing before the undersigned deputy industrial 
 
            commissioner in Sioux City, Iowa, on July 24, 1991.  The 
 
            record was considered fully submitted at the close of the 
 
            hearing although the parties were given leave to submit 
 
            briefs.  The record in this case consists of joint exhibits 
 
            1-42 and claimant's exhibit A; claimant's testimony; 
 
            testimony from claimant's wife, Patti Newsome; and testimony 
 
            from Keith Pease.
 
            issues
 
            Pursuant to the prehearing report and order dated July 24, 
 
            1991, the parties have submitted the following issues for 
 
            resolution:
 
            1.  Whether claimant sustained an injury on February 12, 
 
            1988 which arose out of and in the course of employment with 
 
            employer;
 
            2.  Whether the alleged injury is the cause of temporary and 
 
            permanent disability;
 
            3.  The extent of entitlement to weekly compensation for 
 
            temporary and permanent disability, if any;
 
            4.  The commencement date for permanent partial disability, 
 
            in the event such benefits are awarded; and
 
            5.  Whether claimant's medical expenses are causally 
 
            connected to the work injury and whether such expenses have 
 

 
            
 
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            been authorized by defendants.
 
            Defendants additionally raise the issue of jurisdiction 
 
            under Iowa Code section 85.71.
 
            findings of fact
 
            The undersigned has carefully considered all the testimony 
 
            given at the hearing, the arguments made, and the evidence 
 
            contained in the exhibits herein, and makes the following 
 
            findings:
 
            Claimant, an over-the-road truck driver, while in the 
 
            employment of carrier, Jerry J. Kobs, Inc., Sergeant Bluff, 
 
            Iowa, overturned his truck in Woodbine, Illinois, on 
 
            February 12, 1988 (Exhibit 40).  Claimant was able to 
 
            extricate himself from the truck and was transported via 
 
            police car to Freeport Memorial Hospital.  X-rays of the 
 
            cervical spine showed no fracture or dislocation.  X-rays of 
 
            the thoracic spine showed arthritic changes throughout the 
 
            lumbar intervertebral joint.  X-rays of the lumbar spine 
 
            showed no evidence of any recent injury.  Arthritic changes 
 
            were noted throughout the lumbar intervertebral joints and 
 
            the L5-S1 facet joints.  No destructive bone lesions, 
 
            spondylolysis or spondylolisthesis was present.  Claimant 
 
            was released with instructions to use Tylenol for pain.  He 
 
            was not advised to remain off work (Exs. 1 and 2).
 
            On July 21, 1988, claimant presented to the emergency room 
 
            at Wishard Memorial Hospital with complaints of paresthesia 
 
            in his left lower extremity and loss of dorsiflexion in his 
 
            left foot.  He was noted to have elevated blood sugar.  He 
 
            was scheduled for neurological evaluation and x-rays.  Left 
 
            hip x-rays showed severe degenerative and destructive 
 
            changes from a former fracture which was surgically 
 
            repaired.  Left foot drop was thought to be related to 
 
            diabetes myelitis.  He was prescribed a cane and left foot 
 
            drop brace.  He was referred to physical therapy for 
 
            exercise training (Exs. 5-10).
 
            On October 19, 1988, claimant underwent a social security 
 
            disability examination by Henry E. Montoya, M.D.  His 
 
            complaints were referable to constant pain in his lower back 
 
            associated with numbness in his left leg and a burning 
 
            sensation in his leg and left foot.  He related difficulty 
 
            in standing and walking due to pain and a drop foot.  Dr. 
 
            Montoya observed as follows:
 
               He appears to be quite concerned and worried because he 
 
            has had many troubles in his lifetime with his left lower 
 
            extremity and now the question is that he might have some 
 
            arthritis perhaps in his left hip because of previous 
 
            problems and me may not recover from the nerve damage which 
 
            is now affecting the left leg and the left foot.
 
            
 
            (Ex. 11)
 
            EMG studies were performed on October 25, 1988, and were 
 
            consistent with L5-L1 radiculopathy (Exs. 12-14).  
 
            Lumbosacral spine films taken on March 14, 1989 revealed 
 
            mild sclerosis of the articular processes of L5, S1 (Ex. 
 
            15).  A lumbar myelogram taken on March 28, 1989 was 
 

 
            
 
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            consistent with spinal stenosis most severe at L3-4 and L4-5 
 
            without definite disc herniation (Ex. 19).  A CT scan of the 
 
            lumbosacral spine was then taken.  Results indicated (1) 
 
            congenital spinal stenosis with super-imposed acquired 
 
            degenerative disease of the facets and end plates along with 
 
            ligamentum flavum hypertrophy causing severe spinal stenosis 
 
            from L1 through L5; and (2) no focal herniated nucleus 
 
            pulposis (Ex. 18).
 
            Claimant received no further treatment referable to his 
 
            orthopedic problems until April 1, 1991, when he was 
 
            evaluated by Michael D. Kornblatt at the request of Aetna 
 
            Insurance Company.  He was noted to ambulate with a cane in 
 
            his right hand and unable to put any weight on his left 
 
            lower extremity when walking.  This extremity was observed 
 
            to be externally rotated.  On examination, he had limited 
 
            range of motion of the lumbosacral spine in all directions 
 
            and some tenderness with palpitation of the left posterior 
 
            superior iliac spine.  Flexion, extension, lateral bending 
 
            and rotation was limited.  Straight leg raising was positive 
 
            on the left at 45 degrees.  Atrophy was noted in the left 
 
            thigh and calf.  His left lower extremity was short by 
 
            approximately one-half inch.  He had limited external and 
 
            internal rotation and abduction of the left hip.  X-rays of 
 
            the lumbosacral spine revealed slight narrowing of the L5-
 
            S1, L4-5 and L3-4 disc spaces.  Facet hypertrophy was noted 
 
            at L3-4, L4-5, and L5-S1.  X-rays of the left hip revealed 
 
            severe degenerative arthritic changes involving the femoral 
 
            head and the acetabulum (Ex. 28).
 
            Dr. Kornblatt recommended an MRI scan of the lumbar spine.  
 
            This was performed on April 8, 1981, and revealed 
 
            congenitally narrow spinal canal accentuated by disk bulging 
 
            at L1-2, L2-3, L3-4 and L4-5.  Spinal stenosis was maximum 
 
            at L3-4 and left sided herniations were noted at L2-3 and 
 
            L4-5.  Significant facet degeneration was seen at L5-S1 
 
            bilaterally (Ex. 29).
 
            Dr. Kornblatt recommended further testing including a CT 
 
            scan of the lumbar spine from L3 through S1.  This was 
 
            performed on April 18, 1991 and revealed significant central 
 
            and left L4-5 herniated disc with central left L5-S1 
 
            herniated disc.  Facet arthritis was also noted at L4-5 and 
 
            L5-S1 and L3-4 (Exs. 31 and 32).
 
            Dr. Kornblatt's report dated April 22, 1991, indicates that 
 
            he planned on performing a lumbar decompression on May 15, 
 
            1991.  There is no medical evidence in the record regarding 
 
            this surgical procedure.  However, claimant testified that 
 
            he underwent back surgery on June 13, 1991 by Dr. Kornblatt.  
 
            Claimant testified that presently he experiences involuntary 
 
            motor nerve movement in his left leg and restricted range of 
 
            motion as a result of his back surgery.  He testified that 
 
            he cannot tie his shoe laces or lift more than 25 pounds.  
 
            He can only stand 15 minutes and sit for two hours.
 
            Claimant's source of income is social security disability 
 
            benefits which he was awarded on October 27, 1988.  
 
            Disability was found due to arthritis in the left hip 
 

 
            
 
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            commencing April 21, 1988 (Exs. 38-39).
 
            conclusions of law
 
            The first issue to be resolved is whether this agency has 
 
            jurisdiction over claimant's Iowa workers' compensation 
 
            claim.
 
            Claimant alleges that he is entitled to Iowa workers' 
 
            compensation benefits because his employment was principally 
 
            localized in this state, his employer has a place of 
 
            business in this state and he was working under a contract 
 
            of hire made in this state.
 
            Because the claimant was injured outside the territorial 
 
            limits of Iowa, determination of whether there is 
 
            jurisdiction under the Iowa workers' compensation law 
 
            depends on a review of the facts under Iowa Code section 
 
            85.71.
 
            
 
                 Section 85.71 provides:
 
            
 
                   If an employee, while working outside the 
 
                 territorial limits of this state, suffers an 
 
                 injury on account of which the employee, or in the 
 
                 event of death, the employee's dependents, would 
 
                 have been entitled to the benefits provided by 
 
                 this chapter had such injury occurred within this 
 
                 state, such employee, or in the event of death 
 
                 resulting from such injury, the employee's 
 
                 dependents, shall be entitled to the benefits 
 
                 provided by this chapter, provided that at the 
 
                 time of such injury:
 
            
 
                   1.  The employment is principally localized in 
 
                 this state, that is, the employee's employer has a 
 
                 place of business in this or some other state and 
 
                 the employee regularly works in this state, or if 
 
                 the employee is domiciled in this state, or
 
            
 
            
 
                   2.  The employee is working under a contract of 
 
                 hire made in this state in employment not 
 
                 principally localized in any state, or
 
            
 
            
 
                   3.  The employee is working under a contract of 
 
                 hire made in this state in employment principally 
 
                 localized in another state, whose workers' 
 
                 compensation law is not applicable to the 
 
                 employee's employer, or
 
            
 
            
 
                   4.  The employee is working under a contract of 
 
                 hire made in this state for employment outside the 
 
                 United States.
 
            
 
                 In interpreting section 85.71(1), the Iowa Supreme 
 
            Court in Iowa Beef Processors, Inc. v. Miller, 312 N.W.2d 
 
            530, 534, (Iowa 1981), stated domicile alone is not 
 
            sufficient to entitle an employee, injured outside Iowa, to 
 
            benefits under our Act, but rather, some meaningful 
 
            relationship between domicile and the employer-employee 
 
            relationship must exist.  The court then held that the 
 

 
            
 
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            employer's placement of a help wanted ad, to which claimant 
 
            responded, in an Iowa newspaper was not material to 
 
            claimant's employment and was, therefore, insufficient to 
 
            supply the necessary connection.  The court did not address 
 
            the issue of how sufficient the connection between domicile 
 
            and the employment relationship must be to entitle an 
 
            employee injured in another state to benefits under our Act.
 
            
 
                 The Iowa Supreme Court next addressed the 
 
            interpretation of section 85.71 in George H. Wentz, Inc. v. 
 
            Sabasta, 337 N.W.2d 495 (Iowa 1983).  In Wentz, the court 
 
            expressly overruled Haverly v. Union Construction Co., 18 
 
            N.W.2d 629 (Iowa 1945).  That case held that making an 
 
            employment contract in Iowa would support an award of 
 
            benefits under our Act.  The Wentz court at 499 said:  "We 
 
            think Iowa law on extraterritorial application of our 
 
            workers' compensation act has changed since the Haverly 
 
            decision, and the rule of that case is no longer is valid."
 
            
 
                 The court then said at page 500:
 
            
 
                   The place of contract or hiring becomes 
 
                 significant only when the employment is not 
 
                 principally localized in any state, the law of the 
 
                 state where the employment is principally 
 
                 localized is not applicable to the employer, or 
 
                 the employment is outside the United 
 
                 States....Permitting recovery of Iowa benefits 
 
                 based solely on a showing the contract of hire was 
 
                 made in Iowa, following Haverly, would render 
 
                 nugatory the additional requirements of 
 
                 subsections 85.71(2), (3) and (4) of the act.
 
            
 
     
 
            
 
            
 
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            In Iowa Beef Processors and Wentz, the court referred to the 
 
            Counsel of State Governments Model Act definition of 
 
            principally localized employment which reads as follows:
 
            
 
                 A person's employment is principally localized in 
 
                 this or another state when (1) his employer has a 
 
                 place of business in this or such other state and 
 
                 he regularly works at or from such place of 
 
                 business, or (2) if clause (1) foregoing is not 
 
                 applicable, he is domiciled and spends a 
 
                 substantial part of his working time in the 
 
                 service of his employer in this or such other 
 
                 state;...
 
            Claimant testified that he is not a resident of the state of 
 
            Iowa and has never been domiciled in the state.  There is, 
 
            however, contradictory and conflicting evidence as to 
 
            whether claimant's employer has a place of business in the 
 
            state of Iowa.  In this regard, claimant testified that in 
 
            November 1987 he answered an advertisement posted on a 
 
            billboard at Sapp Brothers in Omaha, Nebraska, for Jerry J. 
 
            Kobs, Refrigerated Service, Sergeant Bluff, Iowa.  He placed 
 
            a phone call from an 800 number listed in the ad and spoke 
 
            with a gentleman by the name of Keith who was the safety 
 
            director.  As far as he knew, Keith was located in Sergeant 
 
            Bluff, Iowa.  After discussing the particulars of the job, a 
 
            reference check was done and claimant was recontacted that 
 
            evening.  He was asked to come to Sergeant Bluff the next 
 
            day and when he arrived he contacted Mr. Jerry Kobs who told 
 
            him to check into a room at the truck stop.  The next 
 
            morning, claimant was contacted by Mr. Kobs and told to get 
 
            breakfast for himself and his wife and to charge it to his 
 
            account and then go back to the motel and wait for someone 
 
            to come and pick him up.  One of Mr. Kobs' employees met him 
 
            at the hotel in a pickup and took him to Mr. Kobs' office 
 
            where he met Mr. Kobs and Keith.  He testified that at that 
 
            time, he filled out employment application forms, drivers' 
 
            qualification cards and was then administered the Department 
 
            of Transportation safety test.  That same afternoon, he made 
 
            his first run for Mr. Kobs.  He took a tractor and an empty 
 
            trailer from Sergeant Bluff, Iowa to John Morrell Meat 
 
            Packing Plant in Sioux Falls, South Dakota.  Claimant 
 
            testified that he was always dispatched from the Sergeant 
 
            Bluff, Iowa office and made many deliveries in the state of 
 
            Iowa.  As to Jerry Kobs' relationship with Pro Drivers, 
 
            claimant testified in a deposition on August 23, 1990, as 
 
            follows:
 
            Q.  Did you ever hear anything about Pro Drivers?
 
            A.  Yes.
 
            Q.  What did you hear about Pro Drivers?  What do you know 
 
            about those people?
 
            A.  The safety director at Mr. Kobs's company, I only know 
 
            him by his first name, Keith, informed me that Pro Drivers 
 
            did not exist and it was nothing more than a mailing address 
 
            in the State of Indiana so that Jerry could hide money and 
 
            that I was never to refer to Pro Drivers and never to 
 

 
            
 
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            attempt to go to that address in Indiana because it was a 
 
            waste of time.
 
               He told me, he said, Every contact you make will be right 
 
            here at Jerry's trailer.  Every paycheck you get will have 
 
            Jerry's name on it, but because of the fact that we can't 
 
            list you as a Kobs's driver for whatever reasons that him 
 
            and Mr. Kobs had worked out, he said, you have to run under 
 
            the name of Pro Drivers.  I told him that I didn't 
 
            understand and he told me I didn't need to understand.
 
            Q.  so you never received any paychecks from Pro Drivers or 
 
            anything of that sort?
 
            A.  No, Ma'am.
 
            
 
            (Ex. 37, pp. 43-44)
 
            Mr. Keith Pease also testified at the hearing.  He stated 
 
            that in 1987 he was employed by Jerry Kobs as safety 
 
            director and by Pro Drivers, Inc., as field representative 
 
            stationed in Sergeant Bluff, Iowa.  He stated that Pro 
 
            Drivers, Inc., is an Indiana corporation whose place of 
 
            business is in Angola, Indiana.  He stated that Pro Drivers, 
 
            Inc., was set up to do the hiring and recruiting of drivers 
 
            for Jerry Kobs.  He indicated that Mr. Kobs is president of 
 
            Pro Drivers and Pro Drivers employs all of Mr. Kobs' truck 
 
            drivers.  He admitted that all payroll checks are mailed 
 
            from Sergeant Bluff, Iowa.  He stated that Mr. Kobs leases 
 
            its drivers from Pro Drivers, Inc. and Pro Drivers employs 
 
            all of the truck drivers.
 
            Obviously, claimant was not aware of the complicated 
 
            relationship between Jerry Kobs and Pro Drivers but since 
 
            most of his dealings were with Mr. Kobs in Sergeant Bluff, 
 
            Iowa, he assumed he was employed by Mr. Kobs.
 
            In any event, the primary focus under Iowa Code section 
 
            85.71 is on the jurisdiction where the employee's employment 
 
            is "principally localized." George H. Wentz, Inc. v. 
 
            Sabasta, 337 N.W.2d 495, 500 (Iowa 1983).  Under Iowa Beef 
 
            Processors, Inc. v. Miller, 312 N.W.2d 530, 533, (Iowa 
 
            1981), a person's employment is principally located in this 
 
            or another state when his employer has a place of business 
 
            in this or such other state and he regularly works at or 
 
            from such place of business.
 
            Claimant's testimony, corroborated by his wife, indicates 
 
            that his employment with defendants was principally 
 
            localized in the state of Iowa in that he spent most of his 
 
            time there while on the job.  Claimant resided in Iowa at 
 
            the time of the accident.  He received all of his 
 
            assignments and paychecks from Sergeant Bluff, Iowa.  Thus, 
 
            85.71(1) is clearly applicable to claimant.  His employment 
 
            is principally localized in the state of Iowa and his 
 
            employer has actively engaged in doing business in Iowa with 
 
            its dispatch office located in Sergeant Bluff, Iowa.  
 
            Therefore, this agency has jurisdiction over claimant's 
 
            claim.
 
            The next issue to be decided is whether claimant sustained 
 
            an injury on February 12, 1988, which arose out of and in 
 

 
            
 
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            the course of employment with employer and, if so, whether 
 
            such injury is a cause of temporary or permanent disability.
 
            Claimant has the burden of proving by a preponderance of the 
 
            evidence that he received an injury on February 12, 1988, 
 
            which arose out of and in the course of his employment. 
 
            McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 
 
            1976); Musselman v. Central Telephone Co., 261 Iowa 352, 154 
 
            N.W.2d 128 (1967). 
 
            In the course of employment means that the claimant must 
 
            prove his injury occurred at a place where he reasonably may 
 
            be performing his duties.  McClure v. Union et al. Counties, 
 
            188 N.W.2d 283 (Iowa 1971).
 
            Arising out of suggests a causal relationship between the 
 
            employment ant the injury.  Crowe v. DeSoto Consol. Sch. 
 
            Dist., 246 Iowa 402, 68 N.W.2d 63 (1955).
 
            A determination that an injury "arises out of" the 
 
            employment contemplates a causal connection between the 
 
            conditions under which the work was performed and the 
 
            resulting injuries; i.e., the injury followed as a natural 
 
            incident of the work.  Musselman, 261 Iowa 352, 154 N.W.2d 
 
            128; Reddick v. Grand Union Tea Co., 230 Iowa 108, 296 N.W. 
 
            800 (1941).
 
            An injury incurs in the course of employment when it is 
 
            within the period of employment at a place where the 
 
            employee reasonably may be performing his duties, and while 
 
            he is fulfilling those duties or engaged in doing something 
 
            incidental thereto.  McClure, Supra, at 283.
 
            The record clearly demonstrates that claimant was in the 
 
            course of employment and performing his employment duties 
 
            when he was involved in a single truck accident.  Claimant 
 
            testified and the accident report corroborates that on 
 
            February 12, 1988, he was eastbound on U.S. 20 hauling a 
 
            mixed load of boxed and carcass lambs when his truck 
 
            overturned on a curve and he suffered some minor injuries.  
 
            A causal connection exists between the conditions under 
 
            which claimant's work was being performed and the resulting 
 
            injury.  Thus, claimant has shown by a preponderance of the 
 
            evidence that the injury he suffered arose out of and in the 
 
            course of employment.
 
            The claimant has the burden of proving by a preponderance of 
 
            the evidence that the injury of February 12, 1988 is 
 
            causally related to the disability on which he now bases his 
 
            claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 
 
            867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 296, 18 N.W.2d 
 
            607 (1945).  A possibility is insufficient; a probability is 
 
            necessary.  Burt v. John Deere Waterloo Tractor Works, 247 
 
            Iowa 691, 73 N.W.2d 732 (1955).  The question of causal 
 
            connection is essentially within the domain of expert 
 
            testimony.  Bradshaw v. Iowa Methodist Hospital, 251 Iowa 
 
            375, 101 N.W.2d 167 (1960). 
 
            However, expert medical evidence must be considered with all 
 
            other evidence introduced bearing on the causal connection.  
 
            Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts 
 
            need not be couched in definite, positive or unequivocal 
 

 
            
 
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            language.  Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 
 
            1974).  However, the expert opinion may be accepted or 
 
            rejected, in whole or in part, by the trier of fact.  Id. at 
 
            907.  Further, the weight to be given to such an opinion is 
 
            for the finder of fact, and that may be affected by the 
 
            completeness of the premise given the expert and other 
 
            surrounding circumstances.  Bodish, 257 Iowa 516, 133 N.W.2d 
 
            867.  See also Musselman v. Central Telephone Co., 261 Iowa 
 
            352, 154 N.W.2d 128 (1967).
 
            While a claimant is not entitled to compensation for the 
 
            results of a preexisting injury or disease, the mere 
 
            existence at the time of a subsequent injury is not a 
 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
 
            preexisting condition or disability that is aggravated, 
 
            accelerated, worsened or lighted up so that it results in 
 
            disability, claimant is entitled to recover.  Nicks v. 
 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
 
            (1962).
 
            When an aggravation occurs in the performance of an 
 
            employer's work and a causal connection is established, 
 
            claimant may recover to the extent of the impairment. 
 
            Ziegler v. United States Gypsum Co., 252 Iowa 613, 620, 106 
 
            N.W.2d 591, 595 (1960).
 
            The Iowa Supreme Court cites, apparently with approval, the 
 
            C.J.S. statement that the aggravation should be material if 
 
            it is to be compensable.  Yeager v. Firestone Tire & Rubber 
 
            Co., 253 Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. 
 
            Workmen's Compensation sec. 555(17)a.
 
            An employee is not entitled to recover for the results of a 
 
            preexisting injury or disease but can recover for an 
 
            aggravation thereof which resulted in the disability found 
 
            to exist.  Olson v. Goodyear Service Stores, 255 Iowa 1112, 
 
            125 N.W.2d 251 (1963); Yeager v. Firestone Tire & Rubber 
 
            Co., 253 Iowa 369, 112 N.W.2d 299 (1961); Ziegler v. United 
 
            States Gypsum Co., 252 Iowa 613, 106 N.W.2d 591 (1960).  See 
 
            also Barz v. Oler, 257 Iowa 508, 133 N.W.2d 704 (1965); 
 
            Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 N.W. 35 
 
            (1934).
 
            In his petition for workers' compensation benefits filed on 
 
            January 19, 1989, claimant stated that he was injured on 
 
            February 12, 1988, and that such injury affected his back 
 
            and lower extremities.  In his deposition, claimant 
 
            testified that at the time of the accident he had severe 
 
            back pain, a useless left leg and a right leg that felt like 
 
            rubber (Ex. 37, pp.66-67).  At the hearing, claimant argued 
 
            that his current back and leg problems were caused by his 
 
            truck accident in February 1988.
 
            The medical evidence does not support claimant's contentions 
 
            that his current disability is causally related to his work 
 
            incident.  A February 12, 1988 emergency record indicates 
 
            that claimant was treated for superficial abrasions and 
 
            discharged.  Physical examination notes indicate he was able 
 
            to move all extremities, had good distal pulses and no 
 

 
            
 
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            extremity trauma.  X-rays of the entire spine revealed no 
 
            fractures or dislocation.  Lumbar spine x-rays showed no 
 
            evidence of any recent injury although arthritic changes 
 
            were noted throughout the intervertebral joints and at L5-S1 
 
            facet joints.  Claimant was discharged the same day without 
 
            incident (Exs. 1-2).
 
            Claimant's next visit to the hospital occurred in July when 
 
            he was seen following two days of foot pain, four or five 
 
            days of foot weakness and an inability to flex his foot 
 
            upward.  He denied trauma and specific notation was made of 
 
            "no back pain." (Ex. 5, p. 1)  However, claimant reported an 
 
            injury to his back in a motor vehicle accident five months 
 
            before which resulted in his requiring complete bed rest for 
 
            two weeks (Ex. 5, p. 2).  There is no documentary evidence 
 
            to support that assertion (Ex. 2).  Claimant specifically 
 
            denied back pain subsequent to that time (Ex. 5, p. 2).  
 
            There is no mention of nose bleeds or psychological 
 
            difficulties which were reported by claimant and his wife 
 
            for the first time to defendants' knowledge at the time of 
 
            hearing.  Claimant's spouse testified that her husband or 
 
            she told the doctors of all of his complaints.
 
            The neurologist who evaluated claimant for his foot 
 
            complaints declared the most likely etiology of his 
 
            complaints to be diabetes (Ex. 5, p. 4).  X-rays of the left 
 
            hip showed severe degenerative and destructive changes.  
 
            There was articulation of the femoral head with the 
 
            acetabulum.  There were sclerotic bones on both sides of the 
 
            hip space (Ex. 7).
 
            In October claimant was seen for evaluation for disability 
 
            determination services by Henry E. Montoya, M.D., whose 
 
            specialty is internal medicine and rheumatology (Ex. 11, p. 
 
            9).  Again, there are no complaints of nose bleed or 
 
            psychiatric problems (Ex. 11, p. 2).  Specific examination 
 
            was directed to the nose and a finding was made of no blood 
 
            or discharge (Ex. 11, pp. 4,6).  Claimant apparently told 
 
            the doctor he had nerve damage (Ex. 11, p. 1).  He denied an 
 
            awareness of arthritis, although, of course, his x-rays at 
 
            the time of injury showed arthritic changes (Ex. 11, p. 5).  
 
            Claimant has reported eating aspirin at a rate of twenty to 
 
            twenty-five per day.  There is no documentation for that 
 
            claim in that he was reportedly taking pain pills as needed.  
 
            Dr. Montoya, who is not an orthopedist, diagnosed diabetes 
 
            mellitus and obesity as well as chronic low back pain and 
 
            left foot drop secondary to a back injury (Ex. 11, p. 7).  
 
            However, the comments made by Dr. Montoya suggest and the 
 
            award made by social security lead to the conclusion that 
 
            claimant's difficulty was a preexisting hip problem rather 
 
            than his back (Ex. 11, p. 8; ex. 39; ex 38).
 
            Additional evidence of the hip problem is found in a May 29, 
 
            1989 medical report which records a diagnosis of avascular 
 
            necrosis (Ex. 17).  The purpose of this visit to the 
 
            hospital appears to be to "clear" claimant's back before 
 
            considering a total hip replacement (Ex. 6).  A myelogram 
 
            was done with a CT scan which showed congenital spinal 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            stenosis and acquired marked degenerative changes.  There 
 
            was neither a nerve root compression nor a herniation (Ex. 
 
            18).
 
            The following month claimant was treated for an upper 
 
            gastrointestinal bleed with a secondary history of alcohol 
 
            abuse.  He was hepatitis-B surface antigen positive (Ex. 21, 
 
            p. 2).  At the time of his hospitalization he had no focal 
 
            or sensory deficits (Ex. 21, p. 1).  Again, there are no 
 
            accounts of nose bleeds or psychological problem.  His 
 
            aspirin intake was reported as three to four per day (Ex. 
 
            21, p. 1).
 
            Dr. Kornblatt did not see claimant until more than three 
 
            years after his injury.  Dr. Kornblatt received a history 
 
            that was inaccurate.  Claimant reported that he was unable 
 
            to work after the injury.  Claimant described his pain as 
 
            going from his left buttocks to his thigh rather than as 
 
            originating in his back (Ex. 28, p. 1).  It may be that the 
 
            pain was accurately described in that it originated with his 
 
            initial hip injury years before.  Dr. Kornblatt reports what 
 
            claimant told him when he writes:  "Mr. Newsome was injured 
 
            at work in a roll over truck accident on February 12, 1988.  
 
            Since then he has had severe, incapacitating left radicular 
 
            leg pain and low back pain."  The doctor asked claimant to 
 
            obtain his old myelogram and studies so that these could be 
 
            evaluated (Ex. 28, p. 3).
 
            Dr. Kornblatt ordered an MRI which showed a congenitally 
 
            narrowed spinal canal with herniations at two levels (Ex. 
 
            29).  These were not present in the prior studies (Ex. 18).  
 
            Dr. Kornblatt refers to the stenosis as congenital rather 
 
            than traumatic.  He then writes that claimant is 
 
            "significant [sic] disabled due to lumbar spinal stenosis 
 
            with lumbar herniated discs and left hip degenerative 
 
            arthritis." (Ex. 32)
 
            Claimant has some significant health problems, but whatever 
 
            disability claimant has at the present time stems from his 
 
            hip.  He had a severe, traumatic injury to his hip.  That 
 
            significant injury was followed by lengthy hospitalizations 
 
            and multiple surgeries.  By contrast he had an employment 
 
            incident for which he was given Tylenol and lost no time 
 
            from work.
 
            There is no statement of medical causation supporting 
 
            claimant's claim.  Dr. Kornblatt merely records what 
 
            claimant reported regarding injury to his back.  There is no 
 
            evidence to support an aggravation of whatever preexisting 
 
            condition claimant may have.
 
            Claimant received no further medical treatment for 
 
            complications related to his February 1988 accident.  
 
            Claimant and his spouse admitted no further medical care was 
 
            requested.  Neither did claimant ask for time off.  Mr. 
 
            Keith Pease testified he was not asked to provide additional 
 
            medical care.  He specifically recalled claimant's telling 
 
            him that he was not hurt and that he was able to drive.  
 
            When claimant was no longer leased to Jerry Kobs, Inc., he 
 
            immediately went to work for another trucking company.  When 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            he quit that work, he applied for unemployment from Pro 
 
            Drivers thereby asserting he was ready, willing and able to 
 
            return to work.
 
            Claimant bears the burden of proof.  He has failed to show 
 
            by a preponderance of the evidence that the injury of 
 
            February 12, 1988 is causally related to the disability on 
 
            which he now bases his claim.
 
            This issue is dispositive of the entire case and further 
 
            analysis is unnecessary.
 
            order
 
            THEREFORE, it is ordered:
 
            That claimant take nothing from this proceeding.
 
            That the parties pay their own costs pursuant to rule 343 
 
            IAC 4.33.
 
            Signed and filed this ____ day of August, 1991.
 
            
 
            
 
                      ______________________________
 
                      JEAN M. INGRASSIA
 
                      DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies to:
 
            
 
            Ms Kay Dull
 
            Attorney at Law
 
            P O Box 3107
 
            Sioux City IA 51102
 
            
 
            Ms Judith Ann Higgs
 
            Attorney at Law
 
            701 Pierce St  Ste 200
 
            P O Box 3086
 
            Sioux City IA 51102
 
            
 
            Mr George Hirschback
 
            Attorney at Law
 
            920 W 21st St
 
            P O Box 155
 
            South Sioux City NE 68776
 
            
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      5-1108; 5-2301
 
                      Filed August 6, 1991
 
                      Jean M. Ingrassia
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            CURTIS NEWSOME,     :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 894197
 
            JERRY J. KOBS, INC. AND PRO,  :
 
            DRIVERS, INC., :
 
                      :     A R B I T R A T I O N
 
                 Employer, :
 
                      :       D E C I S I O N
 
            and       :
 
                      :
 
            AETNA CASUALTY & SURETY  :
 
            COMPANY,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            5-2301
 
            Claimant was injured outside the territorial limits of Iowa, 
 
            defendants raise jurisdiction under 85.71.  Found that 
 
            claimant's employment was principally localized in Iowa and 
 
            employer regularly works out of Iowa with a dispatch office 
 
            in Sergeant Bluff where claimant received all of his 
 
            assignments and paychecks.  Thus, jurisdiction of this 
 
            agency over claimant's claim established.  Iowa Beef 
 
            Processors, Inc. v. Miller, 312 N.W.2d 530, 533, (Iowa 
 
            1981).
 
            
 
            5-1108
 
            Claimant did not prove by a preponderance of the evidence 
 
            that his injury on February 12, 1988 is causally related to 
 
            the disability on which he now bases his claim.  Claimant 
 
            sustained minor abrasions when his truck rolled over on a 
 
            curved road.
 
            
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
         before the iowa industrial commissioner
 
         _________________________________________________________________
 
                     :
 
         DONALD F. PECK,       :
 
                     :
 
              Claimant,   :
 
                     :
 
         vs.         :
 
                     :        File No. 894350
 
         MERRILL MANUFACTURING, CO.,     :
 
                     :          A P P E A L
 
              Employer,   :
 
                     :        D E C I S I O N
 
         and         :
 
                     :
 
         AETNA CASUALTY & SURETY    :
 
         COMPANY,    :
 
                     :
 
              Insurance Carrier,    :
 
              Defendants.      :
 
         _________________________________________________________________
 
         The record, including the transcript of the hearing before the 
 
         deputy and all exhibits admitted into the record, has been 
 
         reviewed de novo on appeal.  The decision of the deputy filed 
 
         February 26, 1991 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 January, 1993.
 
         
 
         
 
         
 
         
 
                   ________________________________
 
                            BYRON K. ORTON
 
                       INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City, Iowa 51102
 
         
 
         Ms. Judith Ann Higgs
 
         Attorney at Law
 
         P.O. Box 3086
 
         Sioux City, Iowa 51102
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
            9998
 
            Filed January 26, 1993
 
            Byron K. Orton
 
            DRR
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                        :
 
            DONALD F. PECK,       :
 
                        :
 
                 Claimant,   :
 
                        :
 
            vs.         :
 
                        :        File No. 894350
 
            MERRILL MANUFACTURING, CO.,     :
 
                        :          A P P E A L
 
                 Employer,   :
 
                        :        D E C I S I O N
 
            and         :
 
                        :
 
            AETNA CASUALTY & SURETY    :
 
            COMPANY,    :
 
                        :
 
                 Insurance Carrier,    :
 
                 Defendants.      :
 
            ____________________________________________________________
 
            _____
 
            
 
            9998
 
            
 
                 Summary affirmance of deputy's decision filed February 
 
            26, 1991.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            DONALD F. PECK,               :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :         File No. 894350
 
            MERRILL MANUFACTURING CO.,    :
 
                                          :      A R B I T R A T I O N
 
                 Employer,                :
 
                                          :         D E C I S I O N
 
            and                           :
 
                                          :
 
            AETNA CASUALTY & SURETY       :
 
            COMPANY,                      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration upon claimant's 
 
            petition filed August 3, 1989.  Donald F. Peck alleges that 
 
            he suffered exposure to a powdered substance known as 
 
            fluorescein in the course of his employment with Merrill 
 
            Manufacturing Company on July 20 or July 28, 1988 and 
 
            thereafter developed extensive symptomatology.  He now seeks 
 
            benefits under the Iowa Workers' Compensation Act from that 
 
            employer and its insurance carrier, Aetna Casualty & Surety 
 
            Company.
 
            
 
                 A hearing was thereafter held in Storm Lake, Iowa, on 
 
            July 26, 1990.  The record consists of joint exhibits 1 
 
            through 39 and 42 through 55, claimant's exhibits 56 through 
 
            101, and the testimony of the following witnesses:  
 
            claimant, Sandra Rollison, David Crippin, M.D., Kim Quirin, 
 
            Steve Rice, Dawn Peck and Karen Stricklet.
 
            
 
                                      issues
 
            
 
                 Pursuant to the prehearing report submitted by the 
 
            parties, it is stipulated that an employment relationship 
 
            existed between Donald Peck and Merrill Manufacturing 
 
            Company on July 28, 1988, that the appropriate rate of 
 
            weekly compensation is $184.55, and that certain weekly 
 
            benefits were voluntarily paid prior to hearing.
 
            
 
                 Issues presented for resolution include:
 
            
 
                 1.  Whether claimant sustained an injury arising 
 
                 out of and in the course of his employment with 
 
                 Merrill Manufacturing Company on or about July 28, 
 
                 1988;
 
            
 
                 2.  Whether there exists a causal relationship 
 
                 between that injury and any resulting disability;
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
                 3.  The nature and extent of claimant's 
 
                 disability, if any;
 
            
 
                 4.  Whether claimant is entitled to medical 
 
                 benefits under Iowa Code section 85.27; and,
 
            
 
                 5.  Whether claimant is entitled to penalty 
 
                 benefits under Iowa Code section 86.13.
 
            
 
                                 findings of fact
 
            
 
                 The undersigned deputy industrial commissioner, having 
 
            heard the testimony and considered all of the evidence, 
 
            finds:
 
            
 
                 Donald Peck is an intelligent 36-year-old man.  He is 6 
 
            feet 1 inch tall and weighs 255 pounds, 10-15 pounds more 
 
            than at the time of his exposure to fluorescein.  He is a 
 
            1972 high school graduate and has worked in packinghouses, a 
 
            factory, a warehouse and in shipping and receiving for 
 
            Merrill Manufacturing Company starting July 5, 1988.
 
            
 
                 On a date originally alleged to have been July 20 and 
 
            now believed to be July 28, 1988, claimant lifted an empty 
 
            pallet and a quantity of red powder (estimated to be five 
 
            pounds) fell on him.  He was at the time wearing a 
 
            sleeveless work shirt unbuttoned to the navel, jeans, a hard 
 
            hat and goggles.  A quantity of the red powder, later 
 
            identified as fluorescein, contacted claimant's skin.  As it 
 
            was a hot day, he was perspiring and the powder turned green 
 
            on contact with perspiration.  Claimant notified the plant 
 
            superintendent and was told to wash up.  When he did, his 
 
            skin turned from green to yellow, then orange before 
 
            resuming normal coloration.
 
            
 
                 After finishing his shift, claimant returned home and 
 
            showered.  As before, his skin was green in places.  Rinse 
 
            water in the shower sequentially turned green, yellow and 
 
            orange.  These color changes are characteristic of 
 
            fluorescein.
 
            
 
                 Claimant testified that the following morning he became 
 
            sick to his stomach and vomited.  His urine was an unusual 
 
            dark color and odor.  He noticed sores on his arm and at 
 
            work, suffered a persistent nosebleed.  During the next few 
 
            days, he continued feeling nauseous and vomiting.  His urine 
 
            remained dark.  The sores (described by claimant as like a 
 
            large pus-infected pimple and by his wife as the size of a 
 
            quarter to a half dollar, red, inflamed and cratered when 
 
            broken) became larger and spread to the back, chest and 
 
            hairline.  Claimant states he developed a "strange" feeling 
 
            in his chest and suffered additional nosebleeds.
 
            
 
                 By August 10, condition of the sores was such that a 
 
            red streak was visible in the right arm.  Fearing blood 
 
            poisoning and at the advice of his wife, Dawn Peck, claimant 
 
            sought treatment at Buena Vista County Hospital and was seen 
 
            by David Crippin, M.D.  Claimant's presenting history was of 
 
            getting chemical on the right forearm at work one month 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            before, making a sore that had gradually become more red and 
 
            pussy.  Dr. Crippin's chart notes reflect:  "The patient 
 
            denies fevers, chills or other complaints."  Diagnosis was 
 
            of right arm cellulitis (soft tissue inflammation) with 
 
            lymphadengitis (relating to lymphoid tissue).
 
            
 
                 Claimant was seen for evaluation by Linda Garb, M.D., 
 
            on June 26, 1990.  A report was thereupon issued by her and 
 
            consulting physician Ilene R. Danse, M.D.  Both Dr. Garb and 
 
            Dr. Danse testified by deposition on July 11, 1990.
 
            
 
                 Claimant gave Dr. Garb the following history:
 
            
 
                 None of the powder got in his eyes because they 
 
                 were protected by the safety glasses.  He does not 
 
                 recall whether he breathed the powder or got any 
 
                 in his mouth.  He does not recall any unusual 
 
                 taste.  He noted no burning or itching sensation 
 
                 of his skin or eye irritation, nor did he develop 
 
                 hives.  He does not recall whether he had any 
 
                 cough, or nose or throat irritation.  He noted no 
 
                 shortness of breath.  He had no nausea or 
 
                 vomiting, dizziness, loss of consciousness, 
 
                 seizures, or headache.
 
            
 
                 . . . .
 
            
 
                 He felt all right that evening, although he 
 
                 noticed his urine was a dark golden yellow color 
 
                 and had a strong odor.  The unusual color and odor 
 
                 lasted for several months.  The next morning he 
 
                 went to work, although he felt nauseated and 
 
                 vomited once or twice.  He vomited 2 to 3 times a 
 
                 day for a couple of days afterward.  Then the 
 
                 vomiting became less frequent, but he continued to 
 
                 have nausea and abdominal discomfort and he 
 
                 ingested a pack of Rolaids every two days which 
 
                 provided some relief.
 
            
 
                 The day after the spill, he had his first 
 
                 nosebleed.  It lasted 15 to 20 minutes and he was 
 
                 able to stop it with pressure.  He states his 
 
                 handkerchief was covered with blood.  He continued 
 
                 to have similar nosebleeds over the next several 
 
                 months.  He only rarely had nosebleeds which 
 
                 lasted for about 5 minutes prior to this.
 
            
 
                 . . . .
 
            
 
                 Within a day or two following the exposure, he 
 
                 noted some shortness of breath which gradually 
 
                 worsened.
 
            
 
                 . . . .
 
            
 
                 Soon after the exposure he developed fatigue and 
 
                 muscle weakness, which persisted to the present.
 
            
 
                 Shortly after the incident, he also noted a 
 
                 personality change, mental confusion, and memory 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
                 loss.
 
            
 
                 . . . .
 
            
 
                 Shortly after the exposure, he developed sharp 
 
                 pains under his right shoulder blade and ribs.  He 
 
                 states these could occur at any time and were not 
 
                 related to position or activity.  It felt as if a 
 
                 knife was stuck in his shoulder blade -- this 
 
                 sharp pain came on suddenly and would cause him to 
 
                 shout out loud with pain at work, which alarmed 
 
                 his co-workers.  The intense pain lasted a moment, 
 
                 then subsided to a burning pain which lasted for 
 
                 20 or 30 minutes, then cleared.  These initially 
 
                 occurred a few times a week and by the spring of 
 
                 1990 had decreased to approximately once a week.
 
            
 
                 Shortly after the exposure, he began losing hair 
 
                 on his scalp, and lost all of the hair in both 
 
                 axillae, and much of the hair on his back.  He 
 
                 attributes this loss to the powder, although he 
 
                 told me his head had been covered by the hard hat 
 
                 and most of the powder fell on the lower half of 
 
                 his face, his chest, and arms -- areas which did 
 
                 not lose hair.  The hair on his scalp and axillae 
 
                 has returned to normal; much of the hair on his 
 
                 back has returned, but is not as profuse as before 
 
                 the incident, according to Mr. Peck.
 
            
 
                 He says despite the fact that he saw physicians on 
 
                 5 occasions over a 3-week period from August 10, 
 
                 1988 to September 3, 1988, for the skin lesions, 
 
                 which he advised the doctors were probably caused 
 
                 by the fluorescein exposure, he never mentioned 
 
                 his symptoms of nausea, vomiting, shortness of 
 
                 breath, sharp pains in his chest which made him 
 
                 call out, nose bleeds, [sic] hair loss, fatigue, 
 
                 muscle weakness, dark yellow urine, personality 
 
                 change, or mental confusion to the physicians.  He 
 
                 says he did not do so because he wanted to keep 
 
                 working and he was concerned the doctors would 
 
                 want him to take time off work.  He had no 
 
                 difficulty in performing his job and, in fact, was 
 
                 promoted during this time.
 
            
 
                 Claimant testified that he continued to suffer from 
 
            nausea and continued to produce dark and foul-colored urine.  
 
            He indicated that other symptoms gradually came on, 
 
            including memory loss, hair loss, nosebleeds, fatigue and 
 
            shortness of breath.  Mr. Peck testified that he normally 
 
            only complains of whatever symptom may be most troubling 
 
            when he seeks medical attention and does not necessarily 
 
            disclose all his symptoms.
 
            
 
                 However, records of the Buena Vista County Hospital 
 
            reflect that claimant had been seen on the order of 60 times 
 
            in the previous decade (a number that is "terribly unusual" 
 
            in the view of Dr. Crippin, a board-certified family 
 
            practitioner who testified at hearing) and commonly 
 
            complained of multiple symptoms.  These symptoms include 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            many which claimant now attributes to his fluorescein 
 
            exposure, including dizziness, fatigue and bronchitis.  
 
            Claimant conceded at hearing that he had complained of 
 
            vomiting on approximately 20 medical visits prior to the 
 
            fluorescein exposure.
 
            
 
                 Claimant continued to work and was even promoted after 
 
            six months to a supervisory position.  However, he testified 
 
            that his job performance deteriorated after he began really 
 
            failing some two or three months after the exposure.  Steve 
 
            Rice, claimant's good friend, testified that sores on 
 
            claimant's arms continued to get worse and he developed 
 
            shortness of breath.  Rice further indicated that claimant 
 
            began slowing down on the job, but had been such a high 
 
            quality worker before that he was still a good worker even 
 
            in his reduced state.
 
            
 
                 Claimant's wife testified that he gradually became more 
 
            fatigued during the fall of 1988.  His hair thinned on his 
 
            head, back and in the armpits (this symptom has not been 
 
            medically documented) and his mood became increasingly 
 
            grumpy.
 
            
 
                 Claimant eventually sought a referral from the Polk 
 
            County Medical Society, and thereby came under the care of 
 
            Mark Thoman, M.D., who promptly took claimant off work.  Dr. 
 
            Thoman is board certified in pediatrics and clinical 
 
            toxicology; he testified by deposition on May 10, 1990.  As 
 
            of that time, he had seen claimant on 13 occasions beginning 
 
            March 26, 1989.
 
            
 
                 In April and May 1989, Dr. Thoman evolved a diagnosis 
 
            of fluorescein toxicity with involvement of several organ 
 
            systems:  respiratory, central nervous system and 
 
            integument, particularly the skin.
 
            
 
                 Claimant was thereafter referred by defendants to the 
 
            Mayo Clinic in Minnesota where he was seen in early May.  
 
            That evaluation was discussed by Melvin A. Amundsen, M.D., 
 
            in a deposition on June 25, 1990.  Dr. Amundsen is board 
 
            certified in internal and preventative medicine and 
 
            occupational medicine.  He is not a toxicologist.  However, 
 
            a working knowledge of toxicology is necessary to a 
 
            specialist in occupational medicine.
 
            
 
                 Dr. Amundsen testified that if a person were normally 
 
            to react to fluorescein, the reaction would typically occur 
 
            immediately and that the most common sign is hives.  Other 
 
            symptoms can include nausea, vomiting, dizziness and 
 
            faintness.  Claimant's primary complaints at Mayo were of 
 
            sharp pain in the back and chest, coughing, sores, shortness 
 
            of breath, irritability, lack of concentration, poor memory, 
 
            reduced sexual interest and fatigue.
 
            
 
                 On examination, fluorescein was not present at the 
 
            lowest detectable level in the blood or urine.  Laboratory 
 
            evaluations were generally unremarkable.  Dr. Fransway of 
 
            the Dermatology Department did not suspect a causal 
 
            relationship between fluorescein toxicity and furunculosis 
 
            (the persistent or simultaneous occurrence of furuncles, 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            boils or painful nodules due to staphylococci bacteria).  
 
            The Department of Neurology conducted a normal neurologic 
 
            exam without evidence of thoracic radiculopathy or other 
 
            disease of the nervous system.  Electromyography of the 
 
            chest region was normal.  Pulmonary function testing, 
 
            including a methacholine challenge, was normal.  Respiratory 
 
            and blood gas studies were normal.  Electrocardiogram was 
 
            normal, except that cardiovascular conditioning was reduced 
 
            below normal (indicating below normal stamina).  Dr. 
 
            Amundsen indicated that every physician who had seen 
 
            claimant at the Mayo Clinic concluded that there was no 
 
            evidence of a relationship between his exposure to 
 
            fluorescein and current complaints.  No impairment was seen 
 
            and there was nothing to indicate that claimant was unable 
 
            to work.  No evidence of any disease or injury was found.  
 
            Although a Minnesota Multiphasic Personality Inventory did 
 
            not indicate psychiatric problems, Dr. Amundsen could 
 
            suggest only psychiatric factors as accounting for 
 
            claimant's symptoms.  However, based on claimant's reported 
 
            symptoms, the staff allergist suggested that if claimant had 
 
            symptomatic benefit from a bronchodilator, one should be 
 
            used.
 
            
 
                 Speaking generally, Dr. Amundsen did not believe that 
 
            any of claimant's reported symptoms were possible based on 
 
            his reported fluorescein exposure.
 
            
 
                 The Mayo Clinic released claimant to return to work.  
 
            Dr. Thoman thereupon recommended that claimant return on a 
 
            part-time basis, and he did so for approximately two weeks.  
 
            Thereafter, Merrill Manufacturing required him to return to 
 
            full-time work.  He did so in early July 1989, and alleged 
 
            at hearing that this return to work led to exacerbated 
 
            shortness of breath, nausea, vomiting, dizziness and 
 
            headaches.
 
            
 
                 Claimant indicated he felt ill on July 28, but went to 
 
            work anyway.  He smelled paint fumes and felt much worse.  
 
            He left work (the parties dispute whether with or without 
 
            permission) and consulted Dr. Crippin, who hospitalized him.
 
            
 
                 Dr. Crippin's initial impression was of 
 
            hyperventilation and shortness of breath, history of 
 
            fluorescein exposure by patient (without confirmed evidence 
 
            of objective findings by Mayo Clinic) and "possible 
 
            hyperventilation syndrome with certainly some anxiety 
 
            overlying features possibly related to work and stress 
 
            versus stress from going down to the doctor yesterday."  
 
            Discharge diagnosis was of shortness of breath with 
 
            hyperventilation and anxiety, secondary thereto.
 
            
 
                 While claimant was hospitalized overnight during this 
 
            incident, he was criticized by Steve Anderson, owner of 
 
            Merrill Manufacturing Company.  Anderson believed claimant 
 
            had left work without permission and accused him of 
 
            misconduct.  On the following day, Dr. Thoman again took 
 
            claimant off work.  Claimant was apparently motivated to 
 
            seek legal advice at about this time and filed his petition 
 
            herein on August 3, 1989.
 
            
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
                 On March 28, 1989, Steven Zorn, M.D., had performed 
 
            pulmonary function testing.  That study was normal.  Dr. 
 
            Zorn performed a repeat pulmonary function study including 
 
            methacholine challenge on August 1, 1989.  As both studies 
 
            were within normal limits, Dr. Zorn found no evidence of 
 
            bronchial hyperreactivity.  However, his comments indicated 
 
            that claimant had slightly increased coughing and wheeze 
 
            which disappeared after the use of a bronchodilator.  In a 
 
            letter dated August 9, 1989 to Dr. Crippin, Dr. Thoman 
 
            interpreted Dr. Zorn's normal studies as showing that 
 
            claimant had a hyperreactive element to his pulmonary status 
 
            dependent upon environmental exposure.  In a letter of July 
 
            11, 1989, Dr. Thoman had opined (based in part upon his 
 
            understanding that claimant had inhaled fluorescein) that 
 
            the exposure had left Mr. Peck with directly related 
 
            chemical dermatological sequelae and a "sensitization" to 
 
            dust, smoke or noxious fumes as a result of respiratory 
 
            irritation from fluorescein.
 
            
 
                 Dr. Crippin further referred claimant to another 
 
            pulmonologist, Robert M. Stewart, M.D., who saw claimant on 
 
            December 6, 1989 and May 2, 1990.  Physical examination was 
 
            normal.  A review of chest x-rays and previous pulmonary 
 
            function studies was found normal.  An additional 
 
            methacholine challenge was performed and interpreted as 
 
            normal.  Nonetheless, it was Dr. Stewart's impression that 
 
            claimant had clinical findings consistent with hyperreactive 
 
            airway disease, even though this could not be documented 
 
            through pulmonary function studies.  "Peak flow" studies 
 
            demonstrated episodic drops in peak flow, which is somewhat 
 
            suggestive of hyperreactive airway disease.  Peak flow 
 
            studies were self-administered by claimant at home, and are 
 
            therefore dependent upon full cooperation.  Dr. Stewart 
 
            stated that he did not know if claimant's problem was in any 
 
            way related to the fluorescein exposure, but was unaware of 
 
            fluorescein causing such problems in other patients.  He 
 
            believed claimant likely to continue having difficulty upon 
 
            future exposure to irritants such as fumes, dust and 
 
            possibly cold air, and recommended employment restrictions 
 
            to avoid such exposure.
 
            
 
                 Claimant underwent a residual physical functional 
 
            capacity assessment in connection with a Social Security 
 
            claim on October 29, 1989.  Dr. Ross found no exertional 
 
            limitations, no postural limitations, no manipulative 
 
            limitations, no visual limitations, no communicative 
 
            limitations and a single environmental limitation:  all 
 
            exposure to fumes, odors, dusts, gases, poor ventilation and 
 
            the like should be avoided.  Dr. Ross found that claimant 
 
            had not shown any significant pulmonary or other damage as 
 
            the result of fluorescein exposure, but had developed a 
 
            sensitivity to certain odors which should be avoided; 
 
            otherwise ventilatory function studies indicated no 
 
            restriction of function.
 
            
 
                 A psychological assessment done for Social Security on 
 
            March 16, 1990 by psychologist John McMeekin, Ed.D., found 
 
            no evidence of psychiatric disorder and intellectual 
 
            functioning from the average range up to superior or higher.
 
            
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
                 Generally speaking, and in the quantities used by 
 
            ophthalmologists (to check for scratches on the cornea or by 
 
            injection for arterial mapping) fluorescein is not an 
 
            especially toxic substance.  Nonetheless, rare adverse 
 
            reactions do occur.  In his deposition testimony, Dr. Thoman 
 
            pointed out his belief that claimant had an "overwhelming" 
 
            exposure to the substance.  He further noted that animal 
 
            studies indicate fluorescein is readily absorbed through the 
 
            respiratory tract and can be sensitizing to the skin and 
 
            respiratory system.  He believed that claimant's skin 
 
            showing signs of exposure within hours and a respiratory 
 
            involvement becoming apparent within some days along with 
 
            later developing symptoms all were consistent with 
 
            fluorescein exposure.  Dr. Thoman believed claimant's 
 
            history and physical did not implicate other conditions as 
 
            potentially causative of symptomatology.
 
            
 
                 With respect to taking claimant off work in July 1989, 
 
            Dr. Thoman testified he believed claimant's hospitalization 
 
            was due to a lung infection (Thoman deposition, page 25).  
 
            As has been seen, this view is inconsistent with that of the 
 
            treating physician, Dr. Crippin.
 
            
 
                 Dr. Thoman also found that claimant suffered toxic 
 
            vitiligo (chronic depigmentation of skin patches), but this 
 
            sign was interpreted by Dr. Garb as merely an untanned area 
 
            in the folds of claimant's neck skin.
 
            
 
                 Dr. Thoman's examination of claimant on the day prior 
 
            to his deposition yielded the following:
 
            
 
                 [A.]  The physical examination, he was a husky 
 
                 fellow, and some of the tests we did along with 
 
                 the physical, he was 72 and a half inches, which 
 
                 is six foot one and a half inch, 257 pounds, his 
 
                 blood pressure was normal, his hearing showed some 
 
                 decrease in the left side, below what would pass 
 
                 for a flight physical under class one or two.  He 
 
                 had 20/20 vision, both on near and far vision.  
 
                 His peripheral vision was okay.  his throat was 
 
                 slightly red.  Other than that, his muscle 
 
                 strength was moderate to good.
 
            
 
                 His deep tendon reflexes were symmetrical and 
 
                 brisk.  His cranial nerves, two through twelve, 
 
                 were normal.  He had the tenderness over the right 
 
                 chest, which he had complained about, and was 
 
                 quite sensitive, not over the kidney, but over the 
 
                 lower rib cage on the right.
 
            
 
                 We did a CBC for a complete blood count, which was 
 
                 normal, SED rate, which was normal.  We did a 
 
                 series of chemical tests.  His glucose and 
 
                 cholesterol were normal, triglycerides were 
 
                 normal.  SGGT was elevated, although he did not 
 
                 have -- he's a husky guy, and it was difficult to 
 
                 feel the liver edge, but he does have an elevated 
 
                 GGT, which can go along with the medication he is 
 
                 taking or chemical exposure.  GPT was elevated.  
 
                 41 is the upper normal for a male.  It was 70.2.  
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
                 SGOT was normal.  His bilirubin was normal, and 
 
                 the urinalysis was normal.
 
            
 
                 So those were the tests we did yesterday.  The 
 
                 history update, physical exam, and the tests, 
 
                 which showed some elevation in some of the liver 
 
                 enzymes, two of the liver enzymes.  Otherwise his 
 
                 tests were -- his medical tests were normal.
 
            
 
            (Dr. Thoman deposition, page 30, line 8 through page 31, 
 
            line 18)
 
            
 
                 Dr. Thoman directly opined that claimant's problems 
 
            were causally related to fluorescein exposure.  He believed 
 
            claimant should be restricted to a non-chemical environment 
 
            and had other limitations due to fatigue or loss of strength 
 
            (for example, being able to drive only an hour or two).  He 
 
            assessed claimant as having sustained a 50 percent 
 
            "functional disability."
 
            
 
                 Dr. Garb testified after an extensive examination of 
 
            claimant on June 26, 1990.  Blood and urine testing was 
 
            normal, except for a slight elevation on one liver function 
 
            test.  Dr. Garb opined that claimant suffers from allergic 
 
            rhinitis (or hay fever) and obesity.  She concluded that 
 
            present complaints were not related to fluorescein exposure.  
 
            Dr. Garb found no permanent functional impairment of the 
 
            respiratory system, cardiovascular system, central nervous 
 
            system, skin or musculoskeletal system.  She believed that 
 
            claimant could continue to work.
 
            
 
                 Dr. Danse based her testimony on a review of claimant's 
 
            medical records, Dr. Garb's examination and research of the 
 
            literature concerning fluorescein exposure.  She noted that 
 
            allergic reactions to fluorescein typically occur within 
 
            moments of receiving intravenous injections.  As did Dr. 
 
            Garb, she found no causal relationship between the skin 
 
            problems for which claimant first saw Dr. Crippin and the 
 
            exposure.  Dr. Danse did not believe claimant had 
 
            experienced a very substantial exposure to fluorescein, in 
 
            that very little would penetrate the intact skin.  She also 
 
            pointed out that the literature (although apparently sparse) 
 
            indicates that there is no dose response; that is, it cannot 
 
            be said that increasing the dosage necessarily increases the 
 
            likelihood of an adverse reaction.  What reactions are 
 
            reported in the literature generally relate to the 
 
            intravenous injection of large quantities of fluorescein.  
 
            Dr. Danse generally found claimant to be objectively normal 
 
            and suggested that he might suffer from hay fever or 
 
            psychological problems (in addition, she simply did not 
 
            believe all that he said).  In the report she co-authored 
 
            with Dr. Garb, it was noted:
 
            
 
                 The first time any of Mr. Peck's symptoms other 
 
                 than skin lesions are mentioned in the records is 
 
                 in March 1989.  It is difficult to believe that he 
 
                 would deliberately not mention these alarming 
 
                 symptoms to his doctors, and in fact tell the 
 
                 doctor at Family Health Center on 3/8/89, as 
 
                 verified inthe [sic] records, that he had no other 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
                 symptoms except some chest pain and scalp hair 
 
                 loss, and now insists all these other symptoms had 
 
                 been present all along and are gradually getting 
 
                 worse.  It is medically improbable that symptoms 
 
                 associated with exposure to fluorescein in July 
 
                 1988 should have their onset in March 1989 and 
 
                 progressively worsen.  It seems much more likely 
 
                 that symptoms at this time are due in part to 
 
                 allergic rhinitis -- which Mr. Peck denied having 
 
                 previously until I advised him it is recorded in 
 
                 the medical records of Dr. Hruska on 4/1/88.  His 
 
                 symptoms of itchy, tearing eyes, nasal congestion 
 
                 with a clear nasal discharge whenever he goes 
 
                 outside are classic symptoms of allergic rhinitis, 
 
                 or hay fever.  Millions of Americans have these 
 
                 annoying symptoms, but do not stay home from work 
 
                 because of hay fever.
 
            
 
                 His several pulmonary function tests, including 
 
                 histamine challenge, cold challenge and exercise 
 
                 test, provide no objective evidence of 
 
                 hyperreactive airway disease.  His use of the peak 
 
                 flow meter indicates his peak flows sometimes are 
 
                 as low as 400 ml.  This is a test that requires 
 
                 full patient cooperation and thus, is not an 
 
                 objective measure of hyperreactive airway disease.  
 
                 Mr. Peck has been placed on several medications 
 
                 which have well-known side-effects.  Several of 
 
                 the symptoms he has, including cough, wheezing, 
 
                 nausea, throat irritation and dryness, and 
 
                 dizziness are known to be associated with use of 
 
                 Intal, Proventil, and Ventolin.  We question 
 
                 whether he needs any of these medicines.
 
            
 
                 In addition to the symptoms which Mr. Peck 
 
                 attributes to fluorescein, Dr. Thoman has stated 
 
                 that Mr. Peck has other symptoms and findings 
 
                 which Dr. Thoman attributes to the fluorescein 
 
                 incident.
 
            
 
                 Dr. Thoman reports that some of Mr. Peck's liver 
 
                 function tests were slightly abnormal; however, no 
 
                 abnormal tests were found in the records.  Liver 
 
                 function tests performed in July 1989, May 1989 
 
                 and March 1989 were normal, so apparently the 
 
                 abnormalities Dr. Thoman found occurred some time 
 
                 later.  The liver function tests performed on June 
 
                 28, 1990 at Dr. Garb's request were all normal 
 
                 except for a mild elevation in the SGPT of 57 
 
                 (normal range 3-36).  This is a level not 
 
                 uncommonly seen in otherwise-healthy people.  
 
                 Significant liver disease is associated with much 
 
                 higher elevations of several liver tests.  In the 
 
                 three studies previously mentioned of over 230,000 
 
                 exposures to fluorescein, abnormal liver function 
 
                 is not reported.  In those chemicals which are 
 
                 associated with abnormal liver function, the 
 
                 abnormality occurs during or shortly after the 
 
                 time of exposure, not months later as in Mr. 
 
                 Peck's case.  Mr. Peck is taking Ibuprofen, which 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
                 has been reported to cause liver damage in humans.
 
            
 
                 Dr. Thoman says Mr. Peck has vitiligo caused by 
 
                 fluorescein.  Vitiligo is caused by very few 
 
                 chemicals.  It is not caused by fluorescein.  This 
 
                 substance is extensively applied topically in 
 
                 eyes; invariably, tearing causes the fluorescein 
 
                 to come in contact with patients' cheeks and 
 
                 eyelids, and no vitiligo has been reported.  The 
 
                 area which Mr. Peck identified as vitiligo is an 
 
                 irregular, barely-discernible area on his throat.  
 
                 Mr. Peck is a large, overweight man, and in order 
 
                 to view the area, I had to have him hold his head 
 
                 up and I pulled the skin taut.  This area is not 
 
                 usually exposed to the sun, which could explain 
 
                 the lack of tanning.
 
            
 
                 Mr. Peck reports his urine turned dark yellow and 
 
                 had a foul odor for months after his exposure.  
 
                 While we commiserate with Mr. Peck's problem, this 
 
                 would not be caused by fluorescein, which in 
 
                 patients receiving injections, turns urine a 
 
                 bright yellow for up to 36 hours.  Foul odors do 
 
                 not occur from fluorescein and it is medically 
 
                 impossible that months of dark yellow urine was 
 
                 [sic] related to this "exposure".  Also, Mr. 
 
                 Peck's urinalyses on several occasions were 
 
                 normal.
 
            
 
                 In fact, Mr. Peck did not sustain any period of 
 
                 total disability following the incident when 
 
                 fluorescein spilled on him.  Objectively, he has 
 
                 minor symptoms which it is our opinion are related 
 
                 to hay fever and the adverse effects of his 
 
                 medications, and do not explain his inability to 
 
                 work.
 
            
 
                 Dr. Thoman suggests that Mr. Peck has become 
 
                 allergic to a wide variety of chemicals because of 
 
                 the fluorescein incident.  That such a condition 
 
                 exists, which has been called environmental 
 
                 illness or chemical AIDS, has been proposed by 
 
                 some physicians to explain unusual symptoms, but 
 
                 scientific analysis of these claims has not 
 
                 corroborated the existence of such illness in the 
 
                 over 15 years that it has been reported.  In 
 
                 recent years, the Scientific Board of the 
 
                 California Medical Association and the American 
 
                 College of Physicians (reports attached) 
 
                 (references 4, 5 and 6) have carefully examined 
 
                 the claims of these practitioners and found no 
 
                 objective evidence to support these conjectures.  
 
                 Patients are done a great disservice when they are 
 
                 given faulty diagnoses and treated unnecessarily 
 
                 with powerful medications with substantial adverse 
 
                 effects.
 
            
 
                 In summary, some fluorescein powder fell on Mr. 
 
                 Peck, a husky 36-year-old warehouseman, while he 
 
                 was at work.  He rinsed most of it off within 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
                 minutes and later showered.  This experience, in 
 
                 our medical and toxicological opinion, has caused 
 
                 him no harm.  He seems to have some seasonal 
 
                 allergic rhinitis (hay fever) which he had prior 
 
                 to this employer and which is non-industrial.
 
            
 
            (Danse-Garb report, pages 19-21)
 
            
 
                 Dr. Crippin testified to his opinion that claimant's 
 
            reported symptoms are causally related to chemical exposure, 
 
            based primarily on timing.  He noted that claimant did not 
 
            mention nosebleeds, shortness of breath, nausea or other 
 
            symptoms when first seen for his dermatological problem, a 
 
            staphylococcus aureus infection (referred to as a common 
 
            bacterial infection which can result from any break in skin 
 
            integrity).  He believed claimant to be asymptomatic, except 
 
            when exposed to a triggering agent, but was unsure whether 
 
            claimant's state of sensitivity was causally related to the 
 
            fluorescein exposure as opposed to any preexisting 
 
            propensity.  He noted that claimant had at least five prior 
 
            bronchial attacks, and felt that if fluorescein had actually 
 
            been inhaled, claimant should have shown a fairly quick 
 
            reaction (at least within a few days of exposure).
 
            
 
                 Claimant currently complains that various fumes 
 
            (painting solutions, gasoline, perfume, etc.) cause 
 
            shortness of breath, nausea, dizziness, headaches and 
 
            disorientation.  He complains that his activities are now 
 
            greatly restricted, and that he has given up many activities 
 
            such as singing in the church choir, acting as a boy scout 
 
            scoutmaster, hunting, fishing, hiking, wood cutting and the 
 
            like.
 
            
 
                                conclusions of law
 
            
 
                 The parties dispute whether claimant sustained an 
 
            injury arising out of and in the course of employment.  
 
            Claimant did suffer an exposure to fluorescein as he related 
 
            (Steve Rice saw the substance on his person), but this 
 
            exposure did not necessarily cause injury.
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that he received an injury on July 20 or 28, 
 
            1988 which arose out of and in the course of his employment. 
 
            McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 
 
            1976); Musselman v. Cent. Tel. Co., 261 Iowa 352, 154 N.W.2d 
 
            128 (1967). 
 
            
 
                 The words "arising out of" refer to the source of the 
 
            injury.  McClure v. Union, et al., Counties, 188 N.W.2d 283 
 
            (Iowa 1971).  This requirement is satisfied by showing a 
 
            causal relationship between the employment and the injury.  
 
            Sheerin v. Holin Co., 380 N.W.2d 415 (Iowa 1986).
 
            
 
                 Claimant has reported numerous symptoms, but few 
 
            objective signs have been seen.  The crux of this dispute is 
 
            whether a causal relationship exists between those reported 
 
            symptoms and fluorescein exposure.  It is claimant's burden 
 
            to prove that causal nexus by a preponderance of the 
 
            evidence.
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of July 20 or 
 
            28, 1988 is causally related to the disability on which he 
 
            now bases his claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 
 
            133 N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 
 
            296, 18 N.W.2d 607 (1945).  A possibility is insufficient; a 
 
            probability is necessary.  Burt v. John Deere Waterloo 
 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
            question of causal connection is essentially within the 
 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
            Hosp., 251 Iowa 375, 101 N.W.2d 167 (1960). 
 
            
 
                 However, expert medical evidence must be considered 
 
            with all other evidence introduced bearing on the causal 
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id. at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman v. Cent. Tel. Co., 261 
 
            Iowa 352, 154 N.W.2d 128 (1967).
 
            
 
                 Claimant has not met his burden of proof on the issue.  
 
            While the original petition alleged an exposure of July 20, 
 
            claimant at hearing claimed an exposure of July 28.  As 
 
            defendants have pointed out, claimant is by no means casual 
 
            about dates.  In testimony about his prior history, claimant 
 
            proved capable to a remarkable degree of specifying exact 
 
            dates with respect to numerous occurrences.  In any event, 
 
            medical treatment was not sought until August 10, 1988, 
 
            either 13 or 21 days following the exposure.  Claimant then 
 
            sought treatment for cellulitis associated with a 
 
            staphylococcus infection (universally described as very 
 
            common) and specifically denied fevers, chills or other 
 
            complaints.  Yet, he now asserts that he had developed very 
 
            extensive symptoms indeed by this time, including nausea and 
 
            vomiting, dark and foul-smelling urine, sores spreading to 
 
            the back, chest and hairline (Dr. Crippin reports sores only 
 
            on the arm), shortness of breath and serious nosebleeds.  It 
 
            seems extremely unlikely that claimant would have actually 
 
            denied these alarming symptoms, especially given his 
 
            "terribly unusual" extensive preexisting medical history, 
 
            including numerous instances of multiple-symptom complaints.
 
            
 
                 While symptoms reported are numerous indeed (of course, 
 
            many of these symptoms also preexisted the exposure), 
 
            objective signs of impairment are another story, although 
 
            claimant has been seen and worked up by numerous 
 
            well-qualified physicians, including the Mayo Clinic.  Tests 
 
            of liver function have been mildly elevated in some areas, 
 
            although as Drs. Garb and Danse point out, the readings are 
 
            not extreme and may well be associated with use of various 
 
            medications, including Ibuprofen.  Claimant has complained 
 
            of hair loss, confirmed by his wife.  Medical documentation 
 
            for hair loss is not seen in the record.  Claimant and his 
 

 
            
 
            Page  14
 
            
 
            
 
            
 
            
 
            wife are, of course, interested in the litigation.  Claimant 
 
            complained of dark and foul-smelling urine for months 
 
            following his exposure, but no medical documentation exists.  
 
            Rather, urinalyses have been normal.  Dr. Thoman felt that 
 
            claimant suffered vitiligo, but Dr. Garb looked at the same 
 
            section of skin and saw only a less tanned area in the folds 
 
            of the neck.  Without determining which physician is 
 
            correct, it seems apparent that Dr. Thoman's finding is at 
 
            least fairly debatable.  Peak flow pulmonary testing has 
 
            shown abnormalities, but there is a major subjective 
 
            component to this testing, because it is done by claimant, 
 
            at home, and is dependent upon his full cooperation.
 
            
 
                 Dr. Crippin finds a causal relationship between 
 
            claimant's reportedly enhanced sensitivity and the original 
 
            occurrence, but this conclusion is based in his own words 
 
            upon "timing."  Dr. Crippin, of course, is not a 
 
            toxicologist or occupational medicine practitioner.  Timing 
 
            of the onset of symptoms (and especially claimant's failure 
 
            to report those symptoms) was a major factor in the contrary 
 
            conclusion reached by Drs. Danse and Garb, both with much 
 
            greater qualifications in those areas.
 
            
 
                 Dr. Thoman, on the other hand, does find a causal nexus 
 
            between exposure and symptomatology, and he is also highly 
 
            qualified in toxicology.
 
            
 
                 Claimant has strenuously argued that Dr. Thoman's 
 
            certification in toxicology, or, in claimant's words, 
 
            "medical" toxicology, is superior to the certification of 
 
            Dr. Danse.  However, the weight of the evidence reflects 
 
            that the certification of these two toxicologists merely 
 
            derives from different organizations.  Dr. Danse sees no 
 
            substantial difference between the two organizations, and 
 
            she and Dr. Amundsen point out that the American Medical 
 
            Association does not recognize either certification.  While 
 
            Dr. Thoman was a treating physician, it is not necessarily 
 
            the case that a treating physician's testimony is to be 
 
            given more weight than a physician who examines claimant in 
 
            anticipation of litigation.  Rockwell Graphics Systems, Inc. 
 
            v. Prince, 366 N.W.2d 187 (Iowa 1985).  Rather, such factors 
 
            as education, compensation, the date of the examination, 
 
            experience and the like go to the value of a physician's 
 
            testimony as questions of fact, not law.
 
            
 
                 A reading of Dr. Thoman's testimony indicates that his 
 
            view is similar to that of devotees of "clinical ecology," 
 
            as per references 4-6 attached to Danse deposition exhibit 
 
            1.  These views are apparently now somewhat controversial in 
 
            the field of toxicology.  At least, those references are 
 
            fairly critical and the theories have not been accepted, at 
 
            least by the California Medical Association or the American 
 
            College of Physicians.  The Danse-Garb report and underlying 
 
            reasons are, with all due respect to the opinion of Dr. 
 
            Thoman, more persuasive to this reader.
 
            
 
                 It may be that claimant's current symptomatology is 
 
            simply a coincidental progression of his numerous 
 
            preexisting symptoms, many of which are of similar ilk.  
 
            Perhaps the symptomatology is in part psychosomatic.  
 

 
            
 
            Page  15
 
            
 
            
 
            
 
            
 
            Perhaps the symptomatology is merely an invention for 
 
            purposes of seeking compensation benefits.  It is 
 
            unnecessary to decide.  What is necessary is to determine 
 
            whether claimant has met his burden of proof in establishing 
 
            that such symptoms exist and are causally related to 
 
            fluorescein exposure.  Given the lack of objective signs 
 
            (subjective symptoms have commonly been found 
 
            non-compensable by this agency in the absence of objective 
 
            proof), the existence of numerous preexisting similar 
 
            symptoms, claimant's failure to make complaint of symptoms 
 
            other than dermatological to any physician until March 1989, 
 
            almost nine months later (and actually denying other 
 
            complaints to Dr. Crippin in August 1988), and the views of 
 
            Drs. Garb and Danse (which seem to this writer more 
 
            consistent with other objectively determinable facts), it 
 
            must be held that claimant has failed to meet that burden of 
 
            proof.  He has not established a compensable injury arising 
 
            out of and in the course of employment with Merrill 
 
            Manufacturing Company as alleged.
 
            
 
                 Other issues are thereby rendered moot.
 
            
 
                           
 
            
 
            
 
            Page  16
 
            
 
            
 
            
 
            
 
            order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Claimant shall take nothing further from these 
 
            proceedings.
 
            
 
                 The costs of this action shall be assessed to 
 
            defendants pursuant to rule 343 IAC 4.33.
 
            
 
                 Signed and filed this ______ day of ____________, 1991.
 
            
 
                 
 
            
 
                 
 
                 
 
                                          ______________________________
 
                                          DAVID RASEY
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Harry H. Smith
 
            Attorney at Law
 
            P.O. Box 1194
 
            Sioux City, Iowa  51102
 
            
 
            Ms. Judith Ann Higgs
 
            Attorney at Law
 
            200 Home Federal Building
 
            P.O. Box 3086
 
            Sioux City, Iowa  51102
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                           1108.30; 1402.30; 2205
 
                           Filed February 26, 1991
 
                           DAVID RASEY
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            DONALD F. PECK,     :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :         File No. 894350
 
            MERRILL MANUFACTURING CO.,    :
 
                      :      A R B I T R A T I O N
 
                 Employer, :
 
                      :         D E C I S I O N
 
            and       :
 
                      :
 
            AETNA CASUALTY & SURETY  :
 
            COMPANY,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ____________________________________________________________
 
            
 
            1108.30; 1402.30; 2205
 
            Claimant failed to prove that exposure to fluorescein was 
 
            causally related to his numerous subjective symptoms.  
 
            Objective signs were few and easily explained as preexisting 
 
            or related to other causes.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            IMOGENE WIELAND,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :         File No. 894597
 
                                          :
 
            JIMMY DEAN MEAT CO.,          :      A R B I T R A T I O N
 
                                          :
 
                 Employer,                :         D E C I S I O N
 
                                          :
 
            and                           :
 
                                          :
 
            TRAVELERS,                    :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Imogene 
 
            Wieland against her employer, Jimmy Dean Meat Company, and 
 
            the Travelers Insurance Company based upon an alleged injury 
 
            to her right leg and back that occurred on August 26, 1988.  
 
            The occurrence of the injury is disputed as is claimant's 
 
            entitlement to benefits for the alleged injury.
 
            
 
                 The case was consolidated with file number 891393 and 
 
            heard at Des Moines, Iowa on August 28, 1990.  The record 
 
            consists of testimony from Imogene Wieland, Dale Wieland, 
 
            Jeff L. Johnson, Dan J. Nanneman and Jerald Ross Lewis.  The 
 
            record also contains joint exhibits A through H, claimant's 
 
            exhibits 1 through 12 and defendants' exhibit I.
 
            
 
                                 findings of fact
 
            
 
                 Having considered all the evidence received, together 
 
            with the appearance and demeanor of the witnesses, the 
 
            following findings of fact are made.
 
            
 
                 Imogene Wieland experienced difficulty with her right 
 
            leg as a result of operating a foot pedal which was part of 
 
            her job at Jimmy Dean Meat Company.  The record fails to 
 
            show that she missed any time from work as a result of the 
 
            condition.  To the contrary, the notes from James Blessman, 
 
            M.D., indicate that she was released to return to work with 
 
            a restriction against using a foot pedal (exhibit F, page 
 
            4).  At the time of hearing, claimant stated that the 
 
            problem with her leg and back were temporary and had gone 
 
            away.  The record contains no medical evidence which shows 
 
            that the leg or back condition was in any manner permanent 
 
            or required any substantial medical treatment.  The record 
 
            contains no evidence of the amount of any medical expenses 
 
            incurred in treating the leg or back.
 
            
 
                 It is therefore found that Imogene Wieland did injure 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            her right leg on or about August 26, 1988 while operating a 
 
            foot pedal which was part of the duties of her employment at 
 
            Jimmy Dean Meat Company.  It is further found that the 
 
            evidence does not support the existence of any injury to her 
 
            back as a result of that work activity.  The evidence fails 
 
            to show that the injury produced any temporary or permanent 
 
            disability.
 
            
 
                                conclusions of law
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that she received an injury on August 26, 
 
            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. Cent. Tel. Co., 261 Iowa 352, 154 N.W.2d 
 
            128 (1967). 
 
            
 
                 Claimant has proven, by a preponderance of the 
 
            evidence, that she suffered a minor injury to her right leg 
 
            on August 26, 1988 as alleged.
 
            
 
                 Claimant has failed to prove, by a preponderance of the 
 
            evidence, that her back was injured as a result of that 
 
            incident or work activity.
 
            
 
                 Claimant has failed to prove, by a preponderance of the 
 
            evidence, that the injury to her leg produced any temporary 
 
            or permanent disability which would entitle her to receive 
 
            weekly compensation under Iowa Code sections 85.33 or 85.34.
 
            
 
                 Claimant has failed to prove, by a preponderance of the 
 
            evidence, that there are any medical expenses which were 
 
            incurred in treating the leg injury which have not been paid 
 
            in full by the employer and its insurance carrier.
 
            
 
                 In summary, claimant has proven the occurrence of a 
 
            minor injury, but has failed to prove that she is entitled 
 
            to any benefit under the Iowa workers' compensation laws as 
 
            a result of that injury.
 
            
 
                           
 
            
 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            order
 
            
 
                 IT IS THEREFORE ORDERED that claimant take nothing from 
 
            this proceeding.
 
            
 
                 IT IS FURTHER ORDERED that the costs of this action are 
 
            assessed against the claimant pursuant to rule 343 IAC 4.33.
 
            
 
                 Signed and filed this ______ day of ____________, 1991.
 
            
 
                 
 
            
 
                 
 
                 
 
                                          ______________________________
 
                                          MICHAEL G. TRIER
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Steven C. Jayne
 
            Attorney at Law
 
            5835 Grand Avenue
 
            Suite 201
 
            Des Moines, Iowa  50312
 
            
 
            Mr. Helmut A. Mueller
 
            Attorney at Law
 
            RR 5
 
            Osceola, Iowa  50213
 
            
 
            Mr. Glenn Goodwin
 
            Attorney at Law
 
            4th Floor, Equitable Building
 
            Des Moines, Iowa  50309
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                           5-1402.40
 
                           Filed January 11, 1991
 
                           MICHAEL G. TRIER
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            IMOGENE WIELAND,    :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :         File No. 894597
 
                      :
 
            JIMMY DEAN MEAT CO.,     :      A R B I T R A T I O N
 
                      :
 
                 Employer, :         D E C I S I O N
 
                      :
 
            and       :
 
                      :
 
            TRAVELERS,     :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ____________________________________________________________
 
            
 
            5-1402.40
 
            Claimant proved a minor injury as alleged, but failed to 
 
            prove entitlement to any benefits as a result of that 
 
            injury.