BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
            MARTHA DEPPE,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File Nos. 909208 & 
 
                                                           865975
 
            MIDWEST MANUFACTURING,        :
 
                                          :              A P P E A L
 
                 Employer,                :
 
                                          :            D E C I S I O N
 
            and                           :
 
                                          :
 
            SENTRY INSURANCE,             :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
            
 
                 The record, including the transcript of the hearing 
 
            before the deputy and all exhibits admitted into the record, 
 
            has been reviewed de novo on appeal.
 
            
 
                                      ISSUES
 
            
 
                 The issues on appeal are:
 
            
 
                 Whether claimant's permanent disability resulting from 
 
            her April 25, 1989 injury is a disability to her left arm or 
 
            a disability to the body as a whole.
 
            
 
                 Whether claimant's permanent disability resulting from 
 
            her alleged January 12, 1989 injury is a disability to her 
 
            left arm or a disability to the body as a whole.
 
            
 
                 Whether claimant is entitled to Second Injury Fund 
 
            benefits as a result of either her alleged April 29, 1987 
 
            injury or her alleged January 12, 1987 injury.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The findings of fact contained in the proposed agency 
 
            decision filed June 20, 1991 are adopted as set forth below.  
 
            Segments designated by asterisks (*****) indicate portions 
 
            of the language from the proposed agency decision that have 
 
            been intentionally deleted and do not form a part of this 
 
            final agency decision.  Segments designated by brackets ([ 
 
            ]) indicate language that is in addition to the language of 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            the proposed agency decision.
 
            
 
                 Claimant was born on December 3, 1950 and completed the 
 
            ninth grade of school.  She dropped out of school at age 15 
 
            in order to get married.  She received her GED certificate 
 
            in 1984.  She worked at various times as a waitress, 
 
            assembly line worker, office cleaner and cook.  On April 19, 
 
            1977, she commenced employment with Midwest Manufacturing 
 
            Company.  She worked there on and off until January 26, 
 
            1989.  She held various jobs there including press operator, 
 
            inspector, spot welder, fork lift operator and multi-spindle 
 
            operator.  She was last employed at Progress Industries as 
 
            an assembly line worker.  She worked there from March 
 
            through May 1990.
 
            
 
                 *****
 
            
 
                 On May 18, 1981, claimant's right (primary) hand was 
 
            amputated when caught in a production press.  Medical 
 
            treatment by Douglas Reagan, M.D., orthopedic surgeon, 
 
            followed, including 18 to 20 surgeries for replacement of 
 
            the right hand and partial fingers.  During her recuperation 
 
            period a left wrist carpal tunnel syndrome was diagnosed and 
 
            released in November 1981.  On October 24, 1983, Dr. Reagan 
 
            assigned a permanent disability rating of 90 percent of the 
 
            right ***** [arm.  Dr. Reagan testified that the crush 
 
            injury to claimant's right hand resulted in muscle and 
 
            tendon damage to the elbow.  He rated claimant's impairment 
 
            of the upper extremity.  (Exhibit 37, pages 20 and 29)].  
 
            Dr. Reagan testified in a deposition dated September 16, 
 
            1985, that claimant may have some difficulty with heavy 
 
            lifting because she has some limitation of motion with 
 
            twisting her wrist or pronation and supination as well as 
 
            difficulty with use of her right hand for fine activities.  
 
            In addition, pinching and grasping will be difficult 
 
            functions for her to perform (Exhibits 1-15).
 
            
 
                 Claimant testified that she returned to Midwest 
 
            Manufacturing for the first time after the May 18, 1981, 
 
            accident on October 16, 1985.  She stated that her right 
 
            hand was virtually useless except as a hook or to hold 
 
            things down.  She stated that there were jobs at Midwest she 
 
            was unable to perform and was first assigned to do spot 
 
            welding.  In December 1985, she was placed as a fork lift 
 
            operator.  She performed this work for about one year but 
 
            developed left-sided upper extremity problems involving her 
 
            hand, wrist and shoulder.  On December 15, 1986, she bid for 
 
            the multi-spindle operator job.  She testified that this job 
 
            required repetitive activity for eight hours a day.  As a 
 
            result, she developed severe pain in her left wrist, elbow 
 
            and shoulder.  Claimant presented to Dr. Reagan on June 29, 
 
            1987, with complaints of left sided upper extremity pain.  
 
            X-rays revealed no bony or soft tissue abnormalities.  
 
            Claimant complained of neck pain also.  X-rays revealed some 
 
            degenerative changes at the C6 level with some narrowing.  
 
            Dr. Reagan's impression included (1) cubital tunnel 
 
            syndrome, right and left; (2) possible ulnar tunnel 
 
            syndrome, right and left; and, (3) left deQuervain's 
 
            syndrome.  Dr. Reagan recommended EMG studies.  These were 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            performed on July 27, 1987, and revealed mild left ulnar 
 
            neuropathy, at or near the elbow.  On July 28, 1987, Dr. 
 
            Reagan performed a deQuervain's release on the left.  
 
            
 
                 Claimant testified that she was released to return to 
 
            work on September 2, 1987, and returned to Midwest as a 
 
            spindle operator, the same job she held previously.  
 
            However, because of persistent problems with left shoulder 
 
            and neck pain, she was taken off work by Dr. Reagan in 
 
            October 1987.  She ultimately had surgery on November 17, 
 
            1987, (ulnar nerve release with epicondylectomy on left 
 
            elbow).
 
            
 
                 Claimant presented to Dr. Reagan on February 17, 1988, 
 
            with left-sided complaints including severe pain in the 
 
            shoulder and back.  She was referred to W. C. Koenig, Jr., 
 
            M.D., at Younker Rehabilitation Center.  Dr. Koenig felt 
 
            that her shoulder and back problems were related to a 
 
            myofascial syndrome.  [Dr. Reagan testified that myofascial 
 
            pain syndrome was a diagnosis associated with pain 
 
            conditions in the upper extremity or perhaps even in other 
 
            parts of the body.  (Ex. 37, p. 16)]  Claimant improved with 
 
            therapy and on May 2, 1988, Dr. Reagan released her to 
 
            return to work.  She returned to work on June 6, 1988 but 
 
            was taken off work again on June 13, 1988, because of 
 
            increased pain problems.  She was off work until August 29, 
 
            1988, when Dr. Reagan felt she could return to work.  On 
 
            December 19, 1988, Dr. Reagan gave claimant a five percent 
 
            permanent partial impairment of the left upper extremity 
 
            (Ex. 19, pp. 25-33).
 
            
 
                 In January 1989, claimant's symptoms were so severe 
 
            that she stopped all work activity.  On January 31, 1989, 
 
            claimant presented to Iowa Methodist Medical Center Clinic 
 
            where she saw Michael J. Makowsky, M.D., with complaints of 
 
            sharp, burning pain in the left hand.  She related that the 
 
            pain radiated often into her left elbow.  His impression was 
 
            overuse syndrome of the left arm and hand.  EMG's were taken 
 
            on February 1, 1989, and were normal.  Claimant returned to 
 
            Dr. Reagan on February 17, 1989, and was injected.  Because 
 
            of pain, Dr. Reagan advised her to remain off work until a 
 
            re-evaluation on March 6, 1989.  During that evaluation, she 
 
            was placed in a wrist splint to limit her motion.  On April 
 
            3, 1989, Dr. Reagan felt that she could return to light duty 
 
            if such could be arranged.  Claimant remained in treatment 
 
            with Dr. Reagan and on September 28, 1989, he indicated that 
 
            she had reached maximum improvement.  On October 26, 1989, 
 
            he gave her a 10 percent impairment rating to the left upper 
 
            extremity (Ex. 19, pp. 34-37).
 
            
 
                 The claimant's last day of work for Midwest 
 
            Manufacturing Company was January 28, 1989.  At that time, 
 
            she reported earning $10.85 per hour.  While off work, 
 
            claimant participated in physical therapy, pain management 
 
            and vocational rehabilitation.  During the first three 
 
            months of 1990, claimant completed both a bio-feedback 
 
            program and physical therapy at Iowa Methodist Medical 
 
            Center.  In March 1990, she completed a vocational analysis 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            and work sampling at Progress Industries.  Her tested 
 
            aptitudes were strongest in clerical coordination and 
 
            material control, and she was placed in a light duty area at 
 
            Progress Industries sorting and packaging small items.  She 
 
            was paid $3.40 per hour.  This sheltered employment was 
 
            discontinued after eight weeks by order of Dr. Makowsky, due 
 
            to swelling developing in the arms and hands caused by 
 
            repetitive use of the upper extremities.  [The restrictions 
 
            placed on claimant by Dr. Makowsky were no repetitive 
 
            grasping nor lifting and no lifting more than ten pounds.  
 
            (Ex. 38, p. 15)]  A vocational evaluation performed by Roger 
 
            Marquardt on November 5, 1990, found that "unskilled jobs 
 
            within Martha Deppe's physical limitations exist in no more 
 
            than 5% of that over-all job market."  (Ex. 32, p. 4).
 
            
 
                 Dr. Reagan again testified by way of deposition on 
 
            January 21, 1991.  He stated he last saw claimant on October 
 
            26, 1989.  He indicated that his records show that claimant 
 
            reached maximum medical improvement on September 28, 1989, 
 
            and at that time was given a permanent partial impairment of 
 
            the left upper extremity of 10 percent.  This included her 
 
            cubital tunnel syndrome, the ulnar tunnel syndrome, the left 
 
            deQuervain's syndrome and any myofascial problems she was 
 
            having in the left extremity.  It was Dr. Reagan's medical 
 
            opinion that claimant's right hand and left upper extremity 
 
            problems were of a permanent nature.  He indicated that she 
 
            is permanently restricted as to her ability to engage in any 
 
            occupations where she has to perform repetitive activities 
 
            (Ex. 37).
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 The conclusions of law contained in the proposed agency 
 
            decision filed June 20, 1991 are adopted as set forth below.  
 
            Segments designated by asterisks (*****) indicate portions 
 
            of the language from the proposed agency decision that have 
 
            been intentionally deleted and do not form a part of this 
 
            final agency decision.  Segments designated by brackets ([ 
 
            ]) indicate language that is in addition to the language of 
 
            the proposed agency decision.
 
            
 
                 In file number 865975, the parties stipulate that 
 
            claimant sustained an injury to her left upper extremity on 
 
            April 25, 1987, which arose out of and in the course of her 
 
            employment with employer and that such injury is a cause of 
 
            temporary and permanent disability.  Defendants have paid 
 
            claimant 40 2/7 weeks of healing period benefits and 12.5 
 
            weeks of permanent partial disability benefits at the 
 
            stipulated rate of $249.14 per week.  Claimant seeks 
 
            additional healing period benefits for the period from June 
 
            14, 1988 to August 30, 1988.
 
            
 
                 Section 85.34(l), Code of Iowa, provides that healing 
 
            period benefits are payable to an injured worker who has 
 
            suffered permanent partial disability until:  (1) he has 
 
            returned to work; (2) is medically capable of returning to 
 
            substantially similar employment; or, (3) has achieved 
 
            maximum medical recovery.  The industrial commissioner has 
 
            recognized that healing period benefits can be interrupted 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            or intermittent.  Willis v. Lehigh Portland Cement Company, 
 
            Vol. 2-1, State of Iowa Industrial Commissioner Decisions, 
 
            485 (1984).
 
            
 
                 Defendants have paid healing period benefits from July 
 
            23, 1987 through September 6, 1987 and from October 13, 1987 
 
            through June 4, 1988.
 
            
 
                 Claimant testified that Dr. Reagan released her to 
 
            return to work on June 6, 1988 and at that time she returned 
 
            to her job as a multi-spindle operator.  She worked until 
 
            June 13, 1988 when, because of increased pain, Dr. Reagan 
 
            took her off work again.  She returned to work on August 30, 
 
            1988, in her usual job as a multi-spindle operator and 
 
            earned $10.85 per hour.
 
            
 
                 The documentary evidence supports claimant's claim that 
 
            she was taken off work on June 13, 1988 and did not return 
 
            until August 30, 1988.  Progress notes from Dr. Reagan dated 
 
            June 13, 1988 through August 29, 1988 corroborate claimant's 
 
            testimony (Ex. 19, p. 33).  Employer's personnel records 
 
            show that claimant returned from a plant injury on June 6, 
 
            1988 (Ex. 33, p. 39) and worked until June 13, 1988, when 
 
            she was taken off work due to a plant injury (Ex. 33, p. 
 
            37).  Claimant returned to work on August 30, 1988 (Ex. 33, 
 
            p. 36).
 
            
 
                 Claimant has met her burden of proof that she is 
 
            entitled to additional healing period benefits from June 14, 
 
            1988 through August 30, 1988.
 
            
 
                 Claimant alleges that she sustained an aggravation of 
 
            her preexisting left upper extremity problems on January 12, 
 
            1989, which arose out of and in the course of employment 
 
            with employer.  Claimant alleges that such injury is a cause 
 
            of temporary and permanent disability.  Employer/insurance 
 
            company stipulate that claimant's injury caused temporary 
 
            disability but dispute that she sustained permanent 
 
            disability.  They have paid claimant temporary total 
 
            disability benefits for the period from January 13, 1989 
 
            through January 15, 1989; from January 30, 1989 through 
 
            February 5, 1989; and from February 6, 1989 through March 4, 
 
            1990.
 
            
 
                 Claimant claims that she is entitled to healing period 
 
            benefits from January 13, 1989 to January 18, 1989 and from 
 
            January 30, 1989 to March 8, 1990.  Claimant also requests 
 
            weekly compensation for permanent disability benefits.
 
            
 
                 The Second Injury Fund of Iowa disputes that claimant 
 
            sustained an injury on January 12, 1989, which arose out of 
 
            and in the course of employment with employer and that such 
 
            injury is a cause of temporary and permanent disability.
 
            
 
                 The uncontroverted medical evidence reveals that 
 
            claimant's extremity symptoms were aggravated by her 
 
            repetitive work activities.  On January 12, 1989, she 
 
            received a cortisone injection due to pain.  She testified 
 
            that her previous condition was exacerbated by her work 
 
            activity.  She stated she was off work from January 13, 1989 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            through January 15, 1989, returned to work and was off again 
 
            on January 29, 1989.  She was referred by employer to 
 
            Michael Makowsky, M.D., for evaluation on January 31, 1989.  
 
            Dr. Makowsky testified in a deposition on October 17, 1990.  
 
            He stated that he has the Midwest factory and has seen most 
 
            of the work areas.  Claimant described to him repetitive 
 
            motions performed while working with up to 900 gears per 
 
            night, each weighing about a pound and a half.  She was 
 
            actively handling these and putting them into the machine 
 
            and then picking them up afterwards.  His findings on 
 
            examination noted swelling in the left hand and some 
 
            enlargement.  She also had some tenderness on palpation and 
 
            a questionable positive Tinel's sign.  His diagnosis was 
 
            overuse syndrome, a general term for a group of medical 
 
            problems that include tendonitis and nerve entrapment.  He 
 
            stated that he took her off work until she had a complete 
 
            evaluation.  She was seen intermittently until May 14, 1990, 
 
            when she was discharged from his care (Ex. 20, pp. 1-10).
 
            
 
                 Claimant remained off work from January 30, 1989 until 
 
            March 13, 1990, when she enrolled in a Program with Progress 
 
            Industries (a non-profit shelter facility for disabled 
 
            persons in Newton, Iowa).
 
            
 
                 Dr. Makowsky testified that he saw claimant on May 14, 
 
            1990 and, at that time, her symptoms appeared more severe 
 
            than before.  He attributed this to the work she was doing 
 
            at Progress Industries and he recommended that she stop 
 
            working there (Ex. 38 & Ex. 20, p. 10).  Claimant has not 
 
            been employed since May 1990.
 
            
 
                 The uncontroverted medical evidence clearly 
 
            demonstrates that claimant sustained an injury on January 
 
            12, 1989, diagnosed by Dr. Makowsky as an overuse syndrome 
 
            of the left arm and tendonitis of the left wrist (Ex. 31, p. 
 
            15).  Claimant has sustained her burden of proving by a 
 
            preponderance of the evidence that such injury is causally 
 
            related to the disability on which she now bases her claim.  
 
            Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 
 
            (1965).  Lindahl v. L. O. Boggs Co., 236 Iowa 296, 18 N.W.2d 
 
            607 (1945).  
 
            
 
                 Physicians who have treated claimant have consistently 
 
            held that claimant's left upper extremity problems have 
 
            resulted in permanent disability.  Dr. Reagan, her primary 
 
            treating physician, gave her a total 10 percent disability 
 
            rating to the left upper extremity.  He imposed significant 
 
            restrictions on claimant's use of her left upper extremity.  
 
            Dr. Makowsky concurred with Dr. Reagan's impairment rating 
 
            and also imposed permanent restrictions on her ability to 
 
            use her left extremity (Ex. 37, p. 22 & Ex. 38, p. 15).
 
            
 
                 Claimant's left upper extremity problems do not extend 
 
            into the body as a whole.  [Upon examination of claimant in 
 
            June 1987 Dr. Reagan found only degenerative changes in 
 
            claimant's cervical vertebrae.  (Ex. 37, p. 11)  His 
 
            testimony that the diagnosis of myofascial pain syndrome was 
 
            associated with pain in the upper extremity indicates that 
 
            claimant's disability on the left was limited to the 
 
            scheduled member arm.  The course of treatment followed by 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            both Drs. Reagan and Makowsky indicates the disability was 
 
            in the arm and not the body as a whole as the primary focus 
 
            of treatment on the arm.  The ratings of impairment were to 
 
            the left upper extremity.
 
            
 
                 An injury to a scheduled member may, because of after 
 
            effects or compensatory change, result in permanent 
 
            impairment of the body as a whole.  Such impairment may in 
 
            turn be the basis for a rating of industrial disability.  It 
 
            is the anatomical situs of the permanent injury or 
 
            impairment which determines whether the schedules in Iowa 
 
            Code section 85.34(2)"a"-"t" are applied.  Lauhoff Grain v. 
 
            McIntosh, 395 N.W.2d 834 (Iowa 1986); Blacksmith v. 
 
            All-American, Inc., 290 N.W.2d 348 (Iowa 1980); Dailey v. 
 
            Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 (1943).  
 
            Soukup v. Shores Co., 222 Iowa 272, 268 N.W. 598 (1936).]
 
            
 
                 *****
 
            
 
                 An injury to a scheduled member which, because of 
 
            after-effects (or compensatory change), creates impairment 
 
            to the body as a whole entitles claimant to industrial 
 
            disability.  Barton v. Nevada Poultry Co., 253 Iowa 285, 110 
 
            N.W.2d 660 (1961).  Dailey, 233 Iowa 758, 10 N.W.2d 569 
 
            (1943).
 
            
 
                 An injury is the producing cause; the disability, 
 
            however, is the result, and it is the result which is 
 
            compensated.  Barton, 253 Iowa 285, 110 N.W.2d 660 (1961); 
 
            Dailey, 233 Iowa 758, 10 N.W.2d 569 (1943).
 
            
 
                 If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
            
 
                 [The only evidence of involvement of the shoulders and 
 
            neck was claimant's subjective complaints of pain.  
 
            Subjective reports of pain without medical corroboration do 
 
            not extend the injury to the body as a whole.  See Weishaar 
 
            v. Snap-on Tools, (Appeal Decision June 28, 1991); 
 
            Terwilliger v. Snap-on Tools Corp., (Appeal Decision May 
 
            24, 1991).  Claimant has not proved that either the April 
 
            25, 1987 injury or the January 12, 1989 injury or any other 
 
            work injury resulted in a disability that extended beyond 
 
            the scheduled member (left arm).]
 
            
 
                 Claimant has not sustained her burden of proof that her 
 
            left upper extremity injuries have resulted in an impairment 
 
            extending beyond the scheduled loss.  Therefore, claimant is 
 
            to be compensated for this loss pursuant to Iowa Code 
 
            section 85.34(2)(m).
 
            
 
                 Employer has paid temporary disability benefits for the 
 
            following period of time; January 13 through January 15, 
 
            1989; January 30 through February 5, 1989; and February 6 
 
            through March 4, 1990.  Claimant has not shown by a 
 
            preponderance of the evidence that she is entitled to 
 
            additional healing period benefits in file number 909208.   
 
            
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
                 Claimant sustained an additional five percent permanent 
 
            partial disability to the left upper extremity when she 
 
            ***** [injured] her left upper extremity ***** [following 
 
            the injury in 1987].  Claimant alleges that the combined 
 
            disability caused by the May 18, 1981 right hand injury 
 
            ***** [the injuries of April 25, 1987 and January 12, 1989 
 
            have] caused industrial disability which should be 
 
            compensated by the Second Injury Fund.  According to Dr. 
 
            Reagan, claimant has sustained a 90 percent disability to 
 
            the right arm and a 10 percent disability to the left upper 
 
            extremity.
 
            
 
                 *****
 
            
 
                 Functional impairment is an element to be considered in 
 
            determining industrial disability which is the reduction of 
 
            earning capacity, but consideration must also be given to 
 
            the injured employee's age, education, qualifications, 
 
            experience and inability to engage in employment for which 
 
            he is fitted.  Olson v. Goodyear Service Stores, 255 Iowa 
 
            1112, 125 N.W.2d 251 (1963).  Barton v. Nevada Poultry, 253 
 
            Iowa 285, 110 N.W.2d 660 (1961).
 
            
 
                 A finding of impairment to the body as a whole found by 
 
            a medical evaluator does not equate to industrial 
 
            disability.  This is so as impairment and disability are not 
 
            synonymous.  Degree of industrial disability can in fact be 
 
            much different than the degree of impairment because in the 
 
            first instance reference is to loss of earning capacity and 
 
            in the latter to anatomical or functional abnormality or 
 
            loss.  Although loss of function is to be considered and 
 
            disability can rarely be found without it, it is not so that 
 
            a degree of industrial disability is proportionally related 
 
            to a degree of impairment of bodily function.
 
            
 
                 Factors to be considered in determining industrial dis
 
            ability include the employee's medical condition prior to 
 
            the injury, immediately after the injury, and presently; the 
 
            situs of the injury, its severity and the length of healing 
 
            period; the work experience of the employee prior to the 
 
            injury, after the injury and potential for rehabilitation; 
 
            the employee's qualifications intellectually, emotionally 
 
            and physically; earnings prior and subsequent to the injury; 
 
            age; education; motivation; functional impairment as a 
 
            result of the injury; and inability because of the injury to 
 
            engage in employment for which the employee is fitted.  Loss 
 
            of earnings caused by a job transfer for reasons related to 
 
            the injury is also relevant.  These are matters which the 
 
            finder of fact considers collectively in arriving at the 
 
            determination of the degree of industrial disability.
 
            
 
                 There are no weighting guidelines that indicate how 
 
            each of the factors are to be considered.  There are no 
 
            guidelines which give, for example, age a weighted value of 
 
            ten percent of the total value, education a value of fifteen 
 
            percent of total, motivation - five percent; work experience 
 
            - thirty percent, etc.  Neither does a rating of functional 
 
            impairment directly correlate to a degree of industrial 
 
            disability to the body as a whole.  In other words, there 
 
            are no formulae which can be applied and then added up to 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            determine the degree of industrial disability.  It therefore 
 
            becomes necessary for the deputy or commissioner to draw 
 
            upon prior experience, general and specialized knowledge to 
 
            make the finding with regard to degree of industrial 
 
            disability.  See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985); Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, 1985).
 
            
 
                 Factors to be considered when assessing industrial 
 
            disability include claimant's age, education, experience, 
 
            impairment and work restrictions.
 
            
 
                 Claimant is currently 40 years old.  She completed the 
 
            ninth grade of school and received her GED certificate in 
 
            1984.  Claimant's work activity has consisted of various 
 
            factory unskilled jobs.  In 1977, she was hired by Midwest 
 
            Manufacturing as a production worker and her duties included 
 
            operating various production machines, driving a fork lift, 
 
            spot welding and other production line assignments.  She 
 
            cannot perform any of her past relevant work.  According to 
 
            Roger Marquardt, a Vocational Specialist, claimant has "no 
 
            marketable transferable skills to other employment."  (Ex. 
 
            32, p. 4)  He noted that in the unskilled market she is 
 
            limited to child care work or duties as a 
 
            telephone/switchboard operator or security guard.  He 
 
            recommended vocational rehabilitation.
 
            
 
                 Claimant has an impairment rating of 90 percent to the 
 
            right arm and 10 percent to the left upper extremity.  Her 
 
            right hand is noticeably disfigured, without thumb and with 
 
            three misplaced fingers.  Obviously, she has no grip on the 
 
            right.  In compensating for her right hand limitations, 
 
            claimant overused her left extremity and developed orbital 
 
            tunnel syndrome, ulnar tunnel syndrome, left deQuervain's 
 
            syndrome and myofascial pain in the left neck, shoulder and 
 
            arm.  She has restricted use of this upper extremity and 
 
            cannot engage in activities requiring repetitive use of the 
 
            left hand and arm; repetitive grasping; and lifting in 
 
            excess of 10 pounds.  Machine-paced jobs are outside of her 
 
            residual functional capacity and without comprehensive 
 
            vocational rehabilitation, she is limited in the type of 
 
            competitive employment she is able to perform.  Due to the 
 
            lack of upper extremity gross movement and fine dexterity 
 
            use, she is unable to perform the duties of her past work.  
 
            At the present time, without further vocational 
 
            rehabilitation, claimant is technically limited to unskilled 
 
            work activity.  According to Mr. Marquardt, "unskilled jobs 
 
            within Martha Deppe's physical limitations exist in no more 
 
            than 5% of that over-all job market."
 
            
 
                 Claimant testified that she received unemployment 
 
            compensation benefits from March through June 1990, and held 
 
            herself out as ready, willing and able to work.  The last 
 
            time she looked for any type of employment was in June 1990.  
 
            ***** Claimant testified that she does not know of any type 
 
            of work she can perform, yet she has not attempted to find 
 
            employment since June 1990 and appears even less motivated 
 
            now that she receives social security disability benefits.
 
            
 
                 *****
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            
 
                 [Iowa Code section 85.64 governs Second Injury Fund 
 
            liability.  Before liability of the Fund is triggered, two 
 
            requirements must be met.  First, the employee must have 
 
            previously experienced a permanent loss or loss of use of a 
 
            hand, arm, foot, leg or eye.  Second, the employee must 
 
            sustain a loss or loss of use of another such specified 
 
            member or organ through a compensable injury.
 
            
 
                 The Second Injury Fund Actcredit for the 
 
            combined losses (225 weeks for a 90 percent disability of 
 
            the right arm and 12.5 weeks for a five percent disability 
 
            of the left arm) exceeds the industrial disability benefits, 
 
            there is no Second Injury Fund benefits due for the April 
 
            25, 1987 injury.  Therefore, claimant takes no Second Injury 
 
            Fund benefits for this injury, (file number 865975).
 
            
 
                 Claimant also seeks a determination of entitlement to 
 
            second injury benefits for an alleged injury which is 
 
            specified as January 12, 1989.  (It is noted that the 
 
            January 12, 1989 injury date was apparently used because 
 
            that was the date when claimant stopped working.  Claimant's 
 
            injury on that date is a cumulative injury.  See Oscar Mayer 
 
            Corp. v. Tasler, 483 N.w.2d 824 (Iowa 1992))  Claimant's 
 
            work following her return to work after the April 15, 1987 
 
            injury caused her continuing problems.  These problems 
 
            resulted in a second surgery (ulnar nerve release with 
 
            epicondylectomy on left elbow).  She eventually had an 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            additional five percent impairment to the left arm.  She had 
 
            a significant loss of actual earnings from $10.85 to $3.40 
 
            per hour.  Dr. Makowsky found the efforts to have claimant 
 
            do repetitive work ill-advised.  At this point in time, she 
 
            could no longer do the work she had previously done and had 
 
            returned to on various occasions.  The severity of 
 
            claimant's industrial disability came as a result of her 
 
            injuries and events subsequent to her April 25, 1987 injury.
 
            
 
                 Claimant alleges she is permanently totally disabled.  
 
            Claimant has the burden of proving she is permanently 
 
            totally disabled.
 
            
 
                 Total disability does not mean a state of absolute 
 
            helplessness.  Permanent total disability occurs where the 
 
            injury wholly disables the employee from performing work 
 
            that the employee's experience, training, education, 
 
            intelligence and physical capacities would otherwise permit 
 
            the employee to perform.  See McSpadden v. Big Ben Coal Co., 
 
            288 N.W.2d 181 (Iowa 1980); Diederich v. Tri-City Ry. Co., 
 
            219 Iowa 587, 258 N.W. 899 (1935).
 
            
 
                 A finding that claimant could perform some work despite 
 
            claimant's physical and educational limitations does not 
 
            foreclose a finding of permanent total disability, however.  
 
            See Chamberlin v. Ralston Purina, File No. 661698 (App. 
 
            October 29, 1987); Eastman v. Westway Trading Corp., II Iowa 
 
            Industrial Commissioner Report 134 (App. 1982).
 
            
 
                 Claimant has not proved she is permanently totally 
 
            disabled.  While she may not be able to do repetitive type 
 
            activities, that does not mean there are not some jobs she 
 
            could do.  She has not sought employment since June 1990 and 
 
            does not appear to be motivated.  According to Mr. 
 
            Marquardt, jobs exist within claimant's physical 
 
            limitations.  The functional impairment to her left arm is 
 
            only ten percent.
 
            
 
                 While claimant is not permanently totally disabled, she 
 
            does have a significant current cumulative industrial 
 
            disability.  Following her April 25, 1987 injury she had a 
 
            deQuervain's release.  Her cumulative injury after that time 
 
            resulted in ulnar nerve release and eventually a total 
 
            functional impairment rating of 10 percent.  She was able on 
 
            several occasions to return to her former job but was unable 
 
            to do so after January 12, 1989.  When all the relevant 
 
            factors are considered including those previously 
 
            specifically discussed, claimant has proved a current 
 
            cumulative industrial disability of 80 percent.  The 80 
 
            percent industrial disability is equal to 400 weeks.  The 
 
            Second Injury Fund's liability would be reduced by the 
 
            combined losses of claimant's right arm (90 percent of 250 
 
            weeks or 225 weeks) and claimant's left arm (10 percent of 
 
            250 weeks or 25 weeks).  The total reduction is 250 weeks.  
 
            The Second Injury Fund's liability is 150 weeks of benefits.  
 
            (File number 909208.)]
 
            
 
                 WHEREFORE, the decision of the deputy is affirmed and 
 
            modified.
 
            
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That in file number 865975, defendants are to pay 
 
            claimant additional healing period benefits from June 14, 
 
            1988 to August 30, 1988, at the stipulated rate of two 
 
            hundred forty-nine and 14/l00 dollars ($249.14).
 
            
 
                 That in file number 909208, defendants shall pay 
 
            claimant twelve point five (12.5) weeks of permanent partial 
 
            disability benefits at the stipulated rate of two hundred 
 
            sixty-six and 98/l00 dollars ($266.98) commencing March 5, 
 
            1990.
 
            
 
                 That the Second Injury Fund shall pay claimant one 
 
            hundred fifty (150) weeks of permanent partial disability 
 
            benefits commencing twenty-five (25) weeks after March 5, 
 
            1990, at the stipulated weekly rate of two hundred sixty-six 
 
            and 98/l00 dollars ($266.98).
 
            
 
                 That claimant and the Second Injury Fund shall each pay 
 
            one-half the costs of the transcription of the hearing.
 
            
 
                 That employer/insurance carrier and the Second Injury 
 
            Fund each pay one-half of all other costs of these 
 
            proceedings pursuant to rule 343 IAC 4.33.
 
            
 
                 That defendants shall receive credit for benefits 
 
            previously paid.
 
            
 
                 That defendant employer and claimant shall determine 
 
            the proper amount of credit for benefits previously paid by 
 
            defendant employer.
 
            
 
                 That all accrued benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue on benefits paid by employer 
 
            pursuant to Iowa Code section 85.30.
 
            
 
                 That interest will accrue on benefits paid by the 
 
            Second Injury Fund commencing on the date of this decision.  
 
            Second Injury Fund of Iowa v. Braden, 459 N.W.2d 467, 473 
 
            (Iowa 1990).
 
            
 
                 That defendants file claim activity reports as 
 
            requested by this agency pursuant to rule 343 IAC 3.l.
 
            
 
                 Signed and filed this ____ day of September, 1992.
 
            
 
            
 
            
 
            
 
                                          
 
                                     ________________________________
 
                                                   BYRON K. ORTON
 
                                              INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            Mr. Fredd J. Haas
 
            Attorney at Law
 
            5001 S.W. 9th St.
 
            Des Moines, Iowa 50315
 
            
 
            Mr. Harry W. Dahl
 
            Attorney at Law
 
            974 73rd St., Ste 16
 
            Des Moines, Iowa 50312
 
            
 
            Mr. Robert D. Wilson
 
            Assistant Attorney General
 
            Tort Claims Division
 
            Hoover State Office Bldg.
 
            Des Moines, Iowa 50319
 
            
 
 
            
 
            
 
            
 
            
 
            
 
                                            5-1108; 1804; 5-3200
 
                                            Filed September 29, 1992
 
                                            Byron K. Orton
 
            
 
            
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
            MARTHA DEPPE,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File Nos. 909208 & 
 
                                                           865975
 
            MIDWEST MANUFACTURING,        :
 
                                          :              A P P E A L
 
                 Employer,                :
 
                                          :            D E C I S I O N
 
            and                           :
 
                                          :
 
            SENTRY INSURANCE,             :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
            5-1108; 1804
 
            Claimant's right hand was amputated in a work-related 
 
            accident on May 18, 1981.  She underwent twenty surgical 
 
            procedures.  Her right hand is virtually useless.  She was 
 
            given a 90 percent impairment rating of the right arm.  
 
            Claimant returned to work in October 1985.  On December 15, 
 
            1986 she bid for and was placed as a multi-spindle operator.  
 
            this work required eight hours of repetitive hand activity.  
 
            She developed severe pain in her left wrist, elbow and 
 
            shoulder.  In July 1987, she had a deQuervain's release on 
 
            the left and in November 1987, ulnar nerve release with 
 
            epicondylectomy on left elbow was performed.  She returned 
 
            to work in June 1988 and worked on and off until January 
 
            1989, when she quit due to left upper extremity pain.  In 
 
            October 1989, she was given a ten percent impairment rating 
 
            to the left upper extremity.
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            5-3200
 
            Claimant's combined disability caused by the May 1981 right 
 
            arm disability and subsequent work injuries have caused 
 
            industrial disability which should be compensated by Second 
 
            Injury Fund.  Claimant's industrial disability after the 
 
            first alleged work injury did not exceed the combined total 
 
            of her prior losses and there was no Fund liability for that 
 
            injury.  Her current total cumulative industrial disability 
 
            after the other work injuries exceeded the combined total of 
 
            her prior losses and there was Fund liability.
 
            Claimant completed the 9th grade of school and received her 
 
            GED certificate in 1984.  Her work activity consists of 
 
            various unskilled factory jobs.  She can't perform her past 
 
            work.  A vocational expert stated that she has no marketable 
 
            transferable skills to other employment.  A functional 
 
            impairment rating of 90 percent to right arm and ten percent 
 
            of left upper extremity was given.  Claimant receives social 
 
            security disability, has not looked for work since June 
 
            1990, and has made no effort to participate in vocational 
 
            rehabilitation.  Claimant is not motivated to work.  
 
            Claimant determined to have a current cumulative industrial 
 
            disability of 80 percent.  Employer is responsible for 25 
 
            weeks and Second Injury Fund liable for 150 weeks.
 
            The Fund's liability is determined by using the following 
 
            formula:
 
             400   weeks  (industrial disability resulting from combined
 
                                effect of all injuries; 500 x 80)
 
            -225   weeks  (impairment value of prior loss [right arm]; 
 
                                90% x 250 weeks)
 
            - 25   weeks  (combined losses from work injuries; 10
 
                                percent impairment to left arm or 10% x
 
                                250 weeks)
 
            =150  weeks   (Second Injury Fund liability)
 
                 
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                      before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            MARTHA DEPPE,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File Nos. 909208 & 
 
            865975
 
            MIDWEST MANUFACTURING,        :
 
                                          :        A R B I T R A T I O N
 
                 Employer,                :
 
                                          :           D E C I S I O N
 
            and                           :
 
                                          :
 
            SENTRY INSURANCE,             :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Martha 
 
            Deppe, claimant, against Midwest Manufacturing, employer, 
 
            and Sentry Insurance, insurance carrier, as well as the 
 
            Second Injury Fund of Iowa, based upon injuries that 
 
            occurred on May 18, 1981 to the right hand; and,  April 25, 
 
            1987 to the left upper extremity (file number 865975); and 
 
            January 12, 1989, aggravation of left upper extremity, (file 
 
            number 909208).  This matter came on for hearing before the 
 
            undersigned deputy industrial commissioner on May 24, 199l, 
 
            in Des Moines, Iowa.  The record in this case consists of 
 
            the testimony of claimant and joint exhibits 1-45.
 
            
 
                                      issues
 
            
 
                 The issues presented for determination in file number 
 
            865975 are as follows:
 
            
 
                 1.  Whether claimant is entitled to additional 
 
            temporary total disability or healing period benefits;
 
            
 
                 2.  The extent of entitlement to weekly compensation 
 
            for permanent disability, if defendants are liable for the 
 
            injury;
 
            
 
                 3.  The type of permanent disability, if the injury is 
 
            found to be a cause of permanent disability;
 
            
 
                 4.  The commencement date for permanent partial 
 
            disability, in the event such benefits are awarded; and,
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
                 5.  Second injury fund liability.
 
            
 
                 The issues presented for determination in file number 
 
            909208 are as follows:
 
            
 
                 1.  Whether the January 12, 1989 injury is a cause of 
 
            permanent disability;
 
            
 
                 2.  Whether claimant is entitled to additional 
 
            temporary total disability or healing period benefits;
 
            
 
                 3.  The extent of entitlement to weekly compensation 
 
            for permanent disability, if defendants are liable for the 
 
            injury;
 
            
 
                 4.  The type of permanent disability, if the injury is 
 
            found to be a cause of permanent disability;
 
            
 
                 5.  The commencement date for permanent partial 
 
            disability, in the event such benefits are awarded; and,
 
            
 
                 6.  Second injury fund liability.
 
            
 
                                 findings of fact
 
            
 
                 The undersigned has carefully considered all the 
 
            testimony given at the hearing, the arguments made, the 
 
            evidence contained in the exhibits herein, and makes the 
 
            following findings:
 
            
 
                 Claimant was born on December 3, 1950 and completed the 
 
            ninth grade of school.  She dropped out of school at age 15 
 
            in order to get married.  She received her GED certificate 
 
            in 1984.  She worked at various times as a waitress, 
 
            assembly line worker, office cleaner and cook.  On April 19, 
 
            1977, she commenced employment with Midwest Manufacturing 
 
            Company.  She worked there on and off until January 26, 
 
            1989.  She held various jobs there including press operator, 
 
            inspector, spot welder, fork lift operator and multi-spindle 
 
            operator.  She was last employed at Progress Industries as 
 
            an assembly line worker.  She worked there from March 
 
            through May 1990.
 
            
 
                 Claimant testified that she applied for social security 
 
            disability benefits in the Summer of 1989.  A hearing was 
 
            held on July 26, 1990.  She was found disabled for social 
 
            security purposes and started receiving benefits in December 
 
            1990.
 
            
 
                 On May 18, 1981, claimant's right (primary) hand was 
 
            amputated when caught in a production press.  Medical 
 
            treatment by Douglas Reagan, M.D., orthopedic surgeon, 
 
            followed, including 18 to 20 surgeries for replacement of 
 
            the right hand and partial fingers.  During her recuperation 
 
            period a left wrist carpal tunnel syndrome was diagnosed and 
 
            released in November 1981.  On October 24, 1983, Dr. Reagan 
 
            assigned a permanent disability rating of 90 percent of the 
 
            right hand.  Dr. Reagan testified in a deposition dated 
 
            September 16, 1985, that claimant may have some difficulty 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            with heavy lifting because she has some limitation of motion 
 
            with twisting her wrist or pronation and supination as well 
 
            as difficulty with use of her right hand for fine 
 
            activities.  In addition, pinching and grasping will be 
 
            difficult functions for her to perform (Exhibits 1-15).
 
            
 
                 Claimant testified that she returned to Midwest 
 
            Manufacturing for the first time after the May 18, 1981, 
 
            accident on October 16, 1985.  She stated that her right 
 
            hand was virtually useless except as a hook or to hold 
 
            things down.  She stated that there were jobs at Midwest she 
 
            was unable to perform and was first assigned to do spot 
 
            welding.  In December 1985, she was placed as a fork lift 
 
            operator.  She performed this work for about one year but 
 
            developed left-sided upper extremity problems involving her 
 
            hand, wrist and shoulder.  On December 15, 1986, she bid for 
 
            the multi-spindle operator job.  She testified that this job 
 
            required repetitive activity for eight hours a day.  As a 
 
            result, she developed severe pain in her left wrist, elbow 
 
            and shoulder.  Claimant presented to Dr. Reagan on June 29, 
 
            1987, with complaints of left sided upper extremity pain.  
 
            X-rays revealed no bony or soft tissue abnormalities.  
 
            Claimant complained of neck pain also.  X-rays revealed some 
 
            degenerative changes at the C6 level with some narrowing.  
 
            Dr. Reagan's impression included (1) cubital tunnel 
 
            syndrome, right and left; (2) possible ulnar tunnel 
 
            syndrome, right and left; and, (3) left deQuervain's 
 
            syndrome.  Dr. Reagan recommended EMG studies.  These were 
 
            performed on July 27, 1987, and revealed mild left ulnar 
 
            neuropathy, at or near the elbow.  On July 28, 1987, Dr. 
 
            Reagan performed a deQuervain's release on the left.  
 
            
 
                 Claimant testified that she was released to return to 
 
            work on September 2, 1987, and returned to Midwest as a 
 
            spindle operator, the same job she held previously.  
 
            However, because of persistent problems with left shoulder 
 
            and neck pain, she was taken off work by Dr. Reagan in 
 
            October 1987.  She ultimately had surgery on November 17, 
 
            1987, (ulnar nerve release with epicondylectomy on left 
 
            elbow).
 
            
 
                 Claimant presented to Dr. Reagan on February 17, 1988, 
 
            with left-sided complaints including severe pain in the 
 
            shoulder and back.  She was referred to W. C. Koenig, Jr., 
 
            M.D., at Younker Rehabilitation Center.  Dr. Koenig felt 
 
            that her shoulder and back problems were related to a 
 
            myofascial syndrome.  Claimant improved with therapy and on 
 
            May 2, 1988, Dr. Reagan released her to return to work.  She 
 
            returned to work on June 6, 1988 but was taken off work 
 
            again on June 13, 1988, because of increased pain problems.  
 
            She was off work until August 29, 1988, when Dr. Reagan felt 
 
            she could return to work.  On December 19, 1988, Dr. Reagan 
 
            gave claimant a five percent permanent partial impairment of 
 
            the left upper extremity (Ex. 19, pages 25-33).
 
            
 
                 In January 1989, claimant's symptoms were so severe 
 
            that she stopped all work activity.  On January 31, 1989, 
 
            claimant presented to Iowa Methodist Medical Center Clinic 
 
            where she saw Michael J. Makowsky, M.D., with complaints of 
 
            sharp, burning pain in the left hand.  She related that the 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            pain radiated often into her left elbow.  His impression was 
 
            overuse syndrome of the left arm and hand.  EMG's were taken 
 
            on February 1, 1989, and were normal.  Claimant returned to 
 
            Dr. Reagan on February 17, 1989, and was injected.  Because 
 
            of pain, Dr. Reagan advised her to remain off work until a 
 
            re-evaluation on March 6, 1989.  During that evaluation, she 
 
            was placed in a wrist splint to limit her motion.  On April 
 
            3, 1989, Dr. Reagan felt that she could return to light duty 
 
            if such could be arranged.  Claimant remained in treatment 
 
            with Dr. Reagan and on September 28, 1989, he indicated that 
 
            she had reached maximum improvement.  On October 26, 1989, 
 
            he gave her a 10 percent impairment rating to the left upper 
 
            extremity (Ex. 19, pp. 34-37).
 
            
 
                 The claimant's last day of work for Midwest 
 
            Manufacturing Company was January 28, 1989.  At that time, 
 
            she reported earning $10.85 per hour.  While off work, 
 
            claimant participated in physical therapy, pain management 
 
            and vocational rehabilitation.  During the first three 
 
            months of 1990, claimant completed both a bio-feedback 
 
            program and physical therapy at Iowa Methodist Medical 
 
            Center.  In March 1990, she completed a vocational analysis 
 
            and work sampling at Progress Industries.  Her tested 
 
            aptitudes were strongest in clerical coordination and 
 
            material control, and she was placed in a light duty area at 
 
            Progress Industries sorting and packaging small items.  She 
 
            was paid $3.40 per hour.  This sheltered employment was 
 
            discontinued after eight weeks by order of Dr. Makowsky, due 
 
            to swelling developing in the arms and hands caused by 
 
            repetitive use of the upper extremities.  A vocational 
 
            evaluation performed by Roger Marquardt on November 5, 1990, 
 
            found that "unskilled jobs within Martha Deppe's physical 
 
            limitations exist in no more than 5% of that over-all job 
 
            market."  (Ex. 32, p. 4).
 
            
 
                 Dr. Reagan again testified by way of deposition on 
 
            January 21, 1991.  He stated he last saw claimant on October 
 
            26, 1989.  He indicated that his records show that claimant 
 
            reached maximum medical improvement on September 28, 1989, 
 
            and at that time was given a permanent partial impairment of 
 
            the left upper extremity of 10 percent.  This included her 
 
            cubital tunnel syndrome, the ulnar tunnel syndrome, the left 
 
            deQuervain's syndrome and any myofascial problems she was 
 
            having in the left extremity.  It was Dr. Reagan's medical 
 
            opinion that claimant's right hand and left upper extremity 
 
            problems were of a permanent nature.  He indicated that she 
 
            is permanently restricted as to her ability to engage in any 
 
            occupations where she has to perform repetitive activities 
 
            (Ex. 37).
 
            
 
                                conclusions of law
 
            
 
                 In file number 865975, the parties stipulate that 
 
            claimant sustained an injury to her left upper extremity on 
 
            April 25, 1987, which arose out of and in the course of her 
 
            employment with employer and that such injury is a cause of 
 
            temporary and permanent disability.  Defendants have paid 
 
            claimant 40 2/7 weeks of healing period benefits and 12.5 
 
            weeks of permanent partial disability benefits at the 
 
            stipulated rate of $249.14 per week.  Claimant seeks 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            additional healing period benefits for the period from June 
 
            14, 1988 to August 30, 1988.
 
            
 
                 Section 85.34(l), Code of Iowa, provides that healing 
 
            period benefits are payable to an injured worker who has 
 
            suffered permanent partial disability until:  (1) he has 
 
            returned to work; (2) is medically capable of returning to 
 
            substantially similar employment; or, (3) has achieved 
 
            maximum medical recovery.  The industrial commissioner has 
 
            recognized that healing period benefits can be interrupted 
 
            or intermittent.  Willis v. Lehigh Portland Cement Company, 
 
            Vol. 2-1, State of Iowa Industrial Commissioner Decisions, 
 
            485 (1984).
 
            
 
                 Defendants have paid healing period benefits from July 
 
            23, 1987 through September 6, 1987 and from October 13, 1987 
 
            through June 4, 1988.
 
            
 
                 Claimant testified that Dr. Reagan released her to 
 
            return to work on June 6, 1988 and at that time she returned 
 
            to her job as a multi-spindle operator.  She worked until 
 
            June 13, 1988 when, because of increased pain, Dr. Reagan 
 
            took her off work again.  She returned to work on August 30, 
 
            1988, in her usual job as a multi-spindle operator and 
 
            earned $10.85 per hour.
 
            
 
                 The documentary evidence supports claimant's claim that 
 
            she was taken off work on June 13, 1988 and did not return 
 
            until August 30, 1988.  Progress notes from Dr. Reagan dated 
 
            June 13, 1988 through August 29, 1988 corroborate claimant's 
 
            testimony (Ex. 19, p. 33).  Employer's personnel records 
 
            show that claimant returned from a plant injury on June 6, 
 
            1988 (Ex. 33, p. 39) and worked until June 13, 1988, when 
 
            she was taken off work due to a plant injury (Ex. 33, p. 
 
            37).  Claimant returned to work on August 30, 1988 (Ex. 33, 
 
            p. 36).
 
            
 
                 Claimant has met her burden of proof that she is 
 
            entitled to additional healing period benefits from June 14, 
 
            1988 through August 30, 1988.
 
            
 
                 Claimant alleges that she sustained an aggravation of 
 
            her preexisting left upper extremity problems on January 12, 
 
            1989, which arose out of and in the course of employment 
 
            with employer.  Claimant alleges that such injury is a cause 
 
            of temporary and permanent disability.  Employer/insurance 
 
            company stipulate that claimant's injury caused temporary 
 
            disability but dispute that she sustained permanent 
 
            disability.  They have paid claimant temporary total 
 
            disability benefits for the period from January 13, 1989 
 
            through January 15, 1989; from January 30, 1989 through 
 
            February 5, 1989; and from February 6, 1989 through March 4, 
 
            1990.
 
            
 
                 Claimant claims that she is entitled to healing period 
 
            benefits from January 13, 1989 to January 18, 1989 and from 
 
            January 30, 1989 to March 8, 1990.  Claimant also requests 
 
            weekly compensation for permanent disability benefits.
 
            
 
                 The Second Injury Fund of Iowa disputes that claimant 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            sustained an injury on January 12, 1989, which arose out of 
 
            and in the course of employment with employer and that such 
 
            injury is a cause of temporary and permanent disability.
 
            
 
                 The uncontroverted medical evidence reveals that 
 
            claimant's extremity symptoms were aggravated by her 
 
            repetitive work activities.  On January 12, 1989, she 
 
            received a cortisone injection due to pain.  She testified 
 
            that her previous condition was exacerbated by her work 
 
            activity.  She stated she was off work from January 13, 1989 
 
            through January 15, 1989, returned to work and was off again 
 
            on January 29, 1989.  She was referred by employer to 
 
            Michael Makowsky, M.D., for evaluation on January 31, 1989.  
 
            Dr. Makowsky testified in a deposition on October 17, 1990.  
 
            He stated that he has the Midwest factory and has seen most 
 
            of the work areas.  Claimant described to him repetitive 
 
            motions performed while working with up to 900 gears per 
 
            night, each weighing about a pound and a half.  She was 
 
            actively handling these and putting them into the machine 
 
            and then picking them up afterwards.  His findings on 
 
            examination noted swelling in the left hand and some 
 
            enlargement.  She also had some tenderness on palpation and 
 
            a questionable positive Tinel's sign.  His diagnosis was 
 
            overuse syndrome, a general term for a group of medical 
 
            problems that include tendonitis and nerve entrapment.  He 
 
            stated that he took her off work until she had a complete 
 
            evaluation.  She was seen intermittently until May 14, 1990, 
 
            when she was discharged from his care (Ex. 20, pp. 1-10).
 
            
 
                 Claimant remained off work from January 30, 1989 until 
 
            March 13, 1990, when she enrolled in a Program with Progress 
 
            Industries (a non-profit shelter facility for disabled 
 
            persons in Newton, Iowa).
 
            
 
                 Dr. Makowsky testified that he saw claimant on May 14, 
 
            1990 and, at that time, her symptoms appeared more severe 
 
            than before.  He attributed this to the work she was doing 
 
            at Progress Industries and he recommended that she stop 
 
            working there (Ex. 38 & Ex. 20, p. 10).  Claimant has not 
 
            been employed since May 1990.
 
            
 
                 The uncontroverted medical evidence clearly 
 
            demonstrates that claimant sustained an injury on January 
 
            12, 1989, diagnosed by Dr. Makowsky as an overuse syndrome 
 
            of the left arm and tendonitis of the left wrist (Ex. 31, p. 
 
            15).  Claimant has sustained her burden of proving by a 
 
            preponderance of the evidence that such injury is causally 
 
            related to the disability on which she now bases her claim.  
 
            Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 
 
            (1965).  Lindahl v. L. O. Boggs Co., 236 Iowa 296, 18 N.W.2d 
 
            607 (1945).  
 
            
 
                 Physicians who have treated claimant have consistently 
 
            held that claimant's left upper extremity problems have 
 
            resulted in permanent disability.  Dr. Reagan, her primary 
 
            treating physician, gave her a total 10 percent disability 
 
            rating to the left upper extremity.  He imposed significant 
 
            restrictions on claimant's use of her left upper extremity.  
 
            Dr. Makowsky concurred with Dr. Reagan's impairment rating 
 
            and also imposed permanent restrictions on her ability to 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            use her left extremity (Ex. 37, p. 22 & Ex. 38, p. 15).
 
            
 
                 Claimant's left upper extremity problems do not extend 
 
            into the body as a whole.
 
            
 
                 An injury to a scheduled member may, because of after 
 
            effects (or compensatory change), result in permanent 
 
            impairment of the body as a whole.  Such impairment may in 
 
            turn form the basis for a rating of industrial disability.  
 
            Dailey v. Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 
 
            (1943).  Soukup v. Shores Co., 222 Iowa 272, 268 N.W. 598 
 
            (1936).
 
            
 
                 An injury to a scheduled member which, because of 
 
            after-effects (or compensatory change), creates impairment 
 
            to the body as a whole entitles claimant to industrial 
 
            disability.  Barton v. Nevada Poultry Co., 253 Iowa 285, 110 
 
            N.W.2d 660 (1961).  Daily, 233 Iowa 758, 10 N.W.2d 569 
 
            (1943).
 
            
 
                 An injury is the producing cause; the disability, 
 
            however, is the result, and it is the result which is 
 
            compensated.  Barton, 253 Iowa 285, 110 N.W.2d 660 (1961); 
 
            Dailey, 233 Iowa 758, 10 N.W.2d 569 (1943).
 
            
 
                 If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
            
 
                 Claimant has not sustained her burden of proof that her 
 
            left upper extremity injury has resulted in an impairment 
 
            extending beyond the scheduled loss.  Therefore, claimant is 
 
            to be compensated for this loss pursuant to Iowa Code 
 
            section 85.34(2)(m).
 
            
 
                 Employer has paid temporary disability benefits for the 
 
            following period of time; January 13 through January 15, 
 
            1989; January 30 through February 5, 1989; and February 6 
 
            through March 4, 1990.  Claimant has not shown by a 
 
            preponderance of the evidence that she is entitled to 
 
            additional healing period benefits in file number 909208.   
 
            
 
                 Claimant sustained an additional five percent permanent 
 
            partial disability to the left upper extremity when she 
 
            aggravated her left upper extremity on January 12, 1989.  
 
            Claimant alleges that the combined disability caused by the 
 
            May 18, 1981 right hand injury and the injury of April 25, 
 
            1987 to the left upper extremity which was aggravated on 
 
            January 12, 1989, has caused industrial disability which 
 
            should be compensated by the second injury fund.  According 
 
            to Dr. Reagan, claimant has sustained a 90 percent 
 
            disability to the right hand and a 10 percent disability to 
 
            the left upper extremity.
 
            
 
                 Under Iowa Code section 85.63 through 85.69, three 
 
            requirements must be met in order to establish Fund 
 
            liability:  First, claimant must have previously lost or 
 
            lost the use of a hand, an arm, a foot, a leg, or an eye; 
 
            second, through another compensable injury, claimant must 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            sustain another loss or loss of use of another member; and 
 
            third, permanent disability must exist as to both injuries.  
 
            If the second injury is limited to a scheduled member, then 
 
            the employer's liability is limited to the schedule and the 
 
            Fund is responsible for the excess industrial disability 
 
            over the combined scheduled loss of the first and second 
 
            injuries.  See Simbro v. Delong's Sportswear, 332 N.W.2d 886 
 
            (Iowa 1983) and Second Injury Fund v. Neelans, 436 N.W.2d 
 
            355 (Iowa 1989).
 
            
 
                 Functional impairment is an element to be considered in 
 
            determining industrial disability which is the reduction of 
 
            earning capacity, but consideration must also be given to 
 
            the injured employee's age, education, qualifications, 
 
            experience and inability to engage in employment for which 
 
            he is fitted.  Olson v. Goodyear Service Stores, 255 Iowa 
 
            1112, 125 N.W.2d 251 (1963).  Barton v. Nevada Poultry, 253 
 
            Iowa 285, 110 N.W.2d 660 (1961).
 
            
 
                 A finding of impairment to the body as a whole found by 
 
            a medical evaluator does not equate to industrial disabil
 
            ity.  This is so as impairment and disability are not syn
 
            onymous.  Degree of industrial disability can in fact be 
 
            much different than the degree of impairment because in the 
 
            first instance reference is to loss of earning capacity and 
 
            in the latter to anatomical or functional abnormality or 
 
            loss.  Although loss of function is to be considered and 
 
            disability can rarely be found without it, it is not so that 
 
            a degree of industrial disability is proportionally related 
 
            to a degree of impairment of bodily function.
 
            
 
                 Factors to be considered in determining industrial dis
 
            ability include the employee's medical condition prior to 
 
            the injury, immediately after the injury, and presently; the 
 
            situs of the injury, its severity and the length of healing 
 
            period; the work experience of the employee prior to the 
 
            injury, after the injury and potential for rehabilitation; 
 
            the employee's qualifications intellectually, emotionally 
 
            and physically; earnings prior and subsequent to the injury; 
 
            age; education; motivation; functional impairment as a 
 
            result of the injury; and inability because of the injury to 
 
            engage in employment for which the employee is fitted.  Loss 
 
            of earnings caused by a job transfer for reasons related to 
 
            the injury is also relevant.  These are matters which the 
 
            finder of fact considers collectively in arriving at the 
 
            determination of the degree of industrial disability.
 
            
 
                 There are no weighting guidelines that indicate how 
 
            each of the factors are to be considered.  There are no 
 
            guidelines which give, for example, age a weighted value of 
 
            ten percent of the total value, education a value of fifteen 
 
            percent of total, motivation - five percent; work experience 
 
            - thirty percent, etc.  Neither does a rating of functional 
 
            impairment directly correlate to a degree of industrial 
 
            disability to the body as a whole.  In other words, there 
 
            are no formulae which can be applied and then added up to 
 
            determine the degree of industrial disability.  It therefore 
 
            becomes necessary for the deputy or commissioner to draw 
 
            upon prior experience, general and specialized knowledge to 
 
            make the finding with regard to degree of industrial dis
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            ability.  See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985);  Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, l985).
 
            
 
                 Factors to be considered when assessing industrial 
 
            disability include claimant's age, education, experience, 
 
            impairment and work restrictions.
 
            
 
                 Claimant is currently 40 years old.  She completed the 
 
            ninth grade of school and received her GED certificate in 
 
            1984.  Claimant's work activity has consisted of various 
 
            factory unskilled jobs.  In 1977, she was hired by Midwest 
 
            Manufacturing as a production worker and her duties included 
 
            operating various production machines, driving a fork lift, 
 
            spot welding and other production line assignments.  She 
 
            cannot perform any of her past relevant work.  According to 
 
            Roger Marquardt, a Vocational Specialist, claimant has "no 
 
            marketable transferable skills to other employment."  (Ex. 
 
            32, p. 4)  He noted that in the unskilled market she is 
 
            limited to child care work or duties as a 
 
            telphone/switchboard operator or security guard.  He 
 
            recommended vocational rehabilitation.
 
            
 
                 Claimant has an impairment rating of 90 percent to the 
 
            right hand and 10 percent to the left upper extremity.  Her 
 
            right hand is noticeably disfigured, without thumb and with 
 
            three misplaced fingers.  Obviously, she has no grip on the 
 
            right.  In compensating for her right hand limitations, 
 
            claimant overused her left extremity and developed orbital 
 
            tunnel syndrome, ulnar tunnel syndrome, left deQuervain's 
 
            syndrome and myofascial pain in the left neck, shoulder and 
 
            arm.  She has restricted use of this upper extremity and 
 
            cannot engage in activities requiring repetitive use of the 
 
            left hand and arm; repetitive grasping; and lifting in 
 
            excess of 10 pounds.  Machine-paced jobs are outside of her 
 
            residual functional capacity and without comprehensive 
 
            vocational rehabilitation, she is limited in the type of 
 
            competitive employment she is able to perform.  Due to the 
 
            lack of upper extremity gross movement and fine dexterity 
 
            use, she is unable to perform the duties of her past work.  
 
            At the present time, without further vocational 
 
            rehabilitation, claimant is technically limited to unskilled 
 
            work activity.  According to Mr. Marquardt, "unskilled jobs 
 
            within Martha Deppe's physical limitations exist in no more 
 
            than 5% of that over-all job market."
 
            
 
                 Claimant testified that she received unemployment 
 
            compensation benefits from March through June 1990, and held 
 
            herself out as ready, willing and able to work.  The last 
 
            time she looked for any type of employment was in June 1990.  
 
            Claimant was found eligible for social security disability 
 
            benefits in December 1990.  Claimant testified that she does 
 
            not know of any type of work she can perform, yet she has 
 
            not attempted to find employment since June 1990 and appears 
 
            even less motivated now that she receives social security 
 
            disability benefits.
 
            
 
                 It is found that as a result of the combined effect of 
 
            the right and left upper extremity injuries, claimant is 80 
 
            percent industrially disabled.  Claimant is, therefore, 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            entitled to 400 weeks of benefits less the scheduled member 
 
            disability.  The right hand was rated at 90 percent which 
 
            amounts to 171 weeks pursuant to Iowa Code section 
 
            85.34(2)(l).  The left upper extremity was rated at 10 
 
            percent which amounts to 25 weeks pursuant to Iowa Code 
 
            section 85.34(2)(m).  The combined scheduled member 
 
            disability equals 196 weeks (171 + 25).
 
            
 
                 The Fund's liability is determined by using the 
 
            following formula:
 
            
 
                 400 weeks  (industrial disability resulting from 
 
            combined                                        effect of 
 
            all injuries 500 weeks x 80%)
 
            
 
                -171 weeks  (impairment value of the prior loss: (right                       
 
            hand) 90% of 190 weeks)
 
            
 
               - 12.50 weeks (File No. 865975: impairment value of the 
 
            second                                    injury (left upper 
 
            extremity) for which                                     
 
            defendant employer is responsible 5% x 250                    
 
            weeks)
 
            
 
              - 12.50 weeks (File No. 909208: impairment value of second                     
 
            injury aggravation of left upper extremity, for                   
 
            which defendant employer is responsible; 5% x 250                 
 
            weeks)
 
                 ____
 
                  250 weeks  Second Injury Fund Liability
 
            
 
                 Accordingly, in file number 909208, claimant has 
 
            established entitlement to 204 weeks of benefits to be paid 
 
            by the State of Iowa Second Injury Fund.
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 In file number 865975, defendants are to pay claimant 
 
            additional healing period benefits from June 14, 1988 to 
 
            August 30, 1988, at the stipulated rate of two hundred 
 
            forty-nine and 14/l00 dollars ($249.14).
 
            
 
                 In file number 909208, defendants shall pay claimant 
 
            twelve point five (12.5) weeks of permanent partial 
 
            disability benefits at the stipulated rate of two hundred 
 
            sixty-six and 98/l00 dollars ($266.98) commencing March 5, 
 
            1990.
 
            
 
                 The Second Injury Fund of Iowa shall pay claimant two 
 
            hundred four (204) weeks of permanent partial disability 
 
            benefits commencing twenty-five (25) weeks after March 5, 
 
            1990, at the stipulated weekly rate of two hundred sixty-six 
 
            and 98/l00 dollars ($266.98).
 
            
 
                 That employer/insurance carrier and the Second Injury 
 
            Fund of Iowa each pay one-half of the costs of these 
 
            proceedings pursuant to rule 343 IAC 4.33.
 
            
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
                 That defendants shall receive credit for benefits 
 
            previously paid.
 
            
 
                 That all accrued benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue on benefits paid by employer 
 
            pursuant to Iowa Code section 85.30.
 
            
 
                 That interest will accrue on benefits paid by the 
 
            Second Injury Fund of Iowa commencing on the date of this 
 
            decision.  Second Injury Fund of Iowa v. Braden, 459 N.W.2d 
 
            467, 473 (Iowa 1990).
 
            
 
                 That defendants file claim activity reports as 
 
            requested by this agency pursuant to rule 343 IAC 3.l.
 
            
 
            
 
            
 
                 Signed and filed this ____ day of June, 1991.
 
            
 
            
 
            
 
            
 
            
 
                                          ______________________________               
 
            JEAN M. INGRASSIA
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Fredd J. Haas
 
            Attorney at Law
 
            5001 SW 9th St
 
            Des Moines  IA  50315
 
            
 
            Mr. Harry W. Dahl
 
            Attorney at Law
 
            974 73rd St
 
            Suite 16
 
            Des Moines  IA  50312
 
            
 
            Mr. Robert D. Wilson
 
            Assistant Attorney General
 
            Hoover Bldg
 
            Des Moines  IA  50319
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                      before the iowa industrial commissioner
 
         ____________________________________________________________
 
                                       :
 
         MARTHA DEPPE,                 :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :      File Nos. 909208 & 865975
 
         MIDWEST MANUFACTURING,        :
 
                                       :             N U N C
 
              Employer,                :
 
                                       :              P R O
 
         and                           :
 
                                       :             T U N C
 
         SENTRY INSURANCE,             :
 
                                       :            O R D E R
 
              Insurance Carrier,       :
 
                                       :
 
         and                           :
 
                                       :
 
         SECOND INJURY FUND OF IOWA,   :
 
                                       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         A decision was rendered in the above named cases on June 20, 
 
         1991.  Subsequently, it was discovered that the body of the 
 
         decision contained a computation error on page 11.  As correctly 
 
         stated in the order, the Second Injury Fund's liability is two 
 
         hundred four (204) weeks rather than two hundred fifty (250) 
 
         weeks set out in the formula on page 11 of the decision.
 
         
 
         
 
              Signed and filed this ____ day of June, 1991.
 
         
 
         
 
         
 
         
 
         
 
                                       ______________________________               
 
         JEAN M. INGRASSIA
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Fredd J. Haas
 
         Attorney at Law
 
         5001 SW 9th St
 
         Des Moines  IA  50315
 
         
 
         Mr. Harry W. Dahl
 
         Attorney at Law
 
         974 73rd St
 
         Suite 16
 
         Des Moines  IA  50312
 
         
 
 
         
 
         Page   1
 
         
 
         
 
         
 
         
 
         
 
         
 
                     before the iowa industrial commissioner
 
         ____________________________________________________________
 
                                       :
 
         RICHARD LOZANO,               :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :         File No. 909492
 
         IOWA STATE PENITENTIARY,      :
 
                                       :      A R B I T R A T I O N
 
              Employer,                :
 
                                       :         D E C I S I O N
 
         and                           :
 
                                       :
 
         STATE OF IOWA,                :
 
                                       :
 
              Insurance Carrier,       :
 
              Defendant.               :
 
         ___________________________________________________________
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration upon the petition of 
 
         claimant, Richard Lozano, against his self-insured employer, the 
 
         Iowa State Penitentiary, defendant.  The case was heard on 
 
         September 30, 1991, in Burlington, Iowa at the Des Moines County 
 
         courthouse.  The record consists of the testimony of claimant.  
 
         The record also consists of the testimony of Ellen Marie Lozano, 
 
         spouse; Deann Carl, daughter; Charles Wilkins; and Assistant 
 
         Deputy Warden.  The record is also comprised of joint exhibits 1-
 
         27.
 
         
 
              It is noted for the record there are numerous exhibits which 
 
         were duplicated more than once.  This resulted in undue delay in 
 
         reviewing the exhibits.  The attorneys are advised to avoid 
 
         duplication in the future.
 
         
 
                                      issue
 
         
 
              The issue to be determined is:  1) Whether claimant is enti
 
         tled to permanent disability, and if so, the extent of benefits 
 
         to which he is entitled.
 
         
 
                                 findings of fact
 
         
 
              The deputy, having heard the testimony and considered all 
 
         the evidence, finds:
 
         
 
              Claimant is a corrections officer at the Penitentiary in 
 
         Fort Madison.  He has been an employee there since February of 
 
         1983.  Claimant possesses a high school diploma.  Prior to his 
 
         employment with the state, claimant had only worked in unskilled 
 
         labor positions, primarily in the factory area.
 
         
 
              The parties stipulated that claimant sustained a 
 
         work-related injury on February 13, 1989.  An inmate struck 
 

 
         
 
         Page   2
 
         
 
         
 
         
 
         
 
         
 
         claimant with a steel bar on the side of the head.  An ambulance 
 
         transported claimant to the Fort Madison Community Hospital.  
 
         Later claimant was air lifted to the University of Iowa Hospitals 
 
         in Iowa City, Iowa where he was hospitalized for a number of 
 
         days.
 
         
 
              On February 15, 1989, claimant had surgery for a longitudi
 
         nal temporal bone fracture.  The surgeon, Dr. (first name 
 
         unknown) Hart, M.D., performed a decompression of the seventh 
 
         nerve using a middle cranial fossa approach.  The treating physi
 
         cian, L. A. Harker, M.D., diagnosed claimant as having "permanent 
 
         facial nerve paralysis, left side of face" (Exhibit 9, page 8).
 
         
 
              One of the examining physicians, Brian F. McCabe, M.D., 
 
         examined claimant.  In his deposition, Dr. McCabe testified that 
 
         claimant had sustained the following:
 
         
 
                 A.  The examination showed a hematoma behind the 
 
              left ear, a disrupted tympanic membrane covered by a 
 
              clot, and a positive Battle -- B-A-T-T-L-E -- sign.  
 
              It's a proper name.
 
         
 
                 Q.  What's it mean?
 
         
 
                 A.  Pardon?
 
         
 
                 Q.  What's it mean?
 
         
 
                 A.  It means that there was, evidence of broken 
 
              blood vessels under the scalp behind the ear, it indi
 
              cates a fracture.
 
         
 
                 Q.  I see.
 
         
 
                 A.  And he had a complete left facial paralysis.
 
         
 
                 Q.  And as a result of your examination, then, did 
 
              you come to a conclusion or -- I'm not sure what the 
 
              examination was even for.  You might tell us that.
 
         
 
                 A.  The examination was to find out what was wrong 
 
              with the patient, what were the sequelae of the injury, 
 
              and to come to some diagnosis.
 
         
 
                 Q.  Okay.  And then -- And as I understand it, your 
 
              impressions were the diagnosis.  Is that right?
 
         
 
                 A.  Yes, the diagnosis is a traumatic temporal bone 
 
              fracture on the left, producing hearing loss and com
 
              plete facial paralysis.
 
         
 
         (Ex. 24, p. 8, ll. 4 thru p. 9, l. 1)
 
         
 
              Subsequent to the date of the injury, claimant experienced 
 
         psychiatric difficulties.  Claimant was referred to the psychi
 
         atric unit at the University of Iowa Hospitals and Clinics.  
 
         Williams R. Yates, M.D., a board certified psychiatrist, treated 
 
         claimant for post-traumatic stress disorder which was related to 
 
         the injury in question.  Dr. Yates initially examined claimant on 
 

 
         
 
         Page   3
 
         
 
         
 
         
 
         
 
         
 
         February 21, 1989.  He opined claimant had "persistent and perva
 
         sive in terms of anxiety symptoms."  (Ex. 25, p. 5, ll. 10 & ll)  
 
         Dr. Yates treated claimant with medication and psychotherapy.
 
         
 
              As of the date of his deposition, Dr. Yates opined the fol
 
         lowing relative to claimant's condition:
 
         
 
              A  Well, over time, I think his symptoms have been 
 
              under reasonable good control.  He, during the early 
 
              portion of his treatment, had significant symptoms that 
 
              were impairing to him in terms of his day-to-day activ
 
              ities and his ability to work.  In the last six months 
 
              to 12 months, he has had some control of his symptoms 
 
              through the treatment approach and treatment plan that 
 
              we have carried out with him and I think that his symp
 
              toms have been under control based upon his response to 
 
              the treatment plan, which is psychotherapy and medica
 
              tion.
 
         
 
         (Ex. 25, p. 6, ll. 4-14)
 
         
 
              Dr. Yates also opined that:
 
         
 
              A  Well, he continues to have what I would consider 
 
              mild to moderate anxiety symptoms and occasional sleep 
 
              disturbances which are related to his psychiatric diag
 
              nosis.  I would think that his prognosis for being able 
 
              to continue working, now that he has done that over a 
 
              period of approximately ten months, that he would be 
 
              able to continue to work; however, I would expect that 
 
              he would continue at times to experience some psycho
 
              logical distress, depending upon what happens on par
 
              ticular days at work.
 
         
 
                 The other question that is unanswered at this point 
 
              is how long will he require medication management and 
 
              what will be his psychiatric status at the time that we 
 
              eventually taper or discontinue his medication.  He's 
 
              obviously able to resume work while taking that medica
 
              tion.  I don't know the extent of his anxiety symptoms 
 
              if we were to withdraw the Imiperimane, and only way we 
 
              will be able to determine that is at some point in the 
 
              future a trial discontinuation of that medication.
 
         
 
         (Ex. 25, p. 8, ll. 6-24)
 
         
 
              With respect to the medical management of claimant's condi
 
         tion, Dr. Yates testified:
 
         
 
              A  I would expect that at least medical management will 
 
              require an additional 12 to 18 months.  Our current 
 
              recommendation would be on a slow taper of the 
 
              Imiperimane medication and in the future -- When I saw 
 
              him on his last visit, he had reported more difficul
 
              ties with nightmares.  Since he had more symptoms, I 
 
              suggest that we hold off for a while before the taper
 
              ing of that medicine.  Once we begin tapering that 
 
              medicine, that process would take three to six months 
 
              and we would have to monitor the return of symptoms as 
 

 
         
 
         Page   4
 
         
 
         
 
         
 
         
 
         
 
              the medicine tapers.
 
         
 
         (Ex. 25, p. 9, ll. 2-11)
 
         
 
              In the prehearing report, the parties stipulated that 
 
         claimant was in the healing period from February 13, 1989 through 
 
         August 29, 1990.  Claimant then returned to work at the Iowa 
 
         State Penitentiary as a corrections officer.  Claimant was 
 
         released to work without restrictions.
 
         
 
              Since his return to work, claimant had requested and he was 
 
         placed on the third shift.  Now all correction officers are 
 
         required to rotate their duties every 90 days.  Claimant has 
 
         maintained at least an average on his yearly evaluations.  He has 
 
         received all promotions and pay raises due to him.
 
         
 
                                conclusions of law
 
         
 
              The sole issue here deals with permanent partial disability 
 
         benefits.
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of earn
 
         ing capacity, but consideration must also be given to the injured 
 
         employee's age, education, qualifications, experience and inabil
 
         ity to engage in employment for which the employee is fitted.  
 
         Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 
 
         (1963).  Barton v. Nevada Poultry, 253 Iowa 285, 110 N.W.2d 660 
 
         (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  
 
         Impairment and disability are not synonymous.  The degree of 
 
         industrial disability can be much different than the degree of 
 
         impairment because industrial disability references to loss of 
 
         earning capacity and impairment references to anatomical or func
 
         tional abnormality or loss.  Although loss of function is to be 
 
         considered and disability can rarely be found without it, it is 
 
         not so that a degree of industrial disability is proportionally 
 
         related to a degree of impairment of bodily function.
 
         
 
              Factors to be considered in determining industrial dis
 
         ability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of the healing period; 
 
         the work experience of the employee prior to the injury and after 
 
         the injury and the potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; earn
 
         ings prior and subsequent to the injury; age; education; motiva
 
         tion; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job trans
 
         fer for reasons related to the injury is also relevant.  
 
         Likewise, an employer's refusal to give any sort of work to an 
 
         impaired employee may justify an award of disability.  McSpadden 
 
         v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980).  These are mat
 
         ters which the finder of fact considers collectively in arriving 
 
         at the determination of the degree of industrial disability.
 
         
 

 
         
 
         Page   5
 
         
 
         
 
         
 
         
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  Neither does a rating of func
 
         tional impairment directly correlate to a degree of industrial 
 
         disability to the body as a whole.  In other words, there are no 
 
         formulae which can be applied and then added up to determine the 
 
         degree of industrial disability.  It therefore becomes necessary 
 
         for the deputy or commissioner to draw upon prior experience as 
 
         well as general and specialized knowledge to make the finding 
 
         with regard to degree of industrial disability.  See Peterson v. 
 
         Truck Haven Cafe, Inc., (Appeal Decision, February 28, 1985); 
 
         Christensen v. Hagen, Inc., (Appeal Decision, March 26, 1985).
 
         
 
              Compensation for permanent partial disability shall begin at 
 
         the termination of the healing period.  Compensation shall be 
 
         paid in relation to 500 weeks as the disability bears to the body 
 
         as a whole.  Section 85.34.
 
         
 
              In the case before this deputy, Dr. Harker has written that 
 
         as of February 7, 1990, he could not fully answer whether 
 
         claimant had incurred a permanent defect as a result of his 
 
         February 13, 1989 work injury.  Medical reports indicate that 
 
         claimant has a mild hearing loss.  (Ex. 9, p. 176-179)  
 
         Additionally, Dr. Harker has indicated in his report of August 
 
         27, 1990:  "He does have some residual that handicaps from this 
 
         injury he did not have before, and will never be 100% again."  
 
         (Ex. 9, p. 244)
 
         
 
              Then there is the psychiatric opinion of Dr. Yates.  
 
         Claimant is able to work so long as he remains on his prescribed 
 
         medications.  It is unknown whether claimant can ever be removed 
 
         from his medications, or even if the medications can be reduced.  
 
         Claimant shows symptoms of anxiety when he is alone with an 
 
         inmate.  He has testified he has nightmares at times.  He must 
 
         take the medication to control the nightmares.
 
         
 
              It is the determination of the undersigned that claimant has 
 
         sustained an industrial disability.  This deputy has witnessed 
 
         some of claimant's residual impairments.  Claimant is unable to 
 
         voluntarily close his left eye.  He is unable to raise his left 
 
         eyebrow.  Claimant has testified he is light sensitive and that 
 
         he is required to wear "photoray glasses" for this purpose.  
 
         Because of his light sensitivity, claimant prefers working the 
 
         night shift so he will not be assigned to an outside job on a 
 
         bright sunny day when he is unable to adjust his eyes as easily.  
 
         Claimant may be precluded from holding certain assignments, or 
 
         from firing a gun because of his inability to close his left eye.
 
         
 
              The undersigned deputy has witnessed claimant's unnatural 
 
         facial expression.  Claimant states he has paralysis of the face.  
 
         Claimant speaks out of the side of his mouth.  His speech is 
 
         slurred.  Claimant is required to verbally communicate in his 
 
         position.  His abilities to do so have been decreased by his 
 
         slurred speech.  The volume of his voice has been affected too.
 
         
 
              Claimant has testified that he has lost his ability to 
 
         smell.  His nose runs uncontrollably.  He has problems detecting 
 
         smoke, fires and natural gas.  This loss is an adverse factor, 
 
         given the nature of claimant's position where he is expected to 
 
         be able to detect fires, or to note other adverse conditions 
 

 
         
 
         Page   6
 
         
 
         
 
         
 
         
 
         
 
         within the prison walls.  This negatively impacts upon his posi
 
         tion.  He may be precluded from certain duties or promotions.  
 
         Claimant may be precluded from other positions normally available 
 
         to him in the private sector.  These include a security guard 
 
         position, or a bank guard.
 
         
 
              Claimant is visibly disfigured.  The disfigurement may 
 
         impair his ability to seek other employment.  It is easy to visu
 
         alize in a prison setting a situation where claimant is the 
 
         object of ridicule and where claimant could overreact to that 
 
         ridicule.
 
         
 
              Therefore, in light of the foregoing, it is the determina
 
         tion of the undersigned that claimant is entitled to 20 percent 
 
         permanent partial disability.
 
         
 
                                      order
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Defendant is to pay unto claimant eighty point four-two-nine 
 
         (80.429) weeks of healing period benefits at the stipulated rate 
 
         of two hundred seventy-two and 53/l00 dollars ($272.53) per week 
 
         from February 13, 1989 through August 29, 1990.
 
         
 
              Defendant is to also pay unto claimant one hundred (100) 
 
         weeks of permanent partial disability benefits at the stipulated 
 
         rate of two hundred seventy-two and 53/l00 dollars ($272.53) per 
 
         week commencing on August 30, 1990.
 
         
 
              Accrued benefits are to be paid in a lump sum together with 
 
         statutory interest at the rate of ten percent (10%) per year pur
 
         suant to section 85.30, Iowa Code, as amended.
 
         
 
              Defendant shall receive credit for all benefits paid to 
 
         claimant.
 
         
 
              Costs are assessed to defendant.
 
         
 
              Defendant shall file a claim activity report as requested by 
 
         this division pursuant to rule 343 IAC 3.1.
 
         
 
         
 
         
 
              Signed and filed this ____ day of April, 1992.
 
         
 
         
 
         
 
         
 
         
 
                                       ______________________________               
 
         MICHELLE A. McGOVERN
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. James P. Hoffman
 
         Attorney at Law
 
         Middle Road
 

 
         
 
         Page   7
 
         
 
         
 
         
 
         
 
         
 
         Box 1087
 
         Keokuk, Iowa  52632
 
         
 
         Mr. Greg Knoploh
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Building
 
         Des Moines, Iowa  50319
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
            1803
 
            Filed April 21, 1992
 
            MICHELLE A. McGOVERN
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            RICHARD LOZANO,               :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :         File No. 909492
 
            IOWA STATE PENITENTIARY,      :
 
                                          :      A R B I T R A T I O N
 
                 Employer,                :
 
                                          :         D E C I S I O N
 
            and                           :
 
                                          :
 
            STATE OF IOWA,                :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendant.               :
 
            ___________________________________________________________
 
            
 
            
 
            
 
            1803
 
            Claimant is a corrections officer.  On Feburary 13, 1989, he 
 
            was struck on the left side of his head with a barbell.  
 
            Claimant had surgery for a longitudinal temporal bone 
 
            fracture.  Later claimant developed post-traumatic stress 
 
            disorder.
 
            Claimant eventually returned to his former position.  He was 
 
            compensated at the same rate of pay.  However, it was 
 
            determined that claimant had sustained an industrial 
 
            disability.  The basis for determining that an industrial 
 
            disability was present is as follows:
 
            
 
                 In the case before this deputy, Dr. Harker has written 
 
            that as of February 7, 1990, he could not fully answer 
 
            whether claimant had incurred a permanent defect as a result 
 
            of his February 13, 1989 work injury.  Medical reports 
 
            indicate that claimant has a mild hearing loss.  (Ex. 9, p. 
 
            176-179)  Additionally, Dr. Harker has indicated in his 
 
            report of August 27, 1990:  "He does have some residual that 
 
            handicaps from this injury he did not have before, and will 
 
            never be 100% again."
 
            
 
                 Then there is the psychiatric opinion of Dr. Yates.  
 
            Claimant is able to work so long as he remains on his 
 
            prescribed medications.  It is unknown whether claimant can 
 
            ever be removed from his medications, or even if the 
 
            medications can be reduced.  Claimant shows symptoms of 
 
            anxiety when he is alone with an inmate.  He has testified 
 
            he has nightmares at times.  He must take the medication to 
 
            control the nightmares.
 

 
            
 
 
 
 
 
 
 
 
 
 
 
            
 
                 This deputy has witnessed some of claimant's residual 
 
            impairments.  Claimant is unable to voluntarily close his 
 
            left eye.  He is unable to raise his left eyebrow.  Claimant 
 
            has testified he is light sensitive and that he is required 
 
            to wear "photoray glasses" for this purpose.  Because of his 
 
            light sensitivity, claimant prefers working the night shift 
 
            so he will not be assigned to an outside job on a bright 
 
            sunny day when he is unable to adjust his eyes as easily.  
 
            Claimant may be precluded from holding certain assignments, 
 
            or from firing a gun because of his inability to close his 
 
            left eye.
 
            
 
                 The undersigned deputy has witnessed claimant's 
 
            unnatural facial expression.  Claimant states he has 
 
            paralysis of the face.  Claimant speaks out of the side of 
 
            his mouth.  His speech is slurred.  Claimant is required to 
 
            verbally communicate in his position.  His abilities to do 
 
            so have been decreased by his slurred speech.  The volume of 
 
            his voice has been affected too.
 
            
 
                 Claimant has testified that he has lost his ability to 
 
            smell.  His nose runs uncontrollably.  He has problems 
 
            detecting smoke, fires and natural gas.  This loss is an 
 
            adverse factor, given the nature of claimant's position 
 
            where he is expected to be able to detect fires, or to note 
 
            other adverse conditions within the prison walls.  This 
 
            negatively impacts upon his position.  He may be precluded 
 
            from certain duties or promotions.
 
            
 
                 Claimant is visibly disfigured.  The disfigurement may 
 
            impair his ability to seek other employment.  It is easy to 
 
            visualize in a prison setting a situation where claimant is 
 
            the object of ridicule and where claimant overreacts to that 
 
            ridicule.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                                            :
 
            PAUL E. KINYON,                 :
 
                                            :
 
                 Claimant,                  :
 
                                            :
 
            vs.                             :
 
                                            :       File No. 909605
 
            JOHN PECKHAM,                   :
 
                                            :          A P P E A L
 
                 Employer,                  :
 
                                            :        D E C I S I O N
 
            and                             :
 
                                            :
 
            FARM BUREAU,                    :
 
                                            :
 
                 Insurance Carrier,         :
 
                 Defendants.                :
 
            ____________________________________________________________
 
            _____
 
            The record, including the transcript of the hearing before 
 
            the deputy and all exhibits admitted into the record, has 
 
            been reviewed de novo on appeal.
 
            issues
 
            Those portions of the proposed agency decision pertaining to 
 
            issues not raised on appeal are adopted as a part of this 
 
            appeal decision.  The issues raised on appeal are:
 
            
 
                 I.   Whether the deputy industrial commissioner 
 
                 failed to make sufficient findings of fact and 
 
                 conclusions of law.
 
            
 
                 II.  Whether the deputy industrial commissioner 
 
                 erred in finding that a single injury date exists 
 
                 for four separate cumulative injuries.
 
            findings of fact
 
            The findings of fact contained in the proposed agency 
 
            decision filed June 5, 1991 are adopted as final agency 
 
            action.
 
            conclusions of law
 
            The record shows that claimant eventually suffered lateral 
 
            epicondylitis of both elbows; carpal tunnel syndrome of both 
 
            wrists; and cubital tunnel syndrome of both arms.  
 
            Claimant's medical conditions first manifested themselves on 
 
            January 2, 1988, while claimant was working for defendant 
 
            Peckham.  Claimant went to see James E. Mansour, M.D., with 
 
            complaints of pain in his right elbow.  Claimant was off 
 
            work for a time in February 1988 due to right arm pain.  In 
 
            March of 1988, claimant was diagnosed by Arnis B. Grundberg, 
 
            M.D., as having lateral epicondylitis of the right elbow, 
 
            and right carpal tunnel syndrome.  Claimant was seen again 
 
            by Dr. Grundberg in November of 1988, and again the 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            diagnosis was lateral epicondylitis of the right elbow and 
 
            right carpal tunnel syndrome.  
 
            Claimant underwent surgery on his right elbow on February 15 
 
            of 1989.  On February 24, 1989, claimant mentioned, for the 
 
            first time, that he was having problems with his left arm as 
 
            well.  Claimant indicated the left arm pain began in the 
 
            spring of 1988, but had been worse since November of 1988.  
 
            Claimant was released to go back to work on March 13, 1989, 
 
            but shortly after this claimant left his farm employment due 
 
            to a wage dispute. 
 
            After leaving his farm job, claimant experienced increasing 
 
            symptoms of left arm pain, and was diagnosed in June of 1989 
 
            as having left arm lateral epicondylitis.  By January of 
 
            1991, claimant was diagnosed with bilateral carpal tunnel 
 
            syndrome, bilateral cubital tunnel syndrome, and bilateral 
 
            epicondylitis.  Subsequent to his farm employment, claimant 
 
            worked in construction, as a truck driver, and as a 
 
            bulldozer operator.  Claimant performed repetitive work 
 
            activity to varying degrees in all of his occupations, 
 
            including his farm work. 
 
            Dr. Grundberg causally relates claimant's right lateral 
 
            epicondylitis, his right cubital tunnel syndrome, his right 
 
            carpal tunnel syndrome, and his left lateral epicondylitis 
 
            to claimant's farm work activity.  Dr. Kirkland indicates 
 
            that any or all of claimant's occupations could be 
 
            responsible for his present conditions.  
 
            Dr. Kirkland's opinion is read to indicate that any of 
 
            claimant's occupations, and in particular his farm work for 
 
            defendant, could possibly be a cause of his present 
 
            conditions.  However, the claimant has the burden of proving 
 
            by a preponderance of the evidence that his present 
 
            conditions are causally related to his work activity for 
 
            defendant.  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).  Since 
 
            Dr. Kirkland does not offer an opinion that claimant's 
 
            conditions are probably caused by his work activity for 
 
            defendant, the only medical opinion in the record supporting 
 
            a causal connection is that of Dr. Grundberg.  
 
            Dr. Grundberg does not causally relate claimant's left 
 
            carpal tunnel syndrome or his left cubital tunnel syndrome 
 
            to claimant's work activity for the defendant in this case.  
 
            Claimant has failed to carry his burden to show by a 
 
            preponderance of the evidence that his left carpal tunnel 
 
            syndrome and his left cubital tunnel syndrome were caused by 
 
            work activity for defendant.  
 
            Claimant clearly had symptoms of right carpal tunnel 
 
            syndrome and right lateral epicondylitis, and these 
 
            conditions were diagnosed, prior to claimant leaving 
 
            employment with defendant.  It is found that claimant's 
 
            right carpal tunnel syndrome and right lateral epicondylitis 
 
            are causally connected to claimant's work activity with 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            defendant Peckham.
 
            Claimant's right cubital tunnel syndrome and left lateral 
 
            epicondylitis were not diagnosed while claimant worked for 
 
            Peckham.  However, claimant did complain of pain in his left 
 
            arm prior to leaving Peckham's employment, and claimant 
 
            described that pain as ongoing since the spring of 1988 and 
 
            as becoming more acute in November 1988.  In addition, Dr. 
 
            Grundberg causally connected claimant's right cubital tunnel 
 
            syndrome and left lateral epicondylitis conditions to his 
 
            work activity with Peckham.  There is no contrary medical 
 
            opinion in the record.  It is found that claimant's right 
 
            cubital tunnel syndrome condition and claimant's left 
 
            lateral epicondylitis condition are causally connected to 
 
            his work activity for defendant Peckham.
 
            WHEREFORE, the decision of the deputy is affirmed and 
 
            modified.
 
            order
 
            THEREFORE, it is ordered:
 
            That defendants shall pay for medical treatment, including 
 
            surgery, connected with claimant's right carpal tunnel 
 
            syndrome, right cubital tunnel syndrome, right lateral 
 
            epicondylitis, and left lateral epicondylitis conditions, 
 
            incurred to date or in the future.  
 
            That defendants shall pay temporary total disability 
 
            benefits at the rate of one hundred ninety-one and 10/100 
 
            dollars ($191.10) during any period of recuperation from 
 
            surgery for the above conditions.
 
            That defendants shall pay any portion of claimant's unpaid 
 
            medical bills relating to the above conditions.  If medical 
 
            care provider bills do not distinguish between treatment for 
 
            conditions found to be compensable in this decision and 
 
            treatment for conditions found not to be compensable in this 
 
            decision, the parties are directed to seek an itemization or 
 
            proportionment from the medical provider prior to seeking 
 
            further order from this agency. 
 
            That defendants shall pay the costs of this matter including 
 
            the transcription of the hearing.  
 
            That defendants shall file a claim activity report pursuant 
 
            to rule 343 IAC 3.1.
 
            Signed and filed this ____ day of December, 1992.
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                               BYRON K. ORTON
 
                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Dennis L. Hanssen
 
            Attorney at Law
 
            2700 Grand Ave., Ste 111
 
            Des Moines, Iowa 50312
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            
 
            Ms. Angela A. Swanson
 
            Attorney at Law
 
            5400 University Ave.
 
            West Des Moines, Iowa 50265
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                          1108.50
 
            Filed December 31, 1992
 
            Byron K. Orton
 
            JMI
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
            _____
 
                                            :
 
            PAUL E. KINYON,                 :
 
                                            :
 
                 Claimant,                  :
 
                                            :
 
            vs.                             :
 
                                            :       File No. 909605
 
            JOHN PECKHAM,                   :
 
                                            :          A P P E A L
 
                 Employer,                  :
 
                                            :        D E C I S I O N
 
            and                             :
 
                                            :
 
            FARM BUREAU,                    :
 
                                            :
 
                 Insurance Carrier,         :
 
                 Defendants.                :
 
            ____________________________________________________________
 
            _____
 
            
 
            1108.50
 
            Claimant suffered a total of six conditions:  right carpal 
 
            tunnel syndrome; left carpal tunnel syndrome; right cubital 
 
            tunnel syndrome; left cubital tunnel syndrome; right lateral 
 
            epicondylitis; left lateral epicondylitis.  Claimant worked 
 
            for defendant farmer, then changed employment to a truck 
 
            driver, bulldozer operator, etc.  Two of the above 
 
            conditions were diagnosed while claimant worked for the 
 
            farmer, the others were diagnosed later.  One of claimant's 
 
            physicians causally related three of the above conditions to 
 
            claimant's work for the farmer.  The other physician said 
 
            any of the six conditions could have been caused by any of 
 
            his employments.  Citing that a probability and not a 
 
            possibility of causal connection was required, the latter 
 
            doctor's opinion was given no weight.  Claimant awarded 
 
            benefits for the three conditions causally connected to his 
 
            work for defendant.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            PAUL E. KINYON,               :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  909605
 
            JOHN PECKHAM,                 :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            FARM BUREAU,                  :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Paul E. 
 
            Kinyon, claimant, against John Peckham, employer, and Farm 
 
            Bureau, insurance carrier, to recover benefits under the 
 
            Iowa Workers' Compensation Act as a result of an injury 
 
            sustained on January 1, 1988.  This matter came on for 
 
            hearing before the undersigned deputy industrial 
 
            commissioner on May 15, 1991.  The matter was considered 
 
            fully submitted at the close of the hearing.  The record in 
 
            this case consists of the testimony of claimant, John 
 
            Peckham and Tom Hall; and joint exhibits 1 through 13.  
 
            
 
                                      issues
 
            
 
                 Pursuant to the prehearing report and order submitted 
 
            and approved on May 15, 1991, the parties stipulate that 
 
            claimant sustained a right arm injury on January 1, 1988, 
 
            which arose out of and in the course of his employment with 
 
            employer and that such injury resulted in temporary and 
 
            permanent partial disability.  The parties dispute that 
 
            claimant sustained other injuries in the course of his 
 
            employment with employer which resulted in the disability on 
 
            which he now bases his claim. 
 
            
 
                                 findings of fact
 
            
 
                 The undersigned has carefully considered all the 
 
            testimony given at the hearing, the arguments made, the 
 
            evidence contained in the exhibits herein, and makes the 
 
            following findings:
 
            
 
                 Claimant was born on September 6, 1946, and obtained 
 
            his GED certificate in 1970.  He worked at various times as 
 
            a trucker, heavy equipment operator, farm hand and 
 
            over-the-road driver.  More specifically, claimant went to 
 
            work for his uncle, John Peckham, employer herein, in 1986 
 
            as a farm hand.  Mr. Peckham owns a grain, cow-calf 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            operation.  Claimant performed general farm hand duties 
 
            which included putting in and taking out crops, caring for 
 
            livestock and overall farm maintenance.  He was the only 
 
            employee performing these duties and he worked without a 
 
            helper.  
 
            
 
                 Claimant testified that he could not remember any 
 
            specific trauma, but on the morning of January 2, 1988, he 
 
            awoke with severe pain in his right arm.  He testified that 
 
            despite the pain he went to work that day and continued 
 
            working until he took two weeks vacation later in the month.  
 
            On January 26, 1988, he saw James E. Mansour, M.D., with 
 
            complaints of right elbow pain.  He received a cortisone 
 
            injection and was referred to Arnis B. Grundberg, M.D.  He 
 
            received another injection from John L. Hoyt, M.D., in 
 
            February 1988 and saw Dr. Grundberg for the first time on 
 
            March 1, 1988.  He testified he was off work for a few weeks 
 
            in February 1988 because of right arm pain and received 
 
            workers' compensation benefits during that time.  When he 
 
            saw Dr. Grundberg in March 1988, he received another 
 
            cortisone injection.  He received no medical treatment again 
 
            until November 1988.  At that time he saw Dr. Grundberg with 
 
            complaints referable to right hand pain and numbness.  He 
 
            testified that Dr. Grundberg ordered an EMG and based on the 
 
            results recommended surgery.  On February 15, 1989, he had 
 
            surgery on his right elbow.  He was released to return to 
 
            work on March 13, 1989.  
 
            
 
                 Claimant testified that he returned to Peckham's 
 
            farming operation for about two weeks and then quit due to a 
 
            wage dispute.  He then went to work for Wenzig Construction 
 
            where he operated a bulldozer from April 1989 until December 
 
            1989 when the construction season ended.  He then worked as 
 
            an over-the-road trucker for Miller Transportation until 
 
            August 1990 when he left due to a wage dispute.  In 
 
            September 1990, he worked approximately three weeks for a 
 
            construction company operating heavy equipment, running a 
 
            backhoe and doing cement work.  He left this job because of 
 
            pain in both arms.  In October 1990, he was rehired by 
 
            Peckham as an over-the-road trucker and is still working in 
 
            this capacity.  
 
            
 
                 When claimant saw Dr. Grundberg on March 1, 1988, he 
 
            diagnosed (1) lateral epicondylitis, right elbow; and (2) 
 
            very mild right carpal tunnel syndrome.  He was injected 
 
            with Depo-Medrol and given an elbow support.  He was told to 
 
            return as needed for further treatment (exhibit 1, page 9).  
 
            
 
                 The injection relieved claimant's discomfort until 
 
            September 1988 when, at that time, he received two more 
 
            injections from Dr. Mansour.  On November 4, 1988, claimant 
 
            was reexamined by Dr. Grundberg for right hand complaints.  
 
            X-rays of the right elbow were taken and were normal.  Dr. 
 
            Grundberg diagnosed (1) lateral epicondylitis, right elbow; 
 
            (2) medial epicondylitis, right elbow; and (3) right carpal 
 
            tunnel syndrome (ex. 1, p. 10).  Dr. Grundberg ordered an 
 
            EMG evaluation.  The results were normal.  Nevertheless, Dr. 
 
            Grundberg recommended surgery to relieve pain over the 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            lateral epicondylitis at the elbow.  This was performed on 
 
            February 15, 1989.  At the same time, claimant's right 
 
            carpal tunnel was injected (ex. 1, p. 10).  He was seen for 
 
            follow-up evaluation on February 24, 1989.  Dr. Grundberg's 
 
            progress notes state that:
 
            
 
                 He also asked me to look at his left elbow where 
 
                 since the Spring of 1988 he has had discomfort 
 
                 over the lateral aspect of the elbow much the same 
 
                 as over the right elbow.  This has been worse 
 
                 since November 1988.  I told him that we need to 
 
                 see how the right elbow recovers from the surgical 
 
                 procedure before we do anything about the left. 
 
            
 
            (exhibit 1, page 11).
 
            
 
                 Dr. Grundberg felt that claimant would be able to 
 
            return to farm work on March 13, 1989.  He saw claimant 
 
            again on June 23, 1989, and at that time, claimant had 
 
            changed occupations and was operating a caterpillar.  During 
 
            this visit Dr. Grundberg diagnosed lateral epicondylitis, 
 
            left elbow and injected it with cortisone.  This helped for 
 
            about two weeks and he was injected again on August 25, 1989 
 
            (ex. 1, p. 11).  
 
            
 
                 On January 3, 1991, claimant presented to Dr. Grundberg 
 
            with complaints of pain on the lateral medial aspects of 
 
            both elbows with radiation to the neck and to the anterior 
 
            chest.  He noted that claimant's right lateral epicondylitis 
 
            symptoms were helped for approximately five to six months 
 
            before the problem returned.  During this visit Dr. 
 
            Grundberg diagnosed (1) bilateral carpal tunnel syndrome; 
 
            (2) bilateral cubital tunnel syndrome; and (3) lateral 
 
            epicondylitis, both elbows, with the right one being 
 
            postoperative state (ex. 1, p. 12).  Dr. Grundberg's January 
 
            3, 1991, progress notes state that, "I explained to him the 
 
            nature of the problem and sent him for an EMG evaluation and 
 
            I will see him back after that.  This particular problem 
 
            came on while working on the farm 3 years ago and therefore 
 
            I think is a work related problem." (ex. 1, p. 12).  
 
            
 
                 During the January 15, 1991, evaluation, claimant asked 
 
            Dr. Grundberg for an impairment rating.  His progress notes 
 
            state as follows:
 
            
 
                 His impairment at the present time is 20% of the 
 
                 right elbow due to cubital tunnel syndrome and 5% 
 
                 of the right elbow due to lateral epicondylitis of 
 
                 the right elbow.; It is also 10% of the arm due to 
 
                 right carpal tunnel syndrome.  This is also true 
 
                 on the left side.  This is a total of 30% of the 
 
                 right arm; 30% of the left arm.  This could be 
 
                 improved, in most instances quite significantly by 
 
                 a surgical procedure on both upper extremities.
 
            
 
            (exhibit 1, page 7)
 
            
 
                 Dr. Grundberg testified in a deposition taken on April 
 
            23, 1991.  He stated that the EMG taken on January 14, 1991, 
 
            showed a bilateral cubital tunnel syndrome and a mild left 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            carpal tunnel syndrome.  Although there was no evidence of 
 
            this on the right side, a diagnosis of right sided carpal 
 
            tunnel syndrome was made based on clinical examination.  Dr. 
 
            Grundberg testified that all indications are that Mr. Kinyon 
 
            should have surgery on the carpal tunnel and the cubital 
 
            tunnel on the side that bothers him the most.  As to the 
 
            cause of claimant's symptoms, Dr. Grundberg testified:
 
            
 
                 A.  I would say that the right lateral 
 
                 epicondylitis, the right cubital tunnel syndrome, 
 
                 the right carpal tunnel syndrome and the left 
 
                 lateral epicondylitis can be substantially 
 
                 referred to his work on the farm.
 
            
 
                 ...
 
            
 
                 A.  The left carpal tunnel syndrome and the left 
 
                 cubital tunnel syndrome from what I have heard so 
 
                 far I would think that very little could be 
 
                 referred back to the farm.
 
            
 
            (exhibit 12, pages 35 & 36)
 
            
 
                 Claimant was referred by employer/insurance carrier to 
 
            Mark B. Kirkland, D.O., for an independent evaluation on 
 
            April 3, 1991.  After reviewing the claimant's medical 
 
            history and noting his complaints, Dr. Kirkland conducted a 
 
            physical examination.  His impression was as follows:
 
            
 
                 Impression:  1)  Status post-lateral epicondylar of the                                     
 
            right elbow.
 
                              2)  Cubital tunnel syndrome on the left.
 
                              3)  Mild cubital tunnel syndrome on the                                        
 
            right.
 
                              4)  Rule out degenerative changes of the                             
 
            cervical spine.                          
 
                              5)  Possible bilateral carpal tunnel                                           
 
            syndrome that seems to be somewhat                                 
 
            resolved at present. 
 
            
 
            (exhibit 1, page 17)
 
            
 
                 Dr. Kirkland opined that all of claimant's problems 
 
            were caused by repetitive types of motions and overuse.  It 
 
            was his impression that any of his employment endeavors 
 
            could have caused these problems.  He stated that, "The 
 
            progression of his condition since March, 1989 could be 
 
            related to the employment with Peckum [sic], other 
 
            employments, and other causes."  He felt that claimant's 
 
            condition developed gradually and cumulatively, but that the 
 
            condition in each arm developed at different times.  He 
 
            stated that, "There is no medical evidence that any 
 
            impairment caused by any condition extends beyond the arm 
 
            into the body as a whole."  He opined that if, in fact, 
 
            claimant does have carpal tunnel syndrome and cubital tunnel 
 
            syndrome, surgery would benefit him and could possibly 
 
            lessen his permanent partial impairment rating.  He noted 
 
            that at the present time, it would be somewhat difficult to 
 
            assign any permanent partial impairment rating to Mr. 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            Kinyon's condition.  He recommended that claimant undergo 
 
            additional testing and evaluation by a neurologist (ex. 1, 
 
            pp. 16-19).
 
            
 
                                conclusions of law
 
            
 
                 The parties stipulate that defendants have paid 
 
            claimant healing period benefits with respect to his right 
 
            arm lateral epicondylitis.  The parties also stipulate that 
 
            defendants have paid claimant 12.5 weeks of permanent 
 
            partial disability benefits based upon a 5 percent permanent 
 
            disability rating to the right arm given by Dr. Grundberg.  
 
            Defendants dispute that claimant is due any additional 
 
            disability benefits from employer Peckham.  Claimant argues 
 
            that he sustained one cumulative injury involving both upper 
 
            extremities during the course of his employment with 
 
            defendant/employer.  Claimant quit Peckham's employ in March 
 
            1989.  Defendants have paid all medical expenses related to 
 
            treatment claimant received for right arm lateral 
 
            epicondylitis.  Defendants have not paid for any medical 
 
            expenses related to treatment which claimant received after 
 
            voluntarily terminating his employment with Peckham.  The 
 
            total unpaid medical expenses equal $1,064.20.  
 
            
 
                 At the hearing, claimant requested that the undersigned 
 
            deputy industrial commissioner determine which of claimant's 
 
            conditions are related to his farm work and order defendants 
 
            to pay for claimant's treatment of these conditions.  
 
            Claimant requested that defendants pay temporary disability 
 
            benefits during claimant's period of recuperation from 
 
            surgery.  
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that he received an injury on January 1, 
 
            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). 
 
            
 
                 An employee is entitled to compensation for any and all 
 
            personal injuries which arise out of and in the course of 
 
            the employment.  Section 85.3(1).
 
            
 
                 The injury must both arise out of and be in the course 
 
            of the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 
 
            Iowa 402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 
 
            of the Iowa Report.  See also Sister Mary Benedict v. St. 
 
            Mary's Corp., 255 Iowa 847, 124 N.W.2d 548 (l963) and Hansen 
 
            v. State of Iowa, 249 Iowa 1147, 91 N.W.2d 555 (1958).
 
            
 
                 The words "out of" refer to the cause or source of the 
 
            injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63. 
 
            
 
                 The words "in the course of" refer to the time and 
 
            place and circumstances of the injury.  McClure v. Union 
 
            et al. Counties, 188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 
 
            402, 68 N.W.2d 63.
 
            
 
                 "An injury occurs in the course of the employment when 
 
            it is within the period of employment at a place the 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            employee may reasonably be, and while he is doing his work 
 
            or something incidental to it."  Cedar Rapids Comm. Sch. 
 
            Dist. v. Cady, 278 N.W.2d 298 (Iowa 1979), McClure, 188 
 
            N.W.2d 283; Musselman, 261 Iowa 352, 154 N.W.2d 128. 
 
            
 
                 The supreme court of Iowa in Almquist v. Shenandoah 
 
            Nurseries, 218 Iowa 724, 731-32, 254 N.W. 35, 38 (1934) 
 
            discussed the definition of personal injury in workers' 
 
            compensation cases as follows:
 
            
 
                 
 
            
 
                 While a personal injury does not include an 
 
                 occupational disease under the Workmen's 
 
                 Compensation Act, yet an injury to the health may 
 
                 be a personal injury.  [Citations omitted.]  
 
                 Likewise a personal injury includes a disease 
 
                 resulting from an injury....The result of changes 
 
                 in the human body incident to the general 
 
                 processes of nature do not amount to a personal 
 
                 injury.  This must follow, even though such 
 
                 natural change may come about because the life has 
 
                 been devoted to labor and hard work.  Such result 
 
                 of those natural changes does not constitute a 
 
                 personal injury even though the same brings about 
 
                 impairment of health or the total or partial 
 
                 incapacity of the functions of the human body. 
 
            
 
                    ....
 
            
 
                 
 
                 A personal injury, contemplated by the Workmen's 
 
                 Compensation Law, obviously means an injury to the 
 
                 body, the impairment of health, or a disease, not 
 
                 excluded by the act, which comes about, not through the 
 
                 natural building up and tearing down of the human body, 
 
                 but because of a traumatic or other hurt or damage to 
 
                 the health or body of an employee.  [Citations 
 
                 omitted.]  The injury to the human body here 
 
                 contemplated must be something, whether an accident or 
 
                 not, that acts extraneously to the natural processes of 
 
                 nature, and thereby impairs the health, overcomes, 
 
                 injures, interrupts, or destroys some function of the 
 
                 body, or otherwise damages or injures a part or all of 
 
                 the body.
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of January 1, 
 
            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 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id., at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 
 
            N.W.2d 128.
 
            
 
                 Claimant testified and the medical evidence 
 
            corroborates that he was asymptomatic prior to January 1, 
 
            1988.  Dr. Grundberg testified:
 
            
 
                 A.  The notes state on the 24th of February that 
 
                 he developed pain in the lateral aspect of the 
 
                 left elbow in 1988, in the spring of 1988.  When 
 
                 you take that into consideration plus the fact 
 
                 that he says that he was favoring his right arm 
 
                 and using his left arm more I think that you can 
 
                 refer some of these problems back to prior to him 
 
                 leaving that work on the farm on the 15th of 
 
                 February, 1989.
 
            
 
            (exhibit 12, page 35)
 
            
 
                 Dr. Grundberg, claimant's treating physician, clearly 
 
            relates some of his bilateral arm problems to his farm work 
 
            with Peckham.  Dr. Kirkland agreed that, "The progression of 
 
            his condition since March, 1989 could be related to the 
 
            employment with Peckum [sic]..."
 
            
 
                 Dr. Grundberg reported on January 15, 1991, that 
 
            claimant's problems could be improved significantly with 
 
            surgery.  Dr. Kirkland also felt that claimant may be a 
 
            candidate for bilateral carpal tunnel releases and releases 
 
            of the ulnar nerve at the cubital tunnel.  Therefore, as to 
 
            those conditions which have been identified by Dr. 
 
            Grundberg, including right lateral epicondylitis, right 
 
            cubital tunnel syndrome, right carpal tunnel syndrome and 
 
            left lateral epicondylitis, the undersigned concludes that 
 
            Peckham should pay for appropriate treatment, including 
 
            surgery, and for temporary disability benefits during a 
 
            period of recuperation.  Defendants should also pay for 
 
            claimant's unpaid medical expenses totaling $1,064.20.  In 
 
            the event claimant has a residual impairment from surgery, 
 
            he has the option of seeking further relief at that time.
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 That defendants pay for treatment and surgery pertinent 
 
            to those impairments identified by Dr. Grundberg as causally 
 
            related to claimant's employment as a farm hand with 
 
            Peckham.
 
            
 
                 That defendants pay claimant temporary disability 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            benefits at the stipulated weekly rate of one hundred 
 
            ninety-one and 10/100 dollars ($191.10) during the period of 
 
            recuperation following surgery.   
 
            
 
                 That defendants pay claimant's unpaid medical bills 
 
            totaling one thousand sixty-four and 20/100 dollars 
 
            ($1,064.20).
 
            
 
                 Costs of this action shall be assessed to defendants 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 Defendants shall file a claim activity report as 
 
            requested by this division pursuant to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of June, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          JEAN M. INGRASSIA
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Dennis L. Hanssen
 
            Attorney at Law
 
            2700 Grand Ave. STE 111
 
            Des Moines, Iowa  50312
 
            
 
            Ms. Angela A. Swanson
 
            Attorney at Law
 
            5400 University Ave.
 
            West Des Moines, Iowa  50265
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                      51402.60
 
                      Filed June 5, 1991
 
                      Jean M. Ingrassia
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            PAUL E. KINYON,               :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  909605
 
            JOHN PECKHAM,                 :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            FARM BUREAU,                  :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            51402.60
 
            Parties stipulate that claimant sustained a right arm injury 
 
            on January 1, 1988.  However, defendants dispute that 
 
            claimant's other impairments arose out of and in the course 
 
            of employment with defendants.
 
            Claimant requested only that defendants pay for treatment 
 
            and surgery for those other impairments identified by his 
 
            treating physician as causally connected to his employment 
 
            as a farm laborer.
 
            Claimant's treating physician's assessment as to which of 
 
            claimant's conditions are related to his work with employer 
 
            given significant weight and consideration.
 
            Defendants ordered to pay for treatment and surgery 
 
            pertinent to those impairments identified by treating 
 
            physician and to pay temporary disability benefits during a 
 
            period of recuperation following surgery.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            RANDALL E. ST. CLAIR,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 909732
 
            ALUMINUM COMPANY OF AMERICA,  :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                 Self-Insured,            :       D E C I S I O N
 
                 Defendant.               :
 
                                          :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This case came on for hearing on July 17, 1991, at 
 
            Davenport, Iowa.  This is a proceeding in arbitration 
 
            wherein claimant seeks compensation for permanent partial 
 
            disability benefits as a result of an alleged injury on 
 
            August 30, 1988.  The record in the proceeding consists of 
 
            the testimony of claimant, claimant's wife and Margaret 
 
            Kundel; and joint exhibits 1 through 4.
 
            
 
                                      issues
 
            
 
                 The issues for resolution are:
 
            
 
                 1.  Whether claimant's alleged injury on August 30, 
 
            1988 arose out of and in the course of his employment;
 
            
 
                 2.  Whether claimant's alleged condition and disability 
 
            is causally connected to the alleged August 30, 1988 injury;
 
            
 
                 3.  The nature and extent of claimant's disability and 
 
            entitlement to disability benefits;
 
            
 
                 4.  Whether claimant is entitled to 85.27 medical 
 
            benefits, the issue being causal connection.
 
            
 
                                 findings of fact
 
            
 
                 The undersigned deputy having heard the testimony and 
 
            considered all the evidence, finds that:
 
            
 
                 Claimant is a 34-year-old high school graduate whose 
 
            only other post-high school education is an eight week 
 
            auctioneering course in 1980 in which he received a 
 
            certificate.  He did some auctioneering in 1987 through 1988 
 
            as a second auctioneer.  He said he had approximately three 
 
            auctions in 1986 and 1987 and made $2,000 in 1987 from this.  
 
            Her first job after high school was assembling screens and 
 
            windows for approximately three and one-half years and then 
 
            he began working for defendant employer on February 16, 
 
            1978.  Claimant married his current wife in November 1989.
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 Claimant described his positions with defendant 
 
            employer, one being the foil mill which he described and 
 
            which he said required no physical work.  He worked at this 
 
            job up to three months before his termination on October 24, 
 
            1989.
 
            
 
                 Claimant did not recall going to Richard P. Forrest, 
 
            D.C., for a C1-C6-C7 adjustment on August 20, 1988, or at 
 
            any other time in 1981, 1985, 1986 or 1988, but he does not 
 
            deny going if the record shows this.  Claimant contends he 
 
            never had low back problems prior to August 29, 1988, but 
 
            did see a chiropractor to get an adjustment on his vertebrae 
 
            when they were out of place.
 
            
 
                 Claimant said that on August 30, 1988, while working on 
 
            a core cutting machine, the core threw him back against the 
 
            metal post hitting his left side and lower back.  He said he 
 
            began having problems in his neck, shoulder blade and back.  
 
            He said he went to the doctor and received some therapy.  He 
 
            was released for light duty on October 14, 1988 and returned 
 
            to work on November 1, 1988 with restrictions which were to 
 
            be reviewed periodically (Joint Exhibit 1, page 49).
 
            
 
                 Claimant was terminated around October 24, 1989 for 
 
            excessive absenteeism.  Claimant saw Charlton H. Barnes, 
 
            M.D., four times in 1988, but claimant was very critical of 
 
            the doctor's treatment but never complained to anyone.  
 
            Shortly after his termination, claimant went back to Dr. 
 
            Barnes around November 1, 1989.  Claimant contends that he 
 
            did not go back to Dr. Barnes between October 12, 1988 until 
 
            November 3, 1989 because he couldn't take time off from 
 
            work.  He said he was disciplined in 1987 and 1988 for 
 
            absenteeism.  Claimant acknowledged he had stomach problems 
 
            prior to January 1, 1988, but said his problems in May 1989 
 
            were for stomach ulcers.  He said he was off work several 
 
            times in 1989 because of the stomach problems.  Dr. Barnes 
 
            put claimant in a work hardening program in October 1990 but 
 
            claimant dropped out after ten days because he found a job 
 
            as a flagman on a construction site.
 
            
 
                 Claimant is now working and has been working since July 
 
            17, 1991 making mail posts at a temporary job with future 
 
            employment slim.
 
            
 
                 Claimant said he had prostrate trouble in early 1989.
 
            
 
                 Claimant acknowledged that he was suspended five days 
 
            in April 1989 for missing five days and never tried to see 
 
            Dr. Barnes.  Claimant was off sick in June 1989 and saw a 
 
            doctor but never asked the doctor to look at his back nor 
 
            did he see or request to see Dr. Barnes regarding his back.  
 
            Claimant was asked several questions regarding several times 
 
            in 1989 in which he was off and he replied that he never 
 
            tried to see a doctor or ask the doctor about his back 
 
            problems.
 
            
 
                 Claimant acknowledged that from November 1, 1988 
 
            through October 23, 1989, he was on the job other than for 
 
            his ulcer problems.
 
            
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
                 Claimant admitted he was worried about being 
 
            termination for absenteeism which went back several years 
 
            including 1985 and 1986.  He doesn't recall dates but 
 
            remembers there were several disciplines due to absenteeism.  
 
            Due to his unemployment, claimant has assisted in doing the 
 
            household chores as he is living on his wife's income.  He 
 
            described other things that he was doing such as painting, 
 
            mowing, cooking, etc.  He said he doesn't have any work 
 
            restrictions.
 
            
 
                 Claimant admits he has made no effort since his October 
 
            1988 release to do auctioneer work.  He contends the auction 
 
            companies already have enough people.  When cross-examined 
 
            as to his contention he had no stomach problems prior to 
 
            January 1, 1988, he emphasized he now has ulcers and didn't 
 
            have ulcers prior to January 1, 1988.  Claimant indicated he 
 
            hasn't considered working in the Quad Cities area.  Claimant 
 
            agreed his October 24, 1989 termination was a matter covered 
 
            under the union contract with defendant employer and he had 
 
            the option of having a union grievance if termination was 
 
            improper.  He never filed a grievance.
 
            
 
                 Ellen St. Clair, claimant's wife, testified that she 
 
            and claimant started going together in July 1989 and married 
 
            in November 1989, but she knew claimant in August 1988.  She 
 
            testified as to claimant having back pain after August 30, 
 
            1988.  She explained his apparent discomfort when riding in 
 
            a car.  She said his ulcer problems started just before he 
 
            was fired.  She blames his ulcer problems on his back 
 
            problems.  She admitted she was aware of claimant's 
 
            absenteeism problem but not in detail and that this was 
 
            stressful to claimant in the summer of 1989.  She also knew 
 
            his suspensions were real problems.
 
            
 
                 Margaret Kundel, a registered nurse, has worked with 
 
            defendant employer eighteen years to the present.  She knows 
 
            claimant reported a back injury on August 30, 1988.  She 
 
            arranged for claimant to see Dr. Barnes, who usually isn't 
 
            used by defendant employer, but since he is in the same area 
 
            as claimant she thought it would be more convenient for 
 
            claimant.  She said claimant never complained about Dr. 
 
            Barnes nor asked for another doctor.
 
            
 
                 She said claimant returned to work on November 1, 1988, 
 
            and   came to the medical department complaining of a back 
 
            injury.  She acknowledged S. L. Casta, M.D., did put some 
 
            work restrictions on claimant reviewable periodically.  She 
 
            said Dr. Casta increased claimant's 35 pound lifting 
 
            restrictions to 50 pounds on January 19, 1989 (Jt. Ex. 1, p. 
 
            51).
 
            
 
                 She said claimant did not work January 29, 30 and 31, 
 
            1989, and claimant saw the doctor on January 31, 1989, and 
 
            claimant had prostatitis at that time.  Ms. Kundel said low 
 
            back pain is a symptom of prostatitis.
 
            
 
                 Richard P. Forrest, D.C., testified by way of his 
 
            deposition on November 6, 1990, that he basically cared for 
 
            claimant through August 20, 1988 and then had his son take 
 
            over from there.  Dr. Forrest said claimant had a low back 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            complaint on March 5, 1988, and his fourth and fifth lumbar 
 
            and right sacroiliac were misaligned (Jt. Ex. 2, p. 8).  On 
 
            August 20, 1988, he determined claimant's low back complaint 
 
            was muscular because he did not adjust any low back 
 
            vertebra.  Claimant indicated he had the pain for four days 
 
            (Jt. Ex. 2, p. 7).
 
            
 
                 Dr. Forrest said he first treated claimant for low back 
 
            pain on January 29, 1980, left lumbar (Jt. Ex. 2, p. 10).  
 
            He testified that he or his son further treated claimant's 
 
            low back in 1980, 1981, 1982, 1984, 1985 and 1986.  His 
 
            records show nothing further on claimant since June 13, 
 
            1990.
 
            
 
                 On cross-examination, the doctor indicated that even 
 
            though the notes refer to claimant's low back and his neck 
 
            he only adjusted claimant's C1-6 and 7 vertebrae and nothing 
 
            below claimant's shoulders (Jt. Ex. 2, p. 18).  He said his 
 
            records indicate claimant was not experiencing any L4 or 5 
 
            problems after March 5, 1988.
 
            
 
                 Dale Howard Weber, M.D., a general practitioner, 
 
            testified by way of his deposition on August 6, 1990 (Jt. 
 
            Ex. 4) that claimant has been a patient of the clinic since 
 
            1962 and he first saw claimant in 1966.  He said from 
 
            January 7, 1983 to April 20, 1987, his records show, in 
 
            part, that on January 5, 1988 claimant was seen for 
 
            abdominal pain thought to be possible ulcers, and on January 
 
            30, 1989, claimant was seen for severe low back pain thought 
 
            to be due to an infected prostrate gland.  He said the 
 
            history taken from the claimant showed claimant was shoved 
 
            against a guardrail on August 30, 1988 and injured his back.  
 
            The doctor related that claimant had a boggy prostrate 
 
            gland, his white count was elevated and his diagnosis was 
 
            acute prostatitis.  He said pain in the back is a common 
 
            symptom of an infected prostrate gland (Jt. Ex. 4, p. 8).  
 
            He testified to additional treatment of claimant on February 
 
            22, 1989 and June 7, 1989.  These appointments dealt with 
 
            respiratory or stomach problems and nothing was mentioned as 
 
            to claimant's back.  He said a report he had of a Dr. 
 
            Jensen, dated January 7, 1988, showed treatment for an 
 
            ulcer-like pain for which claimant was treated.  He said 
 
            claimant's June 7, 1989 visit to him was consistent with 
 
            peptic acid disease, ulcer disease and x-rays actually 
 
            indicated an ulcer (Jt. Ex. 4, pp. 9-10).  He did not have 
 
            any cause for the claimant's over-production of acid which 
 
            causes the ulcer.  He said an ulcer can in some cases be 
 
            caused by stress.  He related he gave claimant an off work 
 
            slip and return to work slip for a period beginning June 7, 
 
            1989 and ending June 19, 1989 because of the stomach 
 
            problems.
 
            
 
                 Although the doctor said stress could cause claimant's 
 
            peptic ulcer disease, he did not want to say that is the 
 
            cause as he did not have any idea what caused the ulcer (Jt. 
 
            Ex. 4, p. 11).  The doctor acknowledged that claimant's 
 
            records show that he had increased acid in the stomach in 
 
            1985.
 
            
 
                 Charlton H. Barnes, M.D., an orthopedic surgeon, 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            testified by way of his deposition (Jt. Ex. 3), on October 
 
            31, 1990, that he first saw claimant on August 31, 1988, at 
 
            which time claimant was complaining of neck and low back 
 
            pain.  He said he took claimant off work on September 7, 
 
            1988 because of the injury claimant described and he 
 
            prescribed physical therapy.  After an October 12, 1988 
 
            appointment, the doctor did not see claimant again until 
 
            November 3, 1989, when claimant returned with the same 
 
            problems he had a year earlier (Jt. Ex. 3, p. 19).
 
            
 
                 The doctor had a CT scan done which showed a mild 
 
            protrusion to the left of the midline at L4-5 interspace, 
 
            but he could not opine within a reasonable degree of medical 
 
            certainty the cause of this (Jt. Ex. 3, p. 10).  On March 
 
            22, 1990, he said claimant had a "degenerative disc 
 
            disease." (Jt. Ex. 3, p. 11)
 
            
 
                 The doctor does not distinguish between possible or 
 
            probable as to whether claimant's August 30, 1988 injury 
 
            caused his problems (Jt. Ex. 3, p. 11).  The doctor later 
 
            supposed possible means maybe, maybe not (Jt. Ex. 3, p. 18).  
 
            He acknowledged that claimant never told him that 
 
            approximately eleven days prior to his alleged August 30, 
 
            1988 injury that he had been treated for neck and back 
 
            problems by a chiropractor.
 
            
 
                 The doctor next saw claimant on November 3, 1989.  
 
            Claimant then had a myelogram on December 7, 1989 and a bone 
 
            scan on December 19, 1989, both of which were normal (Jt. 
 
            Ex. 3, p. 21). A CT scan on November 8, 1989 was normal.  On 
 
            February 19, 1990, the doctor did a diskogram (Jt. Ex. 1, p. 
 
            19).  Dr. Barnes indicated claimant has a degenerative disc 
 
            disease.
 
            
 
                 The doctor said he did not know the relationship 
 
            between the disc condition and the ALCOA incident on August 
 
            30, 1988.  He again said it is possible that the disease 
 
            condition was caused or brought about by the ALCOA incident.  
 
            He said it is also possible that claimant's disc condition 
 
            might have been caused by the problem for which claimant saw 
 
            a chiropractor ten days prior to August 30, 1988.
 
            
 
                 Claimant's medical records at the Medical Associates 
 
            Clinic showed he had stomach problems in December 1986 and 
 
            January 1988 before his alleged August 30, 1988 injury.  On 
 
            January 30, 1989, he had stomach problems again and on said 
 
            date the doctor indicated claimant had acute prostatitis and 
 
            also notes that claimant told him he was shoved against a 
 
            guardrail at work.  Claimant's records continue to show some 
 
            of the problems of 1989.  On September 1, 1989, the records 
 
            show claimant was concerned about the family history of 
 
            coronary artery disease.
 
            
 
                 Dr. Barnes' medical notes are reflected as Joint 
 
            Exhibit 1, page 7 through 21.  When he testified through his 
 
            deposition, he referred to these notes.
 
            
 
                 The medical records of M. A. Sanguino, M.D., a 
 
            neurologist, reflect claimant had left L5-S1 radiculopathy 
 
            (Jt. Ex. 1, p. 25).  Joint Exhibit 1, page 30 to 51, 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            reflects defendant employer's medical notes regarding 
 
            claimant.
 
            
 
                 Claimant relates his August 30, 1988 alleged injury to 
 
            basically all of his current problems.  Claimant downplayed 
 
            his prior back condition and the fact that ten days before 
 
            his alleged injury he saw a chiropractor.  It also appears 
 
            that claimant contends his ulcer and those problems related 
 
            thereto are caused by his alleged work injury.  The 
 
            overwhelming medical evidence indicates that claimant has 
 
            had stomach problems for a number of years and that there 
 
            are many other things that was causing claimant concern, 
 
            some of which were his absenteeism, his worrying about 
 
            getting fired, his suspensions, and family coronary history.  
 
            Also, claimant got married in 1989.  Claimant seems to 
 
            distinguish stomach problems versus an ulcer.  Again, the 
 
            evidence is overwhelming that we may be talking in somatics 
 
            but that there was indication that claimant had an ulcer or 
 
            severe beginning of an ulcer condition prior to August 30, 
 
            1988.  The undersigned finds that claimant's ulcer or 
 
            stomach problems are not a result of any alleged August 30, 
 
            1988 injury.
 
            
 
                 Claimant has the burden of proving that the August 30, 
 
            1988 injury caused his current alleged permanent disability.  
 
            Although it is very surprising to the undersigned that Dr. 
 
            Barnes apparently, after many years of practice, does not 
 
            know the difference between the words "possible" or 
 
            "probable."  In the law, those words have great 
 
            significance.  It is understandable as to why the doctor 
 
            could not determine within medical certainty whether 
 
            claimant's condition is probably or possibly caused by an 
 
            August 30, 1988 alleged work injury.  What is alarming is 
 
            the doctor does not know the difference between the two or 
 
            uses them synonymously.  The undersigned cannot speculate or 
 
            guess as to what the doctor means.  It is clear that the 
 
            doctor is not convinced that claimant's problems are caused 
 
            by an August 30, 1988 alleged injury.
 
            
 
                 The undersigned believes the greater weight of evidence 
 
            indicates that claimant did, in fact, receive an injury on 
 
            August 30, 1988 which resulted in a temporary total 
 
            disability.  The August 30, 1988 injury also substantially 
 
            aggravated temporarily a preexisting condition and the 
 
            undersigned so finds.  The undersigned finds that the period 
 
            of August 31, 1988 through October 30, 1988, to which the 
 
            parties stipulated claimant was off, was, in fact, the 
 
            period in which claimant was temporary totally disabled.
 
            
 
                 The undersigned further finds that claimant's current 
 
            condition or any impairment or permanent disability he may 
 
            have are not the result of claimant's August 30, 1988 work 
 
            injury but are a result of conditions claimant had prior to 
 
            August 30, 1988 or may have developed subsequently but were 
 
            not proximately, substantially or materially the result of 
 
            the August 30, 1988 injury.  Claimant's current work appears 
 
            to be temporary.  It is also clear from the record that 
 
            claimant has an employment record clouded with absenteeism.  
 
            Claimant was terminated from his job because of absenteeism.  
 
            It is obvious he anticipated or feared that that day would 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            come.  Claimant is not motivated.  He has not attempted to 
 
            find employment.  He has not made adequate attempts to take 
 
            advantage of his auctioneering ability.  It seems he is 
 
            satisfied with living on his wife's income and taking care 
 
            of certain household duties.  Claimant did not see Dr. 
 
            Barnes again for over a year and it appears that was only 
 
            shortly after he was fired.  This seems to be no mere 
 
            coincidence.  Claimant seems critical of Dr. Barnes but 
 
            there is nothing in the record that indicates why.  He had 
 
            opportunities to complain and he never did.
 
            
 
                 The 85.27 medical benefit issue had to do with causal 
 
            connection.  There were no medical bills presented to which 
 
            there is a dispute.  The undersigned has found causal 
 
            connection as to a temporary total disability and not 
 
            permanent disability.  Claimant is entitled to have his 
 
            medical bills paid concerning those bills incurred as a 
 
            result of and during his temporary total disability but is 
 
            not entitled to have any bills paid subsequent thereto.  The 
 
            parties' attention is called to section 8 of the prehearing 
 
            report which indicates that if medical bills are in dispute 
 
            that an itemized listing of expenses for which claimant is 
 
            seeking reimbursement should be attached.
 
            
 
                                conclusions of law
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that he received an injury on August 30, 
 
            1988, which arose out of and in the course of his 
 
            employment. McDowell v. Town of Clarksville, 241 N.W.2d 904 
 
            (Iowa 1976); Musselman v. Central Telephone Co., 261 Iowa 
 
            352, 154 N.W.2d 128 (1967). 
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of August 30, 
 
            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 language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id. at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 
 
            N.W.2d 128 (1967).
 
            
 
                 While a claimant is not entitled to compensation for 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            the results of a preexisting injury or disease, the mere 
 
            existence at the time of a subsequent injury is not a 
 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
 
            preexisting condition or disability that is aggravated, 
 
            accelerated, worsened or lighted up so that it results in 
 
            disability, claimant is entitled to recover.  Nicks v. 
 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
 
            (1962).
 
            
 
                 The Iowa Supreme Court cites, apparently with approval, 
 
            the C.J.S. statement that the aggravation should be material 
 
            if it is to be compensable.  Yeager v. Firestone Tire & 
 
            Rubber Co., 253 Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. 
 
            Workmen's Compensation sec. 555(17)a.
 
            
 
                 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, 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).
 
            
 
                 It is further concluded that:
 
            
 
                 Claimant incurred an injury on August 30, 1988 that 
 
            arose out of and in the course of his employment, and that 
 
            said injury caused a temporary total disability but did not 
 
            cause any permanent partial disability.
 
            
 
                 Claimant's temporary total disability began August 31, 
 
            1988 through October 30, 1988, encompassing 8.714 weeks at 
 
            the rate of $316.38.
 
            
 
                 Claimant is entitled to 85.27 medical benefits as to 
 
            his temporary total disability and expenses connected 
 
            therewith.
 
            
 
                                      order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendant shall pay unto claimant eight point 
 
            seven one four (8.714) weeks of temporary total disability 
 
            benefits at the rate of three hundred sixteen and 38/100 
 
            dollars ($316.38) for the period beginning August 31, 1988 
 
            through October 30, 1988.
 
            
 
                 That defendant shall pay accrued weekly benefits in a 
 
            lump sum and shall receive credit against the award for 
 
            weekly benefits previously paid.  The parties have 
 
            stipulated that defendant paid eight point seven one four 
 
            (8.714) weeks of temporary total disability or healing 
 
            period at the rate of two hundred eighty-one and 06/100 
 
            dollars ($281.06).
 
            
 
                 That defendant shall pay claimant's medical expenses 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            connected with his temporary total disability.
 
            
 
                 That defendant shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            
 
                 That defendant shall pay the costs of this action, 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 That defendant shall file an activity report upon 
 
            payment of this award as required by this agency, pursuant 
 
            to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of July, 1991.
 
            
 
            
 
            
 
                                          ______________________________
 
                                          BERNARD J. O'MALLEY
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies to:
 
            
 
            Mr Michael W Liebbe
 
            Attorney at Law
 
            116 E Sixth St
 
            Davenport IA 52801
 
            
 
            Mr Thomas M Kamp
 
            Attorney at Law
 
            600 Davenport Bank Bldg
 
            Davenport IA 52801
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      5-1801; 5-1803
 
                      Filed July 30, 1991
 
                      Bernard J. O'Malley
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            RANDALL E. ST. CLAIR,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 909732
 
            ALUMINUM COMPANY OF AMERICA,  :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                 Self-Insured,            :       D E C I S I O N
 
                 Defendant.               :
 
                                          :
 
            ___________________________________________________________
 
            
 
            5-1801; 5-1803
 
            Found claimant incurred a work injury that arose out of and 
 
            in the course of claimant's employment resulting in 8.714 
 
            weeks of temporary total disability.  No permanent 
 
            disability caused by the work injury was found.