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                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            GEORGE YOULL,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 911743
 
            YOULL PLUMBING AND HEATING,   :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            FEDERATED INSURANCE CO.,      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by George 
 
            Youll against his former employer Youll Plumbing and 
 
            Heating, Inc., based upon an injury that occurred on March 
 
            2, 1989.  Claimant seeks compensation for healing period and 
 
            permanent partial disability or permanent total disability.  
 
            There is an issue regarding whether the permanent disability 
 
            is scheduled member or extends into the body as a whole.  
 
            Claimant also seeks to recover his medical expenses shown in 
 
            exhibit 33.  The dispute regarding those bills is whether 
 
            the medical services were proximately caused by the injury.  
 
            Finally, there is an issue with regard to the rate of 
 
            compensation which should be paid in this case.  It was 
 
            stipulated that claimant was married with two exemptions.
 
            
 
                 The record in the proceeding consists of testimony from 
 
            George Youll, Myrna Youll, Jack Reynolds, James Youll, and 
 
            Ellen Sokolowski.  The record also contains joint exhibits 1 
 
            through 8 and defendants' exhibits A and B.  
 
            
 
                                 findings of fact
 
            
 
                 Having considered all the evidence received, together 
 
            with the appearance and demeanor of the witnesses, it is 
 
            found that George Youll is a credible witness.  This case 
 
            presents a wide ranging variety of medical opinions, but 
 
            certain foundational facts are essentially undisputed.  
 
            
 
                 George Youll is a 62-year-old married man who was 
 
            steadily employed on a full time basis as a plumber and 
 
            sheet metal worker until he was injured on March 2, 1989.  
 
            His work involved strenuous use of his hands, particularly 
 
            when constructing ducts and performing other sheet metal 
 
            work.  George was very good and extremely productive as 
 
            evidenced by testimony from defense witness James Youll.  It 
 
            is readily apparent that he could not have performed as he 
 

 
            
 
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            did if he had any significant preexisting impairment 
 
            affecting either of his hands or arms.  
 
            
 
                 While the record in this case contains estimates and 
 
            opinions from a number of physicians regarding apportionment 
 
            of preexisting impairment based upon degenerative changes, 
 
            the fact of the matter is he had essentially full use of 
 
            both of his upper extremities and hands prior to the time he 
 
            fell on March 2, 1989.  He was not only able to use them 
 
            fully, he was able to use them in a commercial setting at a 
 
            productive level which James Youll described as being able 
 
            to do the work of two men.  For those same reasons, it is 
 
            found that George Youll had full use of both of his legs as 
 
            evidenced by the fact that he was able to stand at a sheet 
 
            metal bench and fabricate sheet metal parts for essentially 
 
            a continuous work day.  He was able to perform the functions 
 
            of climbing and crawling which were associated with 
 
            plumbing, sheet metal and farm well pump work.  The 
 
            statement found in exhibit 34 which was made by David R. 
 
            Youberg, M.D., a physician who had been claimant's family 
 
            physician for a number of years, accurately sets forth the 
 
            ultimate facts of this case.  
 
            
 
                 I am willing to say in any court that George Youll 
 
                 was perfectly capable of working and indeed was 
 
                 working without a great deal of difficulty prior 
 
                 to this accident.  After the accident, he had 
 
                 complaints referable to both his leg and his wrist 
 
                 and was unable to work thereafter.  At the present 
 
                 time, he is rather severely disabled and walks 
 
                 with a decided limp, certainly a condition that 
 
                 was not present prior to the accident.
 
            
 
                 It may be that Mr. Youll had previous injuries and 
 
                 arthritis or degeneration of the wrist that 
 
                 pre-existed the accident.  The accident however 
 
                 accentuated these conditions and caused him to 
 
                 become disabled.
 
            
 
            (joint exhibit 34)
 
            
 
                 That statement from Dr. Youberg is an accurate 
 
            reflection of what has happened in this case.  It is a 
 
            statement made by Dr. Youberg from direct observation.  It 
 
            does not require any exercise of professional opinion or 
 
            judgement in the sense of attempting to reconstruct the 
 
            claimant's pre-injury condition because that pre-injury 
 
            condition was known to Dr. Youberg from  personal 
 
            observation.
 
            
 
                 A complicating factor in this case is a tremor 
 
            condition which afflicts George.  It afflicted him prior to 
 
            the injury in this case.  It was apprently quite minor since 
 
            it had not been noticed by his employer prior to the injury.  
 
            Since the injury, the condition has clearly become much more 
 
            pronounced.  The tremor might not warrant a rating under 
 
            established rating guideline systems, but it clearly 
 
            produces a loss of ability to use the effected member, 
 
            George's right hand and arm.  As previously noted, the 
 

 
            
 
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            tremor did not prevent George from working prior to the 
 
            injury.  As his employer noted, he could perform the work of 
 
            two men.
 
            
 
                 An issue has been raised as to whether or not George 
 
            Youll was a part owner of Youll Plumbing and Heating Inc. at 
 
            the time of his injury.  It is difficult to determine what 
 
            effect, if any, the issue has upon the issues in this case.  
 
            Whether or not George was an owner of the business, he could 
 
            still be an employee covered by the workers' compensation 
 
            laws.  He clearly had been an owner for several years in the 
 
            past.  Those who had known him to be an owner would not 
 
            necessarily have knowledge of changes in the private 
 
            business structure of the corporation or the ownership of 
 
            stock in the corporation.  Defendants' exhibit A and also 
 
            exhibit 35 make some reference to George being an owner.  If 
 
            George were, in fact, self-employed income tax records and 
 
            the payroll records from the corporation would show that 
 
            fact.  There are a number of explanations of how the terms 
 
            "self-employed" and "owner Youll Plumbing" came to be 
 
            entered in the outpatient record (defendants' exhibit A).  
 
            It is possible that George might have told them he was 
 
            self-employed and owned the business.  The clerk entering 
 
            the information might also have assumed that since the title 
 
            of the business was Youll Plumbing that George owned it and 
 
            was self-employed.  Any number of other possible scenarios 
 
            are available which could explain why defendants' exhibit A 
 
            says what it does.  Whatever the reason is, it has no 
 
            bearing on the material issues in this case.  George Youll 
 
            was clearly an employee of the corporation.  He was paid by 
 
            the hour.  Anything regarding the ownership of the 
 
            corporation is extraneous material.  No issue has been 
 
            raised along the lines of corporate officer exclusion, 
 
            insurance coverage or any other issue which might be 
 
            affected by the method of ownership of the corporation.  
 
            
 
                 There is evidence in the record from Ellen Sokolowski, 
 
            a qualified vocational rehabilitation consultant.  She 
 
            identifies a number of positions with which she feels George 
 
            could perform.  Her analysis of this case does not address 
 
            the issue of George's aptitude for performing the types of 
 
            work which she has identified.  He has no work history in 
 
            the sales field or in any other field where he performed any 
 
            significant amount of interpersonal communications or public 
 
            relations type of work.  George is a man who has worked with 
 
            his hands, fabricating inanimate objects such as sheet metal 
 
            ducts and plumbing materials.  Other than for appearing to 
 
            have a pleasant personality there is no testing, evaluation 
 
            or other evidence in the record of this case to indicate 
 
            that he has the capacity to do work which involves dealing 
 
            with people rather than dealing with inanimate objects.  If 
 
            he has not developed those skills by the age of 60 years, it 
 
            is not likely that he will do so subsequently.  It is clear 
 
            that George Youll has a very large degree of disability if 
 
            it is to be evaluated industrially.
 
            
 
                 George was injured on March 2, 1989, when he fell from 
 

 
            
 
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            a ladder while attempting to pull a pump from a well pit.  
 
            He fell from an eight-foot ladder with his left leg going 
 
            into a hole which was part of the well pit.  His fall was 
 
            stopped by his right hand and right leg.  He had been 
 
            standing at the top of the ladder.  When he regained his 
 
            senses after the fall, he was lying face down in the snow.  
 
            His right arm was bent back.  His left heel and leg were in 
 
            the well pit.  
 
            
 
                 George received medical care from a number of sources.  
 
            His initial treatment was with Dr. Youberg.  Dr. Youberg's 
 
            notes, exhibit 2, show the initial injury being to George's 
 
            right wrist and left leg.  A wrist splint was supplied.  No 
 
            mention is made of George's right shoulder.  The parties did 
 
            stipulate the first report of injury into the evidence of 
 
            this case.  Paragraph 19 does list the right shoulder as a 
 
            part of the body affected (ex. 1).  A fall such as the one 
 
            George experienced, where the person lands on their right 
 
            hand with sufficient force to injure the right wrist, could 
 
            produce a similar amount of trauma or impact to the entire 
 
            right arm and shoulder.  If the fall has sufficient force to 
 
            injure a wrist, it would only seem reasonable that the 
 
            amount of force on impact could also injure the shoulder.  
 
            It is therefore found that the original injury did include 
 
            injury to George's right shoulder.  
 
            
 
                 Shortly after the injury, George was seen by Orthopedic 
 
            Surgeon David G. Paulsrud, M.D., on April 21, 1989.  X-rays 
 
            demonstrated severe degenerative arthritis in George's right 
 
            wrist and finger joints.  The left thigh was diagnosed as 
 
            having an incomplete muscle tear.  Dr. Paulsrud recommended 
 
            that George avoid strenuous use of his quadriceps muscles 
 
            for three months in order to promote healing.  Though the 
 
            report does not read coherently, it appears as though the 
 
            doctor simply stated that there was little that could be 
 
            done for the degenerative arthritis in the wrist.  It is 
 
            noted that the disposition section of the report makes 
 
            reference to the left wrist but the history refers to the 
 
            right wrist and it was the right wrist which was injured and 
 
            symptomatic (ex. 3, p. 8).
 
            
 
                 After approximately three months of resting, George 
 
            began developing problems with his left knee locking.  This 
 
            symptoms was noticed when he began exercises to strengthen 
 
            his quadriceps muscles (ex. 2, p. 4).  He was again seen by 
 
            Dr. Paulsrud at which time it was felt that he had a 
 
            meniscus tear and that arthroscopic surgery was indicated 
 
            (ex. 3, p. 9; ex. 11).  Surgery was performed on October 2, 
 
            1989, at which time a medial plica impingement was found and 
 
            corrected (ex. 12).  As indicated by David H. Bartlett, 
 
            M.D., the arthroscopic surgery was necessitated by the work 
 
            injury (ex. 16).  Leonard E. Weber, M.D., agreed with that 
 
            causal connection (ex. 32, p. 64).
 
            
 
                 Dr. Paulsrud provided George with a 5 percent permanent 
 
            impairment rating of his left leg (ex. 3, p. 9).  It is 
 
            noted that the rating was given before the surgery had been 
 
            performed.  The greater weight of the evidence is found in 
 

 
            
 
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            the impairment ratings of Doctors Bartlett, Weber and John 
 
            J. Dougherty, M.D. (exs. 16, p. 24; 32, p. 66; 21, p. 34).  
 
            
 
                 George's right wrist presents a particular problem.  He 
 
            injured the wrist approximately 15 years ago.  Severe 
 
            degenerative changes have been identified.  It is well 
 
            recognized that those degenerative changes would have their 
 
            basis in something which occurred several years ago and not 
 
            in something which occurred in 1989.  Dr. Paulsrud provided 
 
            an impairment rating of 27 percent of the upper extremity 
 
            (ex. 3, p. 9).  He declined to explain how that 27 percent 
 
            was determined.  Dr. Paulsrud declined to apportion the 
 
            disability between that which preexisted the injury and that 
 
            caused by the injury.  Since he "did not see him at anytime 
 
            before the injury."  (ex. 6).  Other physicians, namely 
 
            Doctors Weber and Dougherty placed the impairment resulting 
 
            from this injury in the range of 5 to 10 percent of the 
 
            extremity (ex. 32, p. 66; 21, p. 34).  Dr. Bartlett 
 
            indicated that a rating of 27 percent was probably too high 
 
            (ex. 16, p. 25).  It is found that George Youll had a 
 
            preexisting degeneration in his right wrist which resulted 
 
            from a fall that occurred approximately 15 years ago and 
 
            perhaps from other causes.  That degeneration was made 
 
            symptomatic by the March 2, 1989 fall.  It has made George 
 
            unable to perform the customary functions of a plumber and 
 
            sheet metal worker which he had performed, without apparent 
 
            problem, prior to the March 2, 1989 injury.  Under the 
 
            established AMA Guides rating system, he has only a 5 or 10 
 
            percent impairment of the right upper extremity which is 
 
            attributable to the March 2, 1989 injury.  He also, however, 
 
            has a loss of use of his right hand in an amount which the 
 
            undersigned determines to be in the range of 20 percent of 
 
            the hand when evaluated in terms of loss of ability to use a 
 
            hand for the functions a hand is customarily used for 
 
            performing.  
 
            
 
                 George also injured his shoulder when he fell on March 
 
            2, 1989.  His shoulder has not received an adequate medical 
 
            workup as recommended by Scott B. Neff, D.O. (ex. 29).  Dr. 
 
            Dougherty also recognized the need for additional diagnostic 
 
            testing on the shoulder (ex. 31, p. 55).  Doctors Weber and 
 
            Dougherty both recommended some type of physical therapy 
 
            treatment for the shoulder (ex. 31, p. 56).  Dr. Dougherty 
 
            attributed the shoulder condition to adhesive capsulitis.  
 
            Dr. Weber also felt the shoulder condition was adhesive 
 
            capsulitis related to the fall (ex. 32, pp. 64-65).  Dr. 
 
            Weber concludes by finding a 9 percent impairment of the 
 
            upper extremity (equivalent to 5 percent of the whole 
 
            person) based upon lost motion of the right shoulder (ex. 
 
            32, p. 66).
 
            
 
                 George has had the ongoing difficulty with his right 
 
            shoulder for a considerable amount of time.  It has not 
 
            resolved on his own without treatment.  Defendants have had 
 
            claimant evaluated for the shoulder condition.  Both Doctors 
 
            Dougherty and Weber indicated that he had adhesive 
 
            capsulitis and that the condition might be amenable to 
 

 
            
 
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            treatment.  Defendants chose, however, to not provide any 
 
            treatment for the shoulder.  Since the condition has lasted 
 
            as long as it has, it appears that it will continue for an 
 
            indefinite amount of time and is likely permanent.  
 
            
 
                 George also has a tremor.  It has been identified by 
 
            Neurologist David Friedgood as a benign essential tremor.  
 
            Dr. Friedgood reported that the tremor was clearly 
 
            exacerbated by the injury.  The condition is one which quite 
 
            typically seems to be worse when the person is ill or 
 
            stressed and which seems to improve when the person is 
 
            feeling well (ex. 23, 24).  That assessment is adopted as 
 
            being correct.  The contrary evidence regarding the tremor 
 
            from Dr. Dougherty is particularly unreliable since Dr. 
 
            Dougherty was not even familiar with the term "benign 
 
            essential tremor" prior to his involvement in this case.  
 
            Dr. Weber reported that the current degree of the tremor is 
 
            a natural progression.  The tremor is quite pronounced and 
 
            was observed at hearing.  By itself it would make performing 
 
            work which required any degree of manual dexterity or 
 
            precision quite difficult.  The evidence does not present 
 
            any consensus with regard to the typical characteristics of 
 
            a benign essential tremor being progressive.  It is clear 
 
            from the evidence that it certainly has progressed.  It 
 
            started one and one-half years before this injury.  It is 
 
            now quite pronounced.  While the injury did, in all 
 
            likelihood, aggravate the condition to some extent as 
 
            related by Dr. Friedgood, there is nothing in the record 
 
            which indicates that the tremor condition is any different 
 
            now than what it would have other wise been if the fall had 
 
            not occurred. 
 
            
 
                 George Youll was forced into premature retirement by 
 
            this injury.  He lives in a part of the state where jobs are 
 
            not particularly plentiful.  If he were to take employment 
 
            in those jobs which Vocational Consultant Sokolowski 
 
            identified for him, his hourly reduction in earnings would 
 
            be in the range of nearly 50 percent.  Not only would George 
 
            experience a large reduction in his hourly rate of earnings, 
 
            he would also experience a reduction in the number of hours 
 
            per week during which work would be available for him.  If 
 
            he were to be successful at getting hired at the jobs 
 
            suggested by Sokolowski, he would still experience a 
 
            reduction of more than 50 percent in his actual earnings 
 
            when compared to his pre-injury earnings.
 
            
 
                 Exhibit 33 contains a number of medical expenses which 
 
            were rejected by claimant's group carrier because the group 
 
            carrier believed that charges were incurred for treatment of 
 
            the work injury.  In the prehearing report it was stipulated 
 
            that the expenses were causally connected with the 
 
            conditions upon which this claim is based, even though 
 
            causal connection to the work injury for some of those 
 
            conditions was disputed.  All of the expenses claimed in 
 
            exhibit 33 are therefore found to have been incurred in 
 
            obtaining treatment for the injury of March 2, 1989.  
 
            
 
                 The point at which George reached maximum improvement 
 

 
            
 
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            from the injuries is not easily identified.  On June 27, 
 
            1990, Dr. Friedgood indicated that George needed ongoing 
 
            orthopedic evaluation and that he suspected that when the 
 
            orthopedic problems were resolved the tremor would be less 
 
            of a problem (ex. 23, p. 38).  Lawrence J. Rettenmaier, 
 
            M.D., provided active treatment on June 27, 1990.  On August 
 
            14, 1990, Dr. Rettenmaier reported that it was difficult to 
 
            judge whether maximum benefit had been reached (ex. 26).  On 
 
            September 19, 1990, Dr. Rettenmaier again stated that 
 
            claimant was in a healing period status (ex. 27).  On 
 
            October 22, 1990, George was seen by Dr. Neff for evaluation 
 
            of his right shoulder and further diagnostic treatment was 
 
            recommended (ex. 29).  On January 3, 1991, Dr. Rettenmaier 
 
            suggested treatment by Dr. Neff.  That treatment was not 
 
            ongoing or offered and Dr. Rettenmaier went on to state that 
 
            he felt claimant had reached maximum medical treatment (ex. 
 
            30).  On April 4, 1991, Dr. Dougherty reported that claimant 
 
            had reached maximum medical improvement (ex. 31, p. 56).  In 
 
            that same report, however, in a later paragraph, Dr. 
 
            Dougherty also states that the shoulder would improve with 
 
            physiotherapy.  He also felt that the shoulder condition did 
 
            not result from the fall in 1989.  January 3, 1991, is found 
 
            to be the date when recuperation ceased.  It is when active 
 
            treatment ceased.
 
            
 
                 George was paid $9.35 per hour.  He typically worked 40 
 
            or more hours per week.  When he did not work at least 40 
 
            hours per week, it was because of personal illness or some 
 
            reason other than lack of available work.  The weeks ending 
 
            February 17, 1989 and December 9, 1988, are not 
 
            representative of George's customary work hours.  The 13 
 
            weeks preceding the week in which the injury occurred are, 
 
            therefore, the weeks of February 14, 10 and 3, 1989.  
 
            January 27, 20, 13 and 6, 1989, December 30, 23, 16 and 2, 
 
            1988, and November 25 and 18, 1988.  During those 13 weeks 
 
            George worked a total of 555.75 hours.  His gross earnings 
 
            at $9.35 per hour were $5,196.26.  The average gross weekly 
 
            earnings therefore compute to $399.71.  
 
            
 
                                conclusions of law
 
            
 
                 The party who would suffer loss if an issue were not 
 
            established has the burden of proving that issue by a 
 
            preponderance of the evidence.  Iowa R. of App. P. 14(f).
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the alleged injury 
 
            actually occurred and that it arose out of and in the course 
 
            of employment.  McDowell v. Town of Clarksville, 241 N.W.2d 
 
            904 (Iowa 1976); Musselman v. Cent. Tel. Co., 261 Iowa 352, 
 
            154 N.W.2d 128 (1967).  The words "arising out of" refer to 
 
            the cause or source of the injury.  The words "in the course 
 
            of" refer to the time, place and circumstances of the 
 
            injury.  Sheerin v. Holin Co., 380 N.W.2d 415 (Iowa 1986); 
 
            McClure v. Union County, 188 N.W.2d 283 (Iowa 1971).
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury is a proximate 
 
            cause of the disability on which the claim is based.  A 
 

 
            
 
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            cause is proximate if it is a substantial factor in bringing 
 
            about the result; it need not be the only cause.  A 
 
            preponderance of the evidence exists when the causal 
 
            connection is probable rather than merely possible.  
 
            Blacksmith v. All-American, Inc., 290 N.W.2d 348 (Iowa 
 
            1980); Holmes v. Bruce Motor Freight, Inc., 215 N.W.2d 296 
 
            (Iowa 1974).
 
            
 
                 The question of causal connection is essentially within 
 
            the domain of expert testimony.  The expert medical evidence 
 
            must be considered with all other evidence introduced 
 
            bearing on the causal connection between the injury and the 
 
            disability.  The weight to be given to any expert opinion is 
 
            determined by the finder of fact and may be affected by the 
 
            accuracy of the facts relied upon by the expert as well as 
 
            other surrounding circumstances.  The expert opinion may be 
 
            accepted or rejected, in whole or in part.  Sondag v. Ferris 
 
            Hardware, 220 N.W.2d 903 (Iowa 1974); Anderson v. Oscar 
 
            Mayer & Co., 217 N.W.2d 531 (Iowa 1974); Bodish v. Fischer, 
 
            Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).
 
            
 
                 A personal injury contemplated by the workers' 
 
            compensation law means an injury, the impairment of health 
 
            or a disease resulting from an injury which comes about, not 
 
            through the natural building up and tearing down of the 
 
            human body, but because of trauma.  The injury must be 
 
            something which acts extraneously to the natural processes 
 
            of nature and thereby impairs the health, interrupts or 
 
            otherwise destroys or damages a part or all of the body.  
 
            Although many injuries have a traumatic onset, there is no 
 
            requirement for a special incident or an unusual occurrence.  
 
            Injuries which result from cumulative trauma are 
 
            compensable.  McKeever Custom Cabinets v. Smith, 379 N.W.2d 
 
            368 (Iowa 1985); Olson v. Goodyear Serv. Stores, 255 Iowa 
 
            1112, 125 N.W.2d 251 (1963); Ford v. Goode, 240 Iowa 1219, 
 
            38 N.W.2d 158 (1949); Almquist v. Shenandoah Nurseries, 
 
            Inc., 218 Iowa 724, 254 N.W. 35 (1934).  An occupational 
 
            disease covered by chapter 85A is specifically excluded from 
 
            the definition of personal injury.  Iowa Code section 
 
            85.61(5); Iowa Code section 85A.8.
 
            
 
                 When disability is found in the shoulder, a body as a 
 
            whole situation may exist.  Alm v. Morris Barick Cattle Co., 
 
            240 Iowa 1174, 38 N.W.2d 161 (1949).  In Nazarenus v. Oscar 
 
            Mayer & Co., II Iowa Industrial Commissioner Report 281 
 
            (App. 1982), a torn rotator cuff was found to cause 
 
            disability to the body as a whole.  George has adhesive 
 
            capsulitis.  The shoulder joint itself is impaired.  The 
 
            disability is therefore not limited to the schedule for an 
 
            arm.  Lauhoff Grain v. McIntosh, 395 N.W.2d 834 (Iowa 1986); 
 
            Dailey v. Pooley Lumber Co., 233 Iowa 758, 10 N.W. 569 1840 
 
            (1943).
 
            
 
                 Aggravation of a preexisting condition is one manner of 
 
            sustaining a compensable injury.  While a claimant is not 
 
            entitled to compensation for the results of a preexisting 
 
            injury or disease, its mere existence at the time of a 
 
            subsequent injury is not a defense.  Rose v. John Deere 
 

 
            
 
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            Ottumwa Works, 247 Iowa 900, 76 N.W.2d 756 (1956).  If the 
 
            claimant had a preexisting condition or disability that is 
 
            materially 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 (1962); Yeager v. Firestone Tire & Rubber Co., 
 
            253 Iowa 369, 112 N.W.2d 299 (1961).
 
            
 
                 It is determined that George Youll has proven, by a 
 
            preponderance of the evidence, that his left knee and right 
 
            shoulder were both injured on March 2, 1989, when he fell 
 
            from the ladder.  The disability affecting his shoulder is 
 
            lasting rather than temporary.  It continues for an 
 
            indefinite and undeterminable period.  It is therefore 
 
            proper to treat it as being permanent.  Wallace v. 
 
            Brotherhood, 230 Iowa 1127 300 N.W. 322 (1941).
 
            
 
                 Industrial disability or loss of earning capacity is a 
 
            concept that is quite similar to impairment of earning 
 
            capacity, an element of damage in a tort case.  Impairment 
 
            of physical capacity creates an inference of lessened 
 
            earning capacity.  The basic element to be determined, 
 
            however, is the reduction in value of the general earning 
 
            capacity of the person, rather than the loss of wages or 
 
            earnings in a specific occupation.  Post-injury earnings 
 
            create a presumption of earning capacity.  The earnings are 
 
            not synonymous with earning capacity and the presumption may 
 
            be rebutted by evidence showing the earnings to be an 
 
            unreliable indicator.  Bearce v. FMC Corp., 465 N.W.2d 531 
 
            (Iowa 1991); DeWall v. Prentice, 224 N.W.2d 428, 435 (Iowa 
 
            1974); Carradus v. Lange, 203 N.W.2d 565 (Iowa 1973); 
 
            Holmquist v. Volkswagon of America, Inc., 261 N.W.2d 516 
 
            (Iowa App. 1977) A.L.R.3d 143; Michael v. Harrison County, 
 
            Thirty-fourth Biennial Report of the Industrial Commissioner 
 
            218 (1979); 2 Larson Workmen's Compensation Law, sections 
 
            57.21 and 57.31.
 
            
 
                 At George's age it is unlikely that retraining is 
 
            feasible.  He has no demonstrative aptitude for sales work 
 
            or other work requiring significant interpersonal 
 
            relationships.  To the contrary, his entire work history has 
 
            been directed toward work with inanimate objects.  He tends 
 
            to be highly productive in that regard and even perhaps 
 
            somewhat of a perfectionist.  Such individuals cannot be 
 
            presumed to have the capacity to make the transition into 
 
            some other line or field of work without a significant 
 
            amount of retraining.  Even if the projections related by 
 
            Vocational Consultant Sokolowski are accepted as being 
 
            correct, George still would experience approximately a 50 
 
            percent reduction in actual earnings if he were to return to 
 
            work under the conditions she suggests.  He has been forced 
 
            into an early retirement.  Under these circumstances it is 
 
            the only rational course of conduct available for him.  As 
 
            Dr. Youberg stated it is this injury which makes George 
 
            unable to work.  It is not absolutely essential to 
 
            specifically identify the precise physiological method in 
 
            which the disability occurred.  In this case there is 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            sufficient objective evidence of disability that has come 
 
            about since the injury with no other reasonable source 
 
            except for the injury, that it is sufficient to support a 
 
            finding that George's disability was caused by the injury.  
 
            The fact that he was nearing and is now within the range of 
 
            normal retirement age is a factor which goes to determining 
 
            the extent of disability but not the entitlement.  George is 
 
            clearly a motivated, industrious individual.  When all 
 
            material factors of industrial disability are considered, it 
 
            is determined that George Youll has a 50 percent loss of 
 
            earning capacity and industrial disability as a result of 
 
            the March 2, 1989 injury.  This entitles him to recover 250 
 
            weeks of permanent partial disability compensation.
 
            
 
                 An injured employee is entitled under section 85.34(1) 
 
            to recover healing period compensation.  In this case that 
 
            entitlement is found to end on January 3, 1991, in 
 
            accordance with the statements from Dr. Rettenmaier.  The 
 
            permanent partial disability compensation is therefore 
 
            payable commencing January 4, 1991.  
 
            
 
                 Claimant's rate of compensation is to be based upon 
 
            gross weekly earnings of $399.71.  The case cited by 
 
            defendants in their brief was reversed on appeal by the 
 
            industrial commissioner.  The correct rate is therefore 
 
            $251.83 per week since claimant is married and entitled to 
 
            two exemptions.
 
            
 
                 The medical expenses set forth in exhibit 33 are all 
 
            determined to be the liability of defendants in accordance 
 
            with the stipulations made in the prehearing report.  The 
 
            only issues were the underlying issues of liability and 
 
            causation.  Since the shoulder condition has been found to 
 
            have been caused by the fall and the tremor condition 
 
            aggravated by the fall all the expenses listed on pages 70 
 
            and 71 are to be paid by defendants.  Since claimant has 
 
            paid them back to the group carrier, the total amount of 
 
            $1,697.95 shall be refunded to the claimant.  
 
            
 
                                      order
 
            
 
                 IT IS THEREFORE ORDERED that defendants pay George 
 
            Youll ninety-six and one-seventh (96 1/7) weeks of 
 
            compensation for healing period at the rate of two hundred 
 
            fifty-one and 83/100 dollars ($251.83) per week commencing 
 
            March 2, 1989.
 
            
 
                 It is further ordered that defendants pay George Youll 
 
            two hundred fifty (250) weeks of compensation for permanent 
 
            partial disability at that rate of two hundred fifty-one and 
 
            83/100 dollars ($251.83) per week commencing January 4, 
 
            1991.
 
            
 
                 Defendants are ordered to pay all unpaid, accrued 
 
            amounts in a lump sum together with interest pursuant to 
 
            section 85.30 after credit is given for amounts previously 
 
            paid voluntarily.
 
            
 
                 It is further ordered that defendants pay claimant one 
 
            thousand six hundred ninety-seven and 95/100 dollars 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            ($1,697.95) under the provisions of Code section 85.27.
 
            
 
                 It is further ordered that defendants pay the costs of 
 
            this action pursuant to rule 343 IAC 4.33.
 
            
 
                 It is further ordered that defendants file claim 
 
            activity reports as requested by this agency pursuant to 
 
            rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of January, 1993.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          MICHAEL G. TRIER
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Max Schott
 
            Attorney at Law
 
            6959 University Ave
 
            Des Moines, Iowa  50311-1540
 
            
 
            Mr. Frank Harrison
 
            Attorney at Law
 
            2700 Grand Ave, STE 111
 
            Des Moines, Iowa  50312
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                           51803.1 581803 53001
 
                           Filed January 8, 1993
 
                           Michael G. Trier
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            GOERGE YOULL,  :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 911743
 
            YOULL PLUMBING AND HEATING,   :
 
                      :  A R B I T R A T I O N
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            FEDERATED INSURANCE CO., :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            51803.1 51803
 
            Sixty-two-year-old man awarded 50 percent permanent partial 
 
            disability for shoulder and wrist injuries.
 
            
 
            53001
 
            Rate based on full work weeks.
 
            
 
 
         
 
         
 
         
 
         
 
         
 
         
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                                         :
 
         KAHM-THIEP BACCAM,              :
 
                                         :
 
              Claimant,                  :
 
                                         :
 
         vs.                             :
 
                                         :        File No. 911756
 
         AMANA REFRIGERATION, INC.,      :
 
                                         :          A P P E A L
 
              Employer,                  :
 
                                         :        D E C I S I O N
 
         and                             :
 
                                         :
 
         LIBERTY MUTUAL INSURANCE CO.,   :
 
                                         :
 
              Insurance Carrier,         :
 
              Defendants.                :
 
         _________________________________________________________________
 
         
 
              The record, including the transcript of the hearing before 
 
         the deputy and all exhibits admitted into the record, has been 
 
         reviewed de novo on appeal.
 
         
 
                                      ISSUE
 
         
 
              Claimant states the following issue on appeal:  "Did the 
 
         deputy industrial commissioner error [sic] in finding that the 
 
         claimant sustained only a fifteen percent (15%) industrial 
 
         disability?"
 
         
 
                                 FINDINGS OF FACT
 
         
 
              The findings of fact contained in the proposed agency 
 
         decision filed April 4, 1994 are adopted as final agency action.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              The conclusions of law contained in the proposed agency 
 
         decision filed April 4, 1994 are adopted as set forth below.  
 
         Segments designated by asterisks (*****) indicate portions of the 
 
         language from the proposed agency decision that have been 
 
         intentionally deleted and do not form a part of this final agency 
 
         decision.  Segments designated by brackets ([ ]) indicate 
 
         language that is in addition to the language of the proposed 
 
         agency decision.
 
         
 
              The first issue to address is whether claimant has sustained 
 

 
         
 
         Page   2
 
         
 
         
 
         
 
         
 
         
 
         an industrial disability. 
 
         
 
              The party who would suffer loss if an issue were not 
 
         established has the burden of proving that issue by a 
 
         preponderance of the evidence.  Iowa R. App. P. 14(f).
 
         
 
              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 determine the degree of industrial disability.  It 
 

 
         
 
         Page   3
 
         
 
         
 
         
 
         
 
         
 
         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, l985).
 
         
 
              Claimant was almost 58 years old at the time of the hearing.  
 
         He has limited skills, including communication skills, which 
 
         makes him a difficult worker to place.  
 
         
 
              He has sustained a bulging disc, for which he underwent 
 
         surgery.  Perhaps due to the language barrier, claimant did not 
 
         understand that surgery would not completely and totally resolve 
 
         all of the symptoms he had in the low back.  Or, perhaps it was 
 
         never fully explained to him.  In any event, claimant continues 
 
         to suffered from pain in the low back.  [Claimant has ratings of 
 
         impairment of 10 percent and 25 percent of the body as a whole.]
 
         
 
              All of the medical records indicate claimant could return to 
 
         some type of employment at Amana.  While he briefly tried to work 
 
         at the plant in 1992, he was unable to adequately perform his 
 
         assigned duties.  The cause of his inability to perform any type 
 
         of work at the plant cannot be placed solely on the condition of 
 
         his back. 
 
         
 
              Claimant must take some responsibility for his own plight.  
 
         It appears that he has been consistently counseled that he must 
 
         recondition himself, and that at times, he may feel pain but that 
 
         feeling pain is not always associated with further injury.  
 
         
 
              The opinions regarding claimant's physical capabilities do 
 
         not depict someone incapable of working.  In fact, any 
 
         restrictions indicate claimant is available for a variety of 
 
         labor positions.
 
         
 
              Claimant sustained a low back injury which resulted in 
 
         surgery.  He has some permanent functional impairment and is 
 
         limited in his ability to lift, stoop and bend.
 
         
 
              The employer tried to accommodate claimant's restrictions.  
 
         A specific job was available for claimant, but he was unable to 
 
         perform the required job duties.  After the unsuccessful first 
 
         attempt to return to work, the evidence is inconclusive as to 
 
         what additional efforts (either by claimant or the employer) were 
 
         made to help claimant return to gainful employment.
 
         
 
              Given claimant's age, and apparent lack of assertiveness in 
 
         trying to search for a suitable job, retraining or rehabilitation 
 
         is highly unlikely.
 
         
 

 
         
 
         Page   4
 
         
 
         
 
         
 
         
 
              After considering all of the factors that comprise an 
 
         industrial disability, it is determined that he has sustained a 
 
         ***** [25] percent industrial disability. 
 
         
 
              The next issue to address is whether claimant is entitled to 
 
         treatment rendered by Dr. Abernathey. 
 
         
 
              The employer shall furnish reasonable surgical, medical, 
 
         dental, osteopathic, chiropractic, podiatric, physical 
 
         rehabilitation, nursing, ambulance and hospital services and 
 
         supplies for all conditions compensable under the workers' 
 
         compensation law.  The employer shall also allow reasonable and 
 
         necessary transportation expenses incurred for those services.  
 
         The employer has the right to choose the provider of care, except 
 
         where the employer has denied liability for the injury.  Iowa 
 
         Code section 85.27.  Holbert v. Townsend Engineering Co., 
 
         Thirty-second Biennial Report of the Industrial Commissioner 78 
 
         (Review-reopening 1975).
 
         
 
              The defendants have never denied liability on this claim, 
 
         and as a result, are entitled to control the medical 
 
         practitioners who participate in claimant's care.  Claimant is 
 
         entitled to an independent medical examination once an authorized 
 
         physician has rendered an opinion regarding permanent impairment.  
 
         To this extent, then, claimant is entitled to reimbursement for 
 
         Dr. Abernathey's examination addressing claimant's permanent 
 
         impairment.  Any additional treatment rendered by Dr. Abernathey 
 
         shall be paid for by claimant. 
 
         
 
              WHEREFORE, the decision of the deputy is affirmed and 
 
         modified.
 
         
 
                                       ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants shall pay claimant one hundred twenty-five 
 
         (125) weeks of permanent partial disability benefits at the rate 
 
         of two hundred fifty-nine and 70/100 dollars ($259.70) commencing 
 
         October 23, 1991.
 
         
 
              That defendants shall receive credit against the award for 
 
         permanent partial disability benefits previously paid.
 
         
 
              That defendants shall reimburse claimant for the IME 
 
         supplied by Dr. Abernathey.
 
         
 
              That defendants shall pay interest on the award, as governed 
 
         by Iowa Code section 85.30.
 
         
 
              That defendants shall pay the costs of this matter including 
 

 
         
 
         Page   5
 
         
 
         
 
         
 
         
 
         
 
         the transcription of the hearing.  
 
         
 
              That defendants shall file a claims activity report as 
 
         required by the agency.
 
         
 
              Signed and filed this ____ day of August, 1994.
 
         
 
         
 
         
 
                                       ________________________________
 
                                                BYRON K. ORTON
 
                                           INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. James E. Bobenhouse
 
         Attorney at Law
 
         1120 2nd Ave. SE
 
         Cedar Rapids, IA 52403
 
         
 
         Mr. Greg A. Egbers
 
         Attorney at Law
 
         600 Union Arcade Bldg
 
         111 E Third St.
 
         Davenport, Ia 52801-1596
 
         
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
                                       5-1803
 
                                       Filed August 31, 1994
 
                                       Byron K. Orton
 
                                       
 
         
 
                       BEFORE THE IOWA INDUSTRIAL COMMISSIONER 
 
          _________________________________________________________________
 
                                         :
 
         KAHM-THIEP BACCAM,              :
 
                                         :
 
              Claimant,                  :
 
                                         :
 
         vs.                             :
 
                                         :        File No. 911756
 
         AMANA REFRIGERATION, INC.,      :
 
                                         :          A P P E A L
 
              Employer,                  :
 
                                         :        D E C I S I O N
 
         and                             :
 
                                         :
 
         LIBERTY MUTUAL INSURANCE CO.,   :
 
                                         :
 
              Insurance Carrier,         :
 
              Defendants.                :
 
         _________________________________________________________________
 
         
 
         5-1803
 
         
 
              Claimant awarded 25 percent industrial disability.
 
         
 
 
            
 
            
 
            
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ------------------------------------------------------------
 
            KAHM-THIEP BACCAM,            :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 911756
 
            AMANA REFRIGERATION, INC.,    :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INSURANCE CO.,      :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ------------------------------------------------------------
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by 
 
            claimant, Kahm-Thiep Baccam against his former employer 
 
            Amana Refrigeration, Inc., and its insurance carrier, 
 
            Liberty Mutual Insurance Company. 
 
            
 
                 The record in the case consists of testimony from the 
 
            claimant (mostly through a Laotian interpreter), Khane 
 
            Baccam (claimant's son), Bieng Baccam (claimant's wife), and 
 
            John Hadenfeldt (Manager of Safety for Amana Refrigeration, 
 
            Inc.); claimant's exhibits 1-6; and defendants' exhibits   
 
            A-I.  
 
            
 
                                      ISSUES
 
            
 
                 The parties have submitted the following issues for 
 
            resolution:
 
            
 
                 1.  Whether claimant has sustained an industrial 
 
            disability; and;
 
            
 
                 2.  Whether claimant is entitled to some medical 
 
            benefits.  
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The undersigned deputy, having reviewed all of the 
 
            evidence received, finds the following facts:
 
            
 
                 Claimant was born in North Vietnam, and at the time of 
 
            the hearing, was almost 58 years old.  He has lived in the 
 
            United States since November of 1975, and is a United States 
 
            citizen.   He is married, and at the time of the injury, 
 
            supported one child.  Claimant's workers compensation rate 
 
            is $259.70 per week. 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
                 Claimant graduated from high school in North Vietnam in 
 
            1953.  In 1954, he received a certificate in nursing through 
 
            military training.  From 1957 to 1975, he worked as an x-ray 
 
            technician in Laos, and then moved to the United States. 
 
            
 
                 From January of 1976 through August of 1976, claimant 
 
            worked as an x-ray technician at the University of Iowa 
 
            Hospitals and Clinics.  In 1976, he began working as a 
 
            technician for American Prosthetics.  He helped produce 
 
            various sizes and types of prosthetics.  Claimant held this 
 
            position for eight years. 
 
            
 
                 In 1984, claimant began working for the defendant 
 
            employer.  He sustained an injury on February 15, 1989, 
 
            which arose out of and in the course of his employment.  
 
            Apparently, claimant was carrying a large box of screws and 
 
            sustained an injury to his low back.  Claimant's job on the 
 
            assembly line at the plant required him to lift and turn 
 
            cabinets, place wires and other things into the cabinets, 
 
            and push the cabinets down the line.  Claimant stated that 
 
            his job required a great amount of bending, twisting, 
 
            walking, standing and turning.  A job description is found 
 
            at defendants' exhibit B.  
 
            
 
                 He reported the injury to his supervisor, and received 
 
            medical treatment from Mercy Hospital in Cedar Rapids.  
 
            Eventually, claimant sought treatment from the University of 
 
            Iowa, where he underwent various evaluations and saw 
 
            numerous physicians.  Eventually, it was determined that 
 
            claimant had sustained a right sided posterior disc bulge at 
 
            the L5-S1 level without cord impingement and a decreased 
 
            signal of the L5-S1 disc which suggested disc degeneration 
 
            at that level.  Additional tests, including a CT scan and an 
 
            MRI, were ordered and surgery was recommended.  
 
            
 
                 Claimant underwent surgical repair of the disc in 
 
            October of 1990.  E.M. Found, M.D., performed the surgery.  
 
            Claimant's subsequent recovery notes that claimant has 
 
            always continued to complain of pain.  Additional therapies 
 
            and treatment were undertaken at University of Iowa.  the 
 
            records are replete with notations that the claimant has 
 
            refused to find any type of work other than that which he 
 
            was performing at the time of his injury.  Additionally, 
 
            claimant has maintained that he will not return to work 
 
            until the pain is entirely gone.  Apparently, he associates 
 
            pain with hurting or reinjuring himself.  
 
            
 
                 Claimant tried to return to work in June of 1992, but 
 
            managed only to work for several days.  He has not worked at 
 
            the plant since that time. 
 
            
 
                 Claimant has received several assessments regarding his 
 
            physical capacities.  Lawrence Strathman, M.D., determined 
 
            that claimant was capable of working with a 45 pound lifting 
 
            restriction, and limited stooping and bending.  (Defendants' 
 
            exhibit E)  An assessment from Dr. Found merely restricted 
 
            claimant's work hours for six hours per day for one month 
 
            when he initially returned to work, and was then to work an 
 
            eight hour day.  He specifically released claimant to return 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            to a job called the electrical bracket assembly station.  
 
            Subsequent follow-up visits with Dr. Found denotes 
 
            claimant's positive straight leg raising tests, pain 
 
            radiating into the buttocks and both legs, and limping.  
 
            Claimant also exhibited some inconsistent responses to 
 
            various tests  (Def. Ex D, pp 70-74)
 
            
 
                 Chad Abernathey, M.D., a neurosurgeon, also evaluated 
 
            claimant for what appears to be an independent medical 
 
            examination.  His report, dated April 14, 1993, indicates 
 
            that claimant has a permanent impairment of 25 percent to 
 
            the body as a whole.  (Claimant's Exhibit 1)   He indicated 
 
            that claimant was capable of lifting 50 pounds on a frequent 
 
            basis.  Claimant could stand or walk four to six hours per 
 
            day; and sit four to six hours per day.  Claimant could 
 
            grasp, push and pull, and perform fine manipulations.  He 
 
            could also operate foot controls.  In fact, Dr. Abernathey 
 
            indicated claimant could return to work at the same job he 
 
            was performing at the time of the injury.  (Cl. Ex. 2)  
 
            Other information regarding claimant's limitations and 
 
            abilities are dated in 1991 and 1990.  (Cl. Exs 5 and 6)
 
            
 
                          ANALYSIS AND CONCLUSIONS OF LAW
 
            
 
                 The first issue to address is whether claimant has 
 
            sustained an industrial disability. 
 
            
 
                 The party who would suffer loss if an issue were not 
 
            established has the burden of proving that issue by a 
 
            preponderance of the evidence.  Iowa R. App. P. 14(f).
 
            
 
                 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, expe
 
            rience 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; 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            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
 
            ability.  See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985); Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, l985).
 
            
 
                 Claimant is almost 58 years old.  He has limited 
 
            skills, including communication skills, which makes him a 
 
            difficult worker to place.  
 
            
 
                 He has sustained a bulging disc, for which he underwent 
 
            surgery.  Perhaps due to the language barrier, claimant did 
 
            not understand that surgery would not completely and totally 
 
            resolve all of the symptoms he had in the low back.  Or, 
 
            perhaps it was never fully explained to him.  In any event, 
 
            claimant continues to suffered from pain in the low back.  
 
            
 
                 All of the medical records indicate claimant could 
 
            return to some type of employment at Amana.  While he 
 
            briefly tried to work at the plant in 1992, he was unable to 
 
            adequately perform his assigned duties.  The cause of his 
 
            inability to perform any type of work at the plant cannot be 
 
            placed solely on the condition of his back. 
 
            
 
                 Claimant must take some responsibility for his own 
 
            plight.  It appears that he has been consistently counseled 
 
            that he must recondition himself, and that at times, he may 
 
            feel pain but that feeling pain is not always associated 
 
            with further injury.  
 
            
 
                 The opinions regarding claimant's physical capabilities 
 
            do not depict someone incapable of working.  In fact, any 
 
            restrictions indicate claimant is available for a variety of 
 
            labor positions.
 
            
 
                 Claimant sustained a low back injury which resulted in 
 
            surgery.  He has some permanent functional impairment and is 
 
            limited in his ability to lift, stoop and bend.
 
            
 
                 the employer tried to accommodate claimant's 
 
            restrictions.  A specific job was available for claimant, 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            but he was unable to perform the required job duties.  After 
 
            the unsuccessful first attempt to return to work, the 
 
            evidence is inconclusive as to what additional efforts 
 
            (either by claimant or the employer) were made to help 
 
            claimant return to gainful employment.
 
            
 
                 Given claimant's age, and apparent lack of 
 
            assertiveness in trying to search for a suitable job, 
 
            retraining or rehabilitation is highly unlikely.
 
            
 
                 After considering all of the factors that comprise an 
 
            industrial disability, it is determined that he has 
 
            sustained a 15 percent industrial disability. 
 
            
 
                 The next issue to address is whether claimant is 
 
            entitled to treatment rendered by Dr. Abernathey. 
 
            
 
                 The employer shall furnish reasonable surgical, 
 
            medical, dental, osteopathic, chiropractic, podiatric, 
 
            physical rehabilitation, nursing, ambulance and hospital 
 
            services and supplies for all conditions compensable under 
 
            the workers' compensation law.  The employer shall also 
 
            allow reasonable and necessary transportation expenses 
 
            incurred for those services.  The employer has the right to 
 
            choose the provider of care, except where the employer has 
 
            denied liability for the injury.  Iowa Code section 85.27.  
 
            Holbert v. Townsend Engineering Co., Thirty-second Biennial 
 
            Report of the Industrial Commissioner 78 (Review-reopen 
 
            1975).
 
            
 
                 The defendants have never denied liability on this 
 
            claim, and as a result, are entitled to control the medical 
 
            practitioners who participate in claimant's care.  Claimant 
 
            is entitled to an independent medical examination once an 
 
            authorized physician has rendered an opinion regarding 
 
            permanent impairment.  To this extent, then, claimant is 
 
            entitled to reimbursement for Dr. Abernathey's examination 
 
            addressing claimant's permanent impairment.  Any additional 
 
            treatment rendered by Dr. Abernathey shall be paid for by 
 
            claimant. 
 
            
 
                                       ORDER
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay claimant seventy-five (75) 
 
            weeks of permanent partial disability benefits at the rate 
 
            of two hundred fifty-nine and 70/100 dollars ($259.70) 
 
            commencing October 23, 1991.
 
            
 
                 That defendants shall receive credit against the award 
 
            for permanent partial disability benefits previously paid.
 
            
 
                 That defendants shall reimburse claimant for the IME 
 
            supplied by Dr. Abernathey.
 
            
 
                 That defendants shall pay interest on the award, as 
 
            governed by Iowa Code section 85.30.
 
            
 
                 That defendants shall pay the costs of this action.
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
                 That defendants shall file a claims activity report as 
 
            required by the agency.
 
            
 
                 Signed and filed this ____ day of April, 1994.
 
            
 
            
 
            
 
            
 
                                          
 
                                        ________________________________
 
                                          PATRICIA J. LANTZ
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr James E Bobenhouse
 
            Attorney at Law
 
            1120 2nd Ave SE
 
            Cedar Rapids IA 52403
 
            
 
            Mr Greg A Egbers
 
            Attorney at Law
 
            600 Union Arcade Bldg
 
            111 E Third St
 
            Davenport Ia 52801-1596
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                5-1803
 
                                                Filed April 4, 1994
 
                                                Patricia J. Lantz
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ------------------------------------------------------------
 
            KAHM-THIEP BACCAM,            :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 911756
 
            AMANA REFRIGERATION, INC.,    :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INSURANCE CO.,      
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ------------------------------------------------------------
 
            
 
            
 
            5-1803
 
            Claimant awarded 15% industrial disability.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            BETTY RIEMENSCHNEIDER a/k/a   :
 
            BETTY JEAN KERNS,             :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :         File No. 911765
 
            FURNAS ELECTRIC COMPANY,      :
 
                                          :      A R B I T R A T I O N
 
                 Employer,                :
 
                                          :         D E C I S I O N
 
            and                           :
 
                                          :
 
            LIBERTY MUTUAL INS. CO.,      :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND,           :
 
                                          :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            
 
                                   INTRODUCTION
 
            
 
                 This is a proceeding in arbitration brought by Betty 
 
            Riemenschneider, claimant, against Furnas Electric Company, 
 
            employer, and Liberty Mutual Insurance Company, insurance 
 
            carrier, and the Second Injury Fund of Iowa, defendants, for 
 
            benefits as a result of an injury that occurred on February 
 
            27, 1989.  A hearing was held in Des Moines, Iowa on 
 
            February 4, 1992 and the case was fully submitted at the 
 
            close of the hearing.  Claimant was represented by Harold B. 
 
            Heslinga.  Defendant-employer was represented by Jon K. 
 
            Hoffmann.  Defendant Second Injury Fund of Iowa was 
 
            represented by Shirley A. Steffe.  The record consists of 
 
            the testimony of Betty Riemenschneider, claimant; Larry 
 
            Riemenschneider, claimant's husband; Margaret Covey, 
 
            vocational rehabilitation consultant; Jeff Johnson, voca
 
            tional rehabilitation manager; and joint exhibits 2, 3 and 
 
            4.  Joint Exhibit 1, a deposition of claimant, was excluded 
 
            from evidence by the deputy because claimant was available 
 
            in the courtroom to testify in person and the deposition 
 
            would have been redundant evidence.  The deposition was 
 
            available however to refresh memory, impeach or to rebut 
 
            claimant's hearing testimony, but was not subsequently so 
 
            used.  The deputy ordered a transcript of the hearing.  
 
            Defendant employer and defendant Second Injury Fund of Iowa 
 
            submitted excellent post-hearing briefs.  Claimant did not 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            submit a post-hearing brief.
 
            
 
                                preliminary matter
 
            Defendant employer withdrew the issue of whether it was 
 
            entitled to a credit for non-occupational health plan 
 
            benefits paid to claimant prior to hearing pursuant to Iowa 
 
            Code section 85.38(2).
 
            
 
                                      issues
 
            
 
                 The parties submitted the following issues for 
 
            determination at the time of the hearing:
 
            
 
                 Whether claimant is entitled to permanent disability 
 
            benefits from employer, and if so, the nature and extent of 
 
            the benefits to which she is entitled, to include whether 
 
            claimant is entitled to a scheduled member or industrial 
 
            disability benefits.
 
            
 
                 Whether the Second Injury Fund of Iowa is liable to 
 
            claimant for benefits, and if so, the extent of benefits to 
 
            which claimant is entitled, to include any apportionment 
 
            which is due to the fund.
 
            
 
                                 findings of fact
 
            
 
                 The first loss for purposes of Iowa Code section 85.64 
 
            is a congenital condition described as arthrogryposis 
 
            multiplex congenita, abduction contractures of both hips and 
 
            bilateral club feet.  Injuries to hips are typically body as 
 
            a whole injuries, Lauhoff Grain v. McIntosh, 395 N.W.2d 834 
 
            (Iowa 1986); nevertheless, a body as a whole injury 
 
            qualifies as a previous loss if it affects and causes 
 
            permanent loss or loss of use of a scheduled member.  Second 
 
            Injury Fund of Iowa v. Braden, 459 N.W.2d 467 (Iowa 1990); 
 
            Second Injury Fund v. Neelans, 436 N.W.2d 355 (Iowa 1989); 
 
            Second Injury Fund v. Mich. Coal Co., 274 N.W.2d 300 (Iowa 
 
            1979); Bevins v. Farmstead Foods, File Nos. 834865, 881784, 
 
            877458 and 888705 (Appeal Decision November 26, 1991); 
 
            Shirley v. Shirley Ag Service, Inc., File No. 811696 
 
            (Appeal Decision March 21, 1990); Thompson v. Marshall & 
 
            Swift, File No. 784394 (Appeal Decision August 28, 1989); 
 
            Fulton v. Jimmy Dean, File No. 755039 (Appeal Decision July 
 
            28, 1986); Weiland v. Wilson Foods, File Nos. 744384 & 
 
            797397, Filed June 18, 1987; Lehnertz v. Second Injury Fund 
 
            of Iowa, File No. 922334 (Filed February 26, 1992).
 
            
 
                 It is immaterial whether the previous loss or loss of 
 
            use to one or more of the designated scheduled members in 
 
            section 85.64 is congenital, developmental, or caused by 
 
            disease or injury.  Asay v. Industrial Engineering Equipment 
 
            Company, 33 Biennial Rep., Iowa Indus. Comm'r 224 (Appeal 
 
            Decision December 1977) (District Court Appeal Dismissed); 
 
            Shank v. Mercy Hospital Medical Center, File No. 719627, 
 
            Appeal Decision Filed September 27, 1991 (on appeal).
 
            
 
                 There is no requirement that the first loss be 
 
            traumatic and it need not be compensable.  Id.  Lawyer & 
 
            Higgs, Iowa Workers' Compensation -- Law and Practice, 
 
            (Second Edition) Section 17-3, pages 170 & 171.
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            
 
                 Nothing in section 85.64 bars the applicability of the 
 
            statute if the injury happens to be to two such members, 
 
            where as here, there is a bilateral loss to both arms or 
 
            legs.  Second Injury Fund v. Mich Coal Co., 274 N.W.2d 300 
 
            (Iowa 1979); Putzier v. Wilson Foods Corporation, File Nos. 
 
            804582 & 835165 (Appeal Decision May 24, 1991); Reifenstahl 
 
            v. Second Injury Fund of Iowa, File No. 886573 (Filed 
 
            December 20, 1991); Saylor v. Swift & Company, 34 Biennial 
 
            Rep., Iowa Indus. Comm'r 282, 285 (1979).
 
            
 
                 Iowa Code section 85.64 requires only a previous loss 
 
            or loss of use of one or more of the designated scheduled 
 
            members.  It is immaterial how the loss of loss of use 
 
            originated.
 
            
 
                 The previous loss or loss of use must be a permanent 
 
            disability.  Allen v. The Second Injury Fund, State of Iowa, 
 
            34 Biennial Rep., Iowa Indus. Comm'r 15 (1980); Ross v. 
 
            Service Master-Story Co., Inc., 34 Biennial Rep., Iowa 
 
            Indus. Comm'r 273 (1979); Ross v. Sioux Quality Packers, 
 
            Division of Armour & Company, 34 Biennial Rep., Iowa Indus. 
 
            Comm'r 276 (1978); Anderson v. Second Injury Fund, 262 
 
            N.W.2d 789 (Iowa 1978).
 
            
 
                 Claimant testified that her legs were deformed at birth 
 
            at Winterset, Iowa and that when she was two weeks old she 
 
            was sent to the University of Iowa Hospitals and Clinics.  
 
            In the next four years she had received 15 surgeries on her 
 
            feet and ankles, eight leg surgeries on the left side and 
 
            seven surgeries on the right side (Transcript pages 29 & 
 
            30).  She said the surgeries were successful in that she 
 
            could walk and run on her feet but that her feet were never 
 
            normal compared to an average person (Tr. p. 31).  Copies of 
 
            photographs demonstrate that claimant's deformity at birth 
 
            and during early childhood to both lower extremities, and 
 
            particularly to the feet, was severe!  (Joint Exhibit 2, pp. 
 
            81 - 86).  This is further supported by extensive medical 
 
            records (Ex. 2, pp. 89 - 104).
 
            
 
                 Thomas C. Merchant, M.D., Department of Orthopedic 
 
            Surgery of the University of Iowa Hospitals and Clinics, 
 
            stated on November 25, 1985, that approximately six to eight 
 
            months ago claimant developed recurring severe left foot 
 
            pain.  She had significant foot deformities with two kinds 
 
            of pain -- arthritic type pain and neuritic pain.  He said 
 
            further surgical intervention would not be of benefit nor 
 
            would other forms of conservative therapy.  He concluded by 
 
            stating that he and his associates felt as follows:
 
            
 
                 We, therefore, feel that this patient should be 
 
                 considered completely disabled in that she is 
 
                 unable to stand or walk for long periods of time 
 
                 and that her foot condition also results in her 
 
                 being unable to count on the ability to do the 
 
                 amount of walking necessary to regularly get to 
 
                 and from work and run the basic errands required 
 
                 even in a sedentary job.
 
            
 
            (Ex. 2, p. 104)
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            
 
            
 
                 Yet, on December 23, 1985, Dr. Merchant wrote that 
 
            claimant may return to work on February 1, 1986, and that 
 
            she did not have any work restrictions (Ex. 4, p. 14).
 
            
 
                 On September 14, 1989, Fred Dietz, M.D., Associate 
 
            Professor of Orthopedics at the University of Iowa, wrote 
 
            that her arthrogryposis had resulted in stiff and often 
 
            uncomfortable feet.  He rated this condition as follows:
 
            
 
                 Because of the limitation of motion of both the 
 
                 ankle and the subtalar and the midfoot regions, as 
 
                 well as a slight somewhat varus position of the 
 
                 heel, I feel that her foot impairment results in a 
 
                 lower extremity of impairment of about 65% with a 
 
                 total body impairment of about 25%.
 
            
 
            (Ex. 2, p. 107)
 
            
 
                 On August 14, 1991, he added another five percent 
 
            impairment for her left hip (Ex. 2, p. 106).
 
            
 
                 Since Dr. Dietz speaks primarily in terms of the feet, 
 
            then his impairment rating applies to the feet even though 
 
            he phrased his rating in terms of the lower extremity and to 
 
            the body as a whole.  Since this is a rating to feet, it 
 
            must be divided by two to arrive at the rating for one foot.  
 
            One half of 65 percent of the lower extremity is 32.5 
 
            percent of each lower extremity; 32.5 percent of the lower 
 
            extremity converts to 47 percent of the foot.  Guides to the 
 
            Evaluation of Permanent Impairment, Third Edition, Table 32 
 
            on page 58.  Forty-seven percent of 150 weeks, the allowance 
 
            for a foot, Iowa Code section 85.34(2)(n) results in a 
 
            permanent impairment of each foot of 70.5 weeks for which 
 
            the Second Injury Fund is entitled to a credit from the 
 
            overall industrial disability to be determined in this case.
 
            
 
                 Dr. Dietz determined that claimant's left hip had 
 
            sustained a five percent impairment to the body as a whole 
 
            (Jt. Ex. 2, p. 106).  In order to place five percent of the 
 
            body as a whole on a scheduled member basis, five percent of 
 
            the body as a whole converts to 12.5 percent of the lower 
 
            extremity.  AMA Guides, table 42 on page 65.  Twelve point 
 
            five percent of the 220 week allowance for a leg, Iowa Code 
 
            section 85.34(2)(o), results in a 27.5 percent scheduled 
 
            member impairment for which the Fund is entitled to credit 
 
            from the overall industrial disability to be determined in 
 
            this case.
 
            
 
                 An intervening injury between the first or previous 
 
            injury at birth and the second injury which is the injury of 
 
            February 27, 1989 (which is the subject of this proceeding) 
 
            occurred in August of 1981 when Arnis B. Grundberg, M.D., 
 
            removed a ganglion from the dorsum of claimant's left wrist 
 
            and performed left carpal tunnel surgery on August 24, 1981 
 
            (Jt. Ex. 2, pp. 133 - 135).  Claimant and all parties agree 
 
            that this surgery was successful and that claimant did not 
 
            sustain any permanent impairment or disability from the left 
 
            ganglion and left carpal tunnel surgery.  Therefore, since 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            there is no permanent impairment or disability, this injury 
 
            will not be considered in the determination of claimant's 
 
            overall industrial disability for Second Injury Fund 
 
            purposes, nor will it be considered in the determination for 
 
            disability for this injury of February 27, 1989, nor will it 
 
            be considered for any possible credit from the overall 
 
            industrial disability which will be made for the purpose of 
 
            making a determination of Second Injury Fund liability.  
 
            Claimant testified that she did not have any permanent 
 
            disability as a result of the injury to the left wrist (Tr. 
 
            p. 41).
 
            
 
                 Claimant developed right carpal tunnel syndrome and con
 
            sulted Dr. Grundberg on August 21, 1987.  He surgically 
 
            decompressed the right carpal tunnel on September 3, 1987 
 
            (Ex. 2, pp. 137 - 141).  On April 25, 1988, Dr. Grundberg 
 
            assessed a five percent permanent impairment of the right 
 
            hand due to residuals of the right carpal tunnel syndrome 
 
            (Jt. Ex. 3).  Five percent of the 190 week allowance for the 
 
            hand, Iowa Code section 85.34(2)(l), amounts to another 9.5 
 
            week credit for the Second Injury Fund from claimant's 
 
            overall industrial disability.
 
            
 
                 On July 5, 1988, claimant saw Dr. Grundberg for right 
 
            cubital tunnel syndrome which he decompressed on August 15, 
 
            1988 (Ex. 2, pp. 144 - 149).  Dr. Grundberg assessed a 10 
 
            percent permanent impairment due to residuals from the 
 
            cubital tunnel syndrome (Ex. 2, p. 151).  Ten percent of the 
 
            250 week allowance for the arm, Iowa Code section 
 
            85.34(2)(m), gives the Second Injury Fund a 25 week credit 
 
            for the right cubital tunnel injury.
 
            
 
                 The injury of February 27, 1989, is determined to be 
 
            the second injury ("loss of use of another such member") 
 
            pursuant to section 85.64 which caused permanent disability 
 
            to claimant.  Again, this is an injury to the body as a 
 
            whole, more specifically the right shoulder; but, 
 
            nevertheless, it affected and caused permanent loss of use 
 
            to the right arm.  It therefore qualifies as a threshold or 
 
            entry level second injury for second injury fund benefits.
 
            
 
                 Claimant first reported neck and shoulder strain to Dr. 
 
            Grundberg on February 10, 1989, and the injury date derives 
 
            from the office note of May 26, 1989, where Dr. Grundberg 
 
            stated:  "She has not been working since February 27, 1989."  
 
            (Ex. 2, p. 150), coupled with the fact that this is 
 
            determined to be a cumulative injury based upon claimant's 
 
            testimony and the observation of a number of medical 
 
            practitioners who examined claimant.
 
            
 
                 Dr. Grundberg concluded this note by stating:  "I 
 
            explained to the patient that further surgical therapy is 
 
            not an answer to her problem.  The work that she does there 
 
            is too hard for her and she needs to quit there and go to 
 
            something easier to do somewhere else."  (Ex. 2, pp. 150 & 
 
            151).  On June 13, 1989, Dr. Grundberg called in the 
 
            following restrictions to claimant's employer:  "The patient 
 
            should not do repetitive motions with her right arm.  She 
 
            should not lift, push or pull over 1 pound with her right 
 
            arm.  Full duties with the left."  (Ex. 2, p. 151)
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
                 Claimant eventually saw Alexander Matthews, M.D., a 
 
            thoracic surgeon, on November 27, 1989 (Ex. 2, p. 173) who 
 
            determined that the patient's clinical picture is that of a 
 
            severe right thoracic outlet compression syndrome.  He 
 
            recommended and performed a surgical decompression of the 
 
            right thoracic outlet by transaxillary resection of the 
 
            first right rib on November 28, 1989 (Jt. Ex. 4, p. 3; Jt. 
 
            Ex. 2, p. 175).
 
            
 
                 On April 17, 1990, Robert O. Thompson, M.D., a 
 
            physician in the same firm as Dr. Matthews, stated that 
 
            claimant should be sent for a disability rating.  Yet, there 
 
            is no rating for this injury in the record.  Claimant 
 
            testified that she was never sent to any physician or 
 
            physical therapist for a rating for this injury (Tr. p. 62, 
 
            Jt. Ex. 2, p. 187), however, the records of Thomas W. Bower, 
 
            LPT, on June 6, 1990, state that "...since most of the 
 
            complaints at this time are localized in the shoulder girdle 
 
            area, we feel the patient has sustained an additional 4% 
 
            impairment to the body as a whole on that basis."  (Jt. Ex. 
 
            2, p. 197)
 
            
 
                 Dr. Thompson stated that as long as claimant did 
 
            sensible things, avoided repetitive motion activity and did 
 
            not work above her head that she would not aggravate the 
 
            thoracic outlet syndrome.  He also suggested that claimant 
 
            see a physiatrist for rehabilitation and perhaps enjoy some 
 
            improvement in that manner.  He had nothing further to offer 
 
            (Ex. 2, pp. 186 & 187).
 
            
 
                 Thus it would appear that even though Dr. Matthews and 
 
            Dr. Thompson did not give a specific permanent impairment 
 
            rating claimant is nevertheless substantially impaired 
 
            because she is restricted from repetitive motion activity 
 
            and work above her head (Ex. 2, p. 186).
 
            
 
                 Therapist Bower performed a functional capacity 
 
            examination and determined that claimant could lift 30 
 
            pounds, carry 42 pounds and push or pull 65 pounds at the 
 
            maximum.  Frequently she could only lift 5 to 12 pounds and 
 
            carry 22 pounds.  Repetitively she was not to lift at all or 
 
            carry more than 12 pounds (Jt. Ex. 2, pp. 199 through 201).
 
            
 
                 Prior to claimant's thoracic outlet surgery Paul K. Ho, 
 
            M.D., restricted claimant to light duty with a one pound 
 
            weight limit and no repetitive activities and no overhead 
 
            activities with the right arm for a one month period.  He 
 
            added:  "If she continues to have symptoms then a job change 
 
            I think is indicated."  (Ex. 2, p. 125)
 
            
 
                 Employer was not able to accommodate claimant's 
 
            restrictions and claimant testified that she was terminated 
 
            and that she is still under medical restrictions (Tr. pp. 47 
 
            & 48).
 
            
 
                 Thus, it is apparent that claimant is foreclosed from 
 
            performing her former production type of employments for 
 
            employer which require the repetitive use of her hands and 
 
            arms and shoulders and sometimes working with her arms 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            extended over her head which results in a substantial 
 
            industrial disability loss.  Michael v. Harrison County, 34 
 
            Biennial Rep., Iowa Indus. Comm'r 218, 220 (Appeal Decision 
 
            January 30, 1979); Rohrberg v. Griffin Pipe Products 
 
            Company, I Iowa Indus. Comm'r Rpt. 282 (1981).
 
            
 
                 Although claimant's lifelong foot problems did not 
 
            preclude her from finding minimum wage work in the past as a 
 
            mailroom laborer, waitress, nurse's aide and production line 
 
            worker, when the foot problems are added to her current 
 
            restriction (1) from performing repetitive types of work 
 
            with her hands and arms and (2) her weight lifting 
 
            restrictions of someplace between one pound and 12 pounds on 
 
            a frequent basis and (3) no work overhead, then it can be 
 
            seen that claimant is also foreclosed from most of her 
 
            former employments.  If not totally foreclosed, her opportu
 
            nities to be employed in these occupations are certainly 
 
            greatly diminished (Jt. Ex. 2, pp. 7 & 8) (Tr. pp. 29 - 36).
 
            
 
                 Claimant started to work for employer in May of 1981.  
 
            When claimant applied for work with employer on November 24, 
 
            1980, she stated on the employment application that she did 
 
            not have any physical defects which could prevent her from 
 
            performing the job for which she was applying (Ex. 4, p. 
 
            15).  She worked until a layoff in August of 1981.  She was 
 
            reemployed in May of 1983 and worked until she left work due 
 
            to this injury on February 27, 1989, a period of 
 
            approximately six years (Tr. p. 47; Jt. Ex. 2, pp. 8 & 9).  
 
            Employer tried to accommodate claimant for short periods of 
 
            a few hours in June and July of 1989 but was unable to do so 
 
            within her restrictions and claimant was eventually termi
 
            nated after a one year leave of absence in February of 1990 
 
            (Tr. p. 47, Jt. Ex. 2, p. 45).
 
            
 
                 For employer claimant performed assembly work, building 
 
            work, riveting and setting switches (Tr. pp. 37 - 43).  
 
            Claimant denied and there is no evidence of any prior work 
 
            injuries (Tr. p. 39).
 
            
 
                 Claimant attempted to work in a bait shop in the summer 
 
            of 1990 for a month and a half but maintained she was forced 
 
            to quit because the concrete floors caused burning and 
 
            grinding in her hips and her legs would swell.  Likewise, 
 
            her right arm and shoulder would burn and her hands would 
 
            swell.  She testified that she was earning $6.79 per hour 
 
            when she left employer and was earning $4.00 per hour at the 
 
            bait shop which would constitute approximately a 40 percent 
 
            loss of actual earnings (Tr. pp. 52 & 53, Ex. 2, p. 19).  
 
            She then worked at another marina and bait shop for 
 
            approximately three months from August to October of 1990 at 
 
            $4.00 per hour (Tr. pp. 54 & 55).  Claimant also worked 
 
            approximately one day as a waitress but her legs swelled up 
 
            and her hips burned from standing in one spot on concrete 
 
            floors (Tr. p. 56, Ex. 2, p. 7).
 
            
 
                 Claimant has also worked with her husband in a 
 
            self-employed lawn mowing service without pay and together 
 
            then earned $3,000 in 1989 and $5,000 in 1990.  She operates 
 
            a riding mower with her left hand by manipulating laterals 
 
            (levers) rather than a steering wheel.  She works 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            approximately 10 to 20 minutes at a time (Ex. 2, p. 41) 
 
            using her left dominant hand and arm which is not impaired.  
 
            When it hurts she is able to quit (Tr. p. 50).  She 
 
            typically works four to five hours per day for possibly 
 
            three or four days a week (Tr. p. 51).  She performed the 
 
            same work in 1991 during the mowing season and planned to do 
 
            so again in 1992.  She and her husband simply put all of the 
 
            money in one kitty (Tr. p. 51).
 
            
 
                 Claimant said that her current problem with her hips is 
 
            that they keep popping out.  She said that she would be 
 
            walking along and her hip will go out and she will fall 
 
            clear down (Tr. p. 57).  Claimant testified that as she gets 
 
            older her feet are beginning to twist again into the 
 
            position they were at birth.  They are getting worse and she 
 
            walks with a limp and is forced to sit down frequently (Tr. 
 
            p. 58).  Claimant related that she has trouble raising her 
 
            right arm above her head.  This causes crepitation and makes 
 
            it burn.  Periodically, her fingers will turn blue and swell 
 
            (Tr. p. 63).
 
            
 
                 Claimant was offered private rehabilitation services 
 
            but claimant declined assistance because she preferred to 
 
            mow lawns with her husband (Ex. 2, p. 211 & 212).  Claimant 
 
            also declined to contact the state vocational rehabilitation 
 
            service because she planned to mow lawns with her husband in 
 
            the summer (Ex. 2, p. 13).
 
            
 
                 Maggie Covey, the rehabilitation consultant who 
 
            testified at hearing, met with claimant on one occasion and 
 
            talked to her on the telephone several times (Tr. pp. 105 - 
 
            108).  Covey testified that claimant had no vocational 
 
            interests of any kind other than lawn mowing with her 
 
            husband (Tr. pp. 109).  Claimant did not recontact Covey for 
 
            vocational assistance (Tr. pp. 111).
 
            
 
                 Jeff Johnson, a vocational consultant with the same 
 
            firm as Covey, testified at the hearing that he was retained 
 
            to determine claimant's vocational ability to return to some 
 
            type of work (Tr. p. 114).  He examined the medical records 
 
            and the functional capacity examination of therapist Bower 
 
            and listened to claimant's testimony at the time of the 
 
            hearing and concluded that claimant was limited to light and 
 
            sedentary exertional levels of work without extensive 
 
            standing or walking activities (Tr. pp. 114 - 119).  Johnson 
 
            stated that considering her legs alone, and assuming the 
 
            claimant was precluded from prolonged standing and walking, 
 
            that claimant has lost a 40 percent access to the employment 
 
            market which leaves an access of 60 percent of the 
 
            employment market.  However, due to the weight lifting 
 
            restrictions and inability to raise her arm overhead, she 
 
            has lost 50 percent of the 60 percent access resulting in 
 
            another 30 percent loss of access.  Thus her total loss of 
 
            access to the available employment market in the sedentary 
 
            and light exertional levels is 70 percent (40% + 30%) (Tr. 
 
            pp. 116 - 121 & 125).
 
            
 
                 Johnson further testified that looking at the various 
 
            jobs which claimant has performed, her ability to work 
 
            defies the percentages which he arrived at.  She was working 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            above her evaluated ability to work.  He explained that at 
 
            various times claimant was most likely doing work that would 
 
            not have been recommended to her from a medical vocational 
 
            standpoint (Tr. pp. 127 & 128).  He said that at times she 
 
            was performing at a medium exertional level when she was 
 
            working as a nurse's aide (Tr. pp. 128 & 129).  He testified 
 
            that claimant's highest pay was $6.89 per hour as a 
 
            production clerk (Tr. p. 133) and the lowest wage currently 
 
            available is $4.65 per hour which is the minimum wage in 
 
            Iowa (Tr. p. 133) which would amount to a 32 percent loss of 
 
            earnings capacity based upon Iowa's current minimum wage.  
 
            At the same time it must be considered that if claimant had 
 
            continued to work for employer at her wage of $6.89 per 
 
            hour, her wages would have increased between February of 
 
            1989 when she last worked and the date of the hearing on 
 
            February 4, 1992.
 
            
 
                 Larry Riemenschneider, claimant's husband, testified 
 
            that in 1991, he earned $4,000 mowing lawns and 75 percent 
 
            of that was attributable to his efforts (Tr. pp. 99 & 100).
 
            
 
                 Claimant testified that she did not know what her 
 
            future plans were with regard to reentering the employment 
 
            market because she was pregnant with her first child at the 
 
            time of the hearing.  Claimant also acknowledged that she 
 
            has three step-children who are the natural children of her 
 
            husband and who come to stay with them in their mobile home 
 
            every other weekend (Tr. p. 75).
 
            
 
                 Claimant testified that she could do household work 
 
            such as vacuuming, dishes, dusting and laundry (Tr. p. 66).
 
            
 
                 Claimant had applied for social security disability 
 
            benefits but her claim was denied because they felt that she 
 
            could perform work either as an assembly worker or as a 
 
            nurse's aide (Tr. p. 67).
 
            
 
                 Claimant acknowledged that prior to her termination in 
 
            February of 1990, she had moved 61 miles away from employer 
 
            but that if she could have worked she would have stayed with 
 
            her parents who lived approximately 12 miles from employer 
 
            (Tr. pp. 68 & 69).  Claimant admitted that she told Covey 
 
            that she was not interested in vocational rehabilitation 
 
            counseling or assistance (Tr. p. 72).
 
            
 
                 Claimant testified that she went back to University of 
 
            Iowa Hospitals and Clinics in January and February of 1991 
 
            because her left leg kept going to sleep and her hip was 
 
            popping out (Tr. p. 77).  She added that her congenital 
 
            lower extremity condition was still progressing and one of 
 
            the doctors at the university predicted that it would be 
 
            necessary to amputate her left foot before she was 35 years 
 
            of age.  There is no medical evidence to support this 
 
            statement of claimant.  Furthermore, a decision of 
 
            industrial disability should be based upon facts in 
 
            existence and in the record at the time of the hearing 
 
            rather than speculation about what might happen in the 
 
            future.  Steward v. Crouse Cartage Co., File No. 738644, 
 
            Appeal Decision filed February 20, l987; Umphress v. 
 
            Armstrong Rubber Co., File No. 723184, Appeal Decision 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            August 27, 1987.
 
            
 
                 Claimant testified in particular that her left foot is 
 
            twisting more and more all the time and she does not have 
 
            good circulation in both feet (Tr. p. 79).  Claimant said 
 
            that her left foot was twisting and the bones on the top of 
 
            the foot were raising to the point where she could not wear 
 
            her shoe (Tr. pp. 83 & 84).
 
            
 
                 Claimant testified that even after all of the surgeries 
 
            -- the right and left carpal tunnel surgeries, the ulnar 
 
            nerve surgery, and the thoracic outlet surgery --  that she 
 
            did not feel that any of them had benefited her as far as 
 
            pain in her right upper extremity (Tr. p. 84).  She said the 
 
            surgeries did not cause any additional problems but she just 
 
            never got any better (Tr. p. 86).
 
            
 
                 Claimant testified that she consulted with Alfredo D. 
 
            Socarras, M.D., a neurologist (Jt. Ex. 2, pp. 206 - 208); 
 
            Anson A. Yeager, M.D., a vascular surgeon (Ex. 2, p. 189); 
 
            Robert O. Thompson, M.D., another vascular surgeon (Ex. 2, 
 
            p. 187); and, W. C. Koenig, Jr., M.D., a physical medicine 
 
            and rehabilitation doctor (Ex. 2, pp. 204 & 205, and none of 
 
            them had anything further that they could offer her (Tr. p. 
 
            187).
 
            
 
                 It is determined that claimant's cumulative injury to 
 
            the right shoulder was an injury to the body as a whole 
 
            because it affected the shoulder girdle which are the 
 
            muscles around the shoulder according to therapist Bower 
 
            (Ex. 2, pp. 192 & 197).  A shoulder injury is considered to 
 
            be an injury to the body as a whole.  Payton v. 
 
            Sheller-Globe Corp., File No. 895808, filed December 10, 
 
            1991 (on appeal); Tompkins v. John Morrelland Co., File No. 
 
            946532, filed December 22, 1991 (on appeal); Nazarenus v. 
 
            Oscar Mayer & Co., II Iowa Indus. Comm'r Rpt. 281 (1982); 
 
            Godwin v. Hicklin G.M. Power, II Iowa Indus. Comm'r Rpt. 
 
            170 (1981); Alm v. Morris Barick Cattle Co., 240 Iowa 1174, 
 
            38 N.W.2d 161 (1949); and Tarr v. John Deere Waterloo Works, 
 
            File No. 951330, filed March 5, 1992.
 
            
 
                 Furthermore, Dr. Matthews performed thoracic outlet 
 
            surgery which involved an incision in the right thoracic 
 
            area at the level of the first rib and a removal of a 
 
            portion of that rib (Ex. 2, pp. 174 & 175).  Thoracic outlet 
 
            syndrome is compensable as an injury to the body as a whole 
 
            because the physical anatomical abnormality is located in 
 
            the trunk of the body rather than in the arm, despite the 
 
            fact that the disability is manifested primarily in the 
 
            individual's ability to use the arm.  Furthermore, thoracic 
 
            outlet syndrome is a cumulative trauma injury.  Rice v. Todd 
 
            Uniform Co., File Nos. 807855, 847940, Filed  April 4, 1989.  
 
            This injury affected and caused a loss of use to claimant's 
 
            right arm.  Her complaints with all of the doctors have been 
 
            pain and numbness in her hand and in her arm up to her 
 
            shoulder (Jt. Ex. 2, pp. 126, 127, 150, 165, 186-188, 
 
            194-197).  Her right arm goes to sleep (Ex. 2, p. 173).  
 
            Therefore, with respect to employer, this is a body as a 
 
            whole injury for which claimant is entitled to industrial 
 
            disability benefits.  With respect to the Second Injury Fund 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            of Iowa, this is a body as a whole injury which affects a 
 
            scheduled member which qualifies as a "loss or loss of use 
 
            of another such member or organ" under Iowa Code section 
 
            85.64.
 
            
 
                 Claimant, born July 19, 1958, was 30 years old at the 
 
            time of the injury and 33 years old at the time of the 
 
            hearing.  At these younger ages claimant's industrial 
 
            disability is mitigated because of the fact that claimant is 
 
            young enough to seek vocational rehabilitation assistance 
 
            and to be retrained for several occupations in the general 
 
            economy.  Becke v. Turner-Busch, Inc., 34 Biennial Rep., 
 
            Iowa Indus. Comm'r 34 (Appeal Decision 1979); Walton v. B & 
 
            H Tank Corporation, II Iowa Indus. Comm'r Rpt. 426 (1981); 
 
            McCoy v. Donaldson Company, Inc., File Nos. 752670 & 805200 
 
            (Appeal Decision 1989).
 
            
 
                 Claimant has the benefit of a high school education but 
 
            has no further education or training since high school (Tr. 
 
            p. 29 & 37).  With a high school education a person in their 
 
            early 30's with a varied employment background such as 
 
            claimant's is capable of being retrained.  Conrad v. 
 
            Marquette School, Inc., IV Iowa Indus. Comm'r Rpt. 74, 89 
 
            (1984).  Claimant has proven her trainability by completing 
 
            the nurse's aide course in between her first and second 
 
            periods of employment with employer (Ex. 2, p. 8).
 
            
 
                 Employer offered claimant private vocational 
 
            rehabilitation and she declined both private vocational 
 
            rehabilitation assistance and the State of Iowa Vocational 
 
            Rehabilitation Assistance Program.  Thus, claimant's 
 
            motivation to be retrained or reenter the employment market 
 
            is brought into question.  Schelle v. Hygrade Food Products, 
 
            33 Biennial Rep., Iowa Indus. Comm'r 121 (1977).
 
            
 
                 Claimant's short-lived employment at two bait houses 
 
            and as a waitress at the Pale Moon Cafe due to her 
 
            subjective symptoms of pain and burning in her extremities, 
 
            coupled with her complete satisfication to be employed on a 
 
            part-time basis in her husband's lawn mowing business, also 
 
            calls in to question her motivation to return to the full 
 
            time employment market.  Claimant's first pregnancy when 
 
            considered with her many other problems probably reduced her 
 
            motivation for full time employment.  Since claimant has not 
 
            made a serious effort to be employed, there is a paucity of 
 
            evidence in order to determine what claimant can and cannot 
 
            do within the boundaries of her restrictions and disability.  
 
            Schofield v. Iowa Beef Processors, Inc., II Iowa Indus. 
 
            Comm'r Rpt. 334, 336 (1981).
 
            
 
                 An employee making a claim for industrial disability 
 
            will benefit from a serious attempt to find work in the 
 
            competitive employment market.  Hild v. Natkin and Company, 
 
            I Iowa Indus. Comm'r Rpt. 144 (Appeal Decision 1981); 
 
            Beintema v. Sioux City Engineering Co., II Iowa Indus. 
 
            Comm'r Rpt. 24 (1981); Cory v. Northwestern States Portland 
 
            Cement Company, 33 Biennial Rep., Iowa Indus. Comm'r 104, 
 
            (1976).  Employers are responsible for their reduction in 
 
            earning capacity caused by the injury.  They are not 
 
            responsible for a reduction in actual earnings because the 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            employee resists returning to work.  Williams v. Firestone 
 
            Tire and Rubber Company, III Iowa Indus. Comm'r Rpt. 279 
 
            (1982).
 
            
 
                 Claimant's application for social security disability 
 
            benefits and the stated intention to apply again indicate 
 
            that claimant is more interested in being disabled than 
 
            finding real work in the competitive labor market.
 
            
 
                 Claimant definitely is foreclosed from most production 
 
            line work which requires repetitive use of her hands and 
 
            arms as well as jobs which require the lifting of over 12 
 
            pounds frequently or working overhead, but there are other 
 
            jobs which claimant could perform in the competitive labor 
 
            market even though Johnson (employer's witness) testified 
 
            that she has a 70 percent loss of access to the employment 
 
            market.  However, Johnson's testimony is not controverted, 
 
            contradicted, rebutted or refuted by any other evidence.  
 
            Johnson also noted that claimant defied these statistics in 
 
            finding and keeping employment prior to this injury.
 
            
 
                 WHEREFORE, taking into consideration the congenital 
 
            deformity to claimant's lower extremities, the right carpal 
 
            tunnel injury, the right ulnar nerve/cubital tunnel injury, 
 
            and the right thoracic outlet syndrome which is the current 
 
            injury, it is determined that claimant has an overall 
 
            permanent industrial disability from all sources of 60 
 
            percent of the body as a whole for which the normal 
 
            entitlement is 300 weeks of permanent partial disability 
 
            benefits.  Iowa Code section 85.34(2)(u).
 
            
 
                 It is further determined that when excluding the 
 
            pre-existing hand, arm, foot and leg injuries which caused 
 
            permanent disability claimant has sustained a 35 percent 
 
            industrial disability to the body as a whole attributable to 
 
            this injury of February 27, 1989, for which the entitlement 
 
            is 175 weeks of permanent partial disability benefits.  
 
            Second Injury Fund v. Mich. Coal Co., 274 N.W.2d 300 (Iowa 
 
            1979)
 
            
 
                 Claimant is not entitled to any benefits from the 
 
            Second Injury Fund of Iowa because the credits to which the 
 
            Fund is entitled eliminate the liability of the Second 
 
            Injury Fund of Iowa.  This conclusion is calculated as 
 
            follows:  Claimant's total industrial disability overall is 
 
            300 weeks.  The credits to which the Fund is entitled total 
 
            378 weeks and are determined as follows:  (1) the scheduled 
 
            member permanent functional impairment value of the right 
 
            foot is 70.5 weeks; (2) the scheduled member permanent 
 
            functional impairment value of the left foot is 70.5 weeks; 
 
            (3) the scheduled member permanent functional impairment 
 
            value of the left hip is 27.5 weeks; (4) the scheduled mem
 
            ber permanent functional impairment value of the right hand 
 
            from the right carpal tunnel surgery is 9.5 weeks; (5) the 
 
            scheduled member permanent functional impairment value of 
 
            the ulnar nerve/cubital tunnel injury is 25 weeks; (6) the 
 
            credit for the industrial disability caused by the injury of 
 
            February 27, 1989, is 175 weeks.  The credits in the amount 
 
            of 378 weeks exceed the overall 300 week entitlement based 
 
            upon a 60 percent industrial disability to the body as a 
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            whole from all compensable sources.
 
            
 
                 Since claimant has more than one prior loss, the Fund 
 
            is entitled to a credit for all prior losses and not just 
 
            the single prior loss relied on by claimant.  Shank v. Mercy 
 
            Hospital Medical Center, File No. 719627, Appeal Decision 
 
            Filed September 27, 1991 (on appeal).
 
            
 
                 The single most substantial industrial disability 
 
            factor in this case with respect to the right shoulder 
 
            injury of February 27, 1989, is the fact that prior to this 
 
            injury claimant was able to work for her employer of several 
 
            years and after this injury she was foreclosed from 
 
            performing this work in the future.  Defendant employer had 
 
            no work which claimant could perform based upon her 
 
            restrictions against repetitive work, lifting more than 12 
 
            pounds frequently and working with her right upper extremity 
 
            extended above her head.  The same restrictions prohibit 
 
            claimant from returning to her prior employments as a 
 
            waitress and as a nurse's aide.  Claimant's industrial 
 
            disability has been reduced by her lack of interest in 
 
            vocational rehabilitation and returning to the competitive 
 
            employment market.
 
            
 
                                conclusions of law
 
            
 
                 WHEREFORE, based upon the foregoing and following 
 
            principles of law, these conclusions of law are made.
 
            
 
                 Claimant has sustained a 60 percent industrial 
 
            disability to the body as a whole and is entitled to 300 
 
            weeks of workers' compensation benefits caused by the 
 
            cumulative injury to the right shoulder and neck on February 
 
            27, 1989.  McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 
 
            (Iowa 1985).  Iowa Code section 85.34(2)(u).  Rice v. Todd 
 
            Uniform Co., File Nos. 807855, 847940, Filed  April 4, 1989.
 
            
 
                 That the carpal tunnel injury to the right wrist and 
 
            the cubital tunnel injury to the right forearm are each 
 
            separate distinct incidents and not part of this cumulative 
 
            injury of February 27, 1989.  Id.
 
            
 
                 That the overall industrial disability to claimant from 
 
            all sources for purposes of the Second Injury Fund liability 
 
            is a 60 percent industrial disability to the body as a whole 
 
            for an entitlement of 300 weeks but that the Fund is 
 
            entitled to 378 weeks in credits which eliminates the 
 
            liability of the Second Injury Fund of Iowa.  Iowa Code 
 
            section 85.64.
 
            
 
                 That the degree of industrial disability to the body as 
 
            a whole caused by the second injury alone is 35 percent 
 
            industrial disability for which the employer is liable and 
 
            which results in a credit to the Second Injury Fund of 175 
 
            weeks of permanent partial disability benefits.  Second 
 
            Injury Fund v. Mich. Coal Co., 274 N.W.2d 300 (Iowa 1979)
 
            
 
                 That the Second Injury Fund is entitled to a credit for 
 
            the first and intervening injuries of a permanent nature on 
 
            a scheduled member basis but not on an apportioned 
 

 
            
 
            Page  14
 
            
 
            
 
            
 
            
 
            industrial disability basis.  Shank v. Mercy Hospital 
 
            Medical Center, File No. 719627, Appeal Decision Filed 
 
            September 27, 1991 (on appeal).
 
            
 
                 That the congenital deformity to claimant's feet, legs 
 
            and hips is an injury to the body as a whole, but 
 
            nevertheless, qualifies as a previous loss under Iowa Code 
 
            section 85.64 because it caused loss of use, impairment and 
 
            disability to claimant's feet which are scheduled members.  
 
            Iowa Code section 85.64.
 
            
 
                 That the bilateral nature of claimant's first injury 
 
            does not prevent it from being a loss of use to a member 
 
            pursuant to Iowa Code section 85.64.  Second Injury Fund v. 
 
            Mich Coal Co., 274 N.W.2d 300 (Iowa 1979); Putzier v. Wilson 
 
            Foods Corporation, File Nos. 804582 & 835165 (Appeal 
 
            Decision May 24, 1991); Reifenstahl v. Second Injury Fund of 
 
            Iowa, File No. 886573 (Filed December 20, 1991); Saylor v. 
 
            Swift & Company, 34 Biennial Rep., Iowa Indus. Comm'r 282, 
 
            285 (1979).
 
            
 
                 That the injury to claimant's right shoulder and neck 
 
            for which she received right thoracic outlet surgery is an 
 
            injury to the body as a whole, but nevertheless qualifies as 
 
            a loss or loss of use of another such member because it 
 
            affected and caused a loss of use of claimant's right arm.  
 
            Second Injury Fund of Iowa v. Braden, 459 N.W.2d 467 (Iowa 
 
            1990); Second Injury Fund v. Neelans, 436 N.W.2d 355 (Iowa 
 
            1989); Second Injury Fund v. Mich. Coal Co., 274 N.W.2d 300 
 
            (Iowa 1979); Bevins v. Farmstead Foods, File Nos. 834865, 
 
            881784, 877458 and 888705 (Appeal Decision November 26, 
 
            1991); Shirley v. Shirley Ag Service, Inc., File No. 811696 
 
            (Appeal Decision March 21, 1990); Thompson v. Marshall & 
 
            Swift, Inc., File No. 784394 (Appeal Decision August 28, 
 
            1989); Fulton v. Jimmy Dean, File No. 755039 (Appeal 
 
            Decision July 28, 1986); Weiland v. Wilson Foods, File Nos. 
 
            744384 & 797397, Filed June 18, 1987; Lehnertz v. Second 
 
            Injury Fund of Iowa, File No. 922334 (Filed February 26, 
 
            1992); Rice v. Todd Uniform Co., File Nos. 807855, 847940, 
 
            Filed  April 4, 1989
 
            
 
                           
 
            
 
            
 
            Page  15
 
            
 
            
 
            
 
            
 
            order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 That defendant-employer pay to claimant one hundred 
 
            seventy-five (175) weeks of permanent partial disability 
 
            benefits at the stipulated rate of one hundred sixty-eight 
 
            and 08/l00 dollars ($168.08) per week commencing on April 
 
            16, 1990, as stipulated to by the parties.
 
            
 
                 That defendant employer is entitled to a credit for 
 
            sixty-six point one-four-three (66.143) weeks of permanent 
 
            partial disability benefits paid to claimant prior to 
 
            hearing at the rate of one hundred sixty-eight and 08/l00 
 
            dollars ($168.08) per week in the total amount of eleven 
 
            thousand one hundred seventeen and 32/l00 dollars 
 
            ($11,117.32).
 
            
 
                 That all accrued benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue pursuant to Iowa Code section 
 
            85.30.
 
            
 
                 No amounts are due from the Second Injury Fund of Iowa 
 
            to claimant.
 
            
 
                 That the costs of this action, including the cost of 
 
            the attendance of the court reporter at hearing and the 
 
            transcript of the hearing are charged to defendant employer 
 
            pursuant to Iowa Code section 86.40, 86.19(1) and rule 343 
 
            IAC 4.33.
 
            
 
                 That defendant-employer file claim activity reports as 
 
            requested by this agency pursuant to rule 343 IAC 3.l.
 
            
 
            
 
            
 
                 Signed and filed this ____ day of March, 1992.
 
            
 
            
 
            
 
            
 
            
 
                                          ______________________________               
 
            WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Harold B. Heslinga
 
            Attorney at Law
 
            118 North Market Street
 
            Oskaloosa, Iowa  52577
 
            
 
            Mr. James C. Huber
 
            Mr. Jon Kurt Hoffmann
 
            Attorneys at Law
 
            500 Liberty Building
 
            Des Moines, Iowa  50309
 
            
 

 
            
 
            Page  16
 
            
 
            
 
            
 
            
 
            Ms. Shirley Ann Steffe
 
            Assistant Attorney General
 
            Tort Claims Division
 
            Hoover State Office Building
 
            Des Moines, Iowa  50319
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
         1108.50; 1402.40; 1803.1; 2209; 3201; 3202; 3203; 5-1803
 
         Filed March 31, 1992
 
         WALTER R. McMANUS, JR.
 
         
 
                     before the iowa industrial commissioner
 
         ____________________________________________________________
 
                                       :
 
         BETTY RIEMENSCHNEIDER a/k/a   :
 
         BETTY JEAN KERNS,             :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :         File No. 911765
 
         FURNAS ELECTRIC COMPANY,      :
 
                                       :      A R B I T R A T I O N
 
              Employer,                :
 
                                       :         D E C I S I O N
 
         and                           :
 
                                       :
 
         LIBERTY MUTUAL INS. CO.,      :
 
                                       :
 
              Insurance Carrier,       :
 
                                       :
 
         and                           :
 
                                       :
 
         SECOND INJURY FUND,           :
 
                                       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         
 
         3201; 3202; 3203
 
         The previous injury was a congenital bilateral condition of the 
 
         hips, legs and feet described as arthrogryposis multiplex 
 
         congenita, abduction contractures of both hips and bilateral club 
 
         feet.
 
         A body as a whole injury qualifies as the previous loss if it 
 
         affects and causes loss or loss of use of a scheduled member 
 
         described in section 85.64.  Several cites.
 
         It is immaterial whether it is congenital, developmental or 
 
         caused by injury or disease.  Cites.
 
         The statute only requires previous loss or loss of use of a 
 
         designated member.  Section 85.64.
 
         The previous loss is not required to be traumatic.  It need not 
 
         be compensable.  Cites.
 
         Nothing in section 85.64 requires a unilateral loss but rather 
 
         the loss or loss of use of either the previous or subsequent 
 
         injury can be bilateral.  Several cites.
 
         Both the previous and subsequent loss must cause permanent 
 
         disability.  Cites.
 
         Subsequent loss in this case was an injury to the body as a whole 
 
         diagnosed by some as simply a shoulder injury and diagnosed by 
 
         others as thoracic outlet syndrome, but it affected and caused 
 
         loss of use to the right arm.  Several cites.
 
         The subsequent injury was also determined to be a cumulative 
 
         injury.  Cite.
 
         Three intervening injuries between the previous and subsequent 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         injury were evaluated, as well as numerous industrial disability 
 
         factors in order to determine that claimant's overall industrial 
 
         for which the Second Injury Fund was responsible was 60 percent 
 
         industrial disability to the body as a whole with a value of 300 
 
         weeks of permanent partial disability benefits.
 
         The fund was entitled to a credit for the scheduled member value 
 
         of all previous injuries and the industrial disability value of 
 
         the subsequent injury which wiped out their liability because the 
 
         credits amounted to 378 weeks.  Cite.
 
         Overall industrial disability was reduced because claimant had 
 
         rejected vocational rehabilitation; had not seriously sought 
 
         employment in the competitive employment market; was pregnant and 
 
         expecting her first child; and was perfectly content to assist 
 
         her husband in a self-employment lawn mowing service for the past 
 
         four summers.
 
         The intervening injuries to her left wrist, right wrist and right 
 
         forearm were not part of the cumulative injury to her right 
 
         shoulder but were separate incidents.
 
         
 
         
 
         1108.50; 1402.40; 1803.1; 2209
 
         With respect to employer, it was determined that claimant was 
 
         entitled to industrial disability benefits for an injury to the 
 
         body as a whole for a 35 percent industrial disability because 
 
         claimant was foreclosed from this employment and most former 
 
         employments even though the only impairment rating amounted to 
 
         four percent of the body as a whole for the right shoulder.  She 
 
         was restricted from repetitive work with her upper extremities; 
 
         was not to lift over 12 pounds frequently; and was not to work 
 
         with her right arm overhead.  Claimant's lack of motivation to 
 
         work in the competitive employment market reduced her industrial 
 
         disability.
 
         
 
         
 
         
 
         5-1803
 
         Claimant awarded 175 weeks of permanent partial disability 
 
         benefits from employer.
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            STEVE SOURBIER,               :
 
                                          :         File No. 911942
 
                 Claimant,                :
 
                                          :      A R B I T R A T I O N
 
            vs.                           :
 
                                          :         D E C I S I O N
 
            STATE OF IOWA,                :
 
                                          :
 
                 Employer,                :
 
                 Defendant.               :
 
            ___________________________________________________________
 
            
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration upon the petition 
 
            of claimant, Steve Sourbier, against his employer, the Iowa 
 
            Highway Patrol and the State of Iowa, self-insured employer, 
 
            defendant.  The case was heard on August 15, 1990, in 
 
            Council Bluffs, Iowa at the Pottawatamie Courthouse.  The 
 
            record consists of the testimony of claimant.  The record 
 
            also consists of the testimony of Sergeant Calvin W. Clark 
 
            and Michael A. Scheibeler.  Additionally, the record 
 
            consists of claimant's exhibits 1-5 and defendant's exhibits 
 
            A-Q.
 
            
 
                                      issue
 
            
 
                 The only issue to be determined is:
 
            
 
                 The nature and extent of claimant's permanent partial 
 
            disability benefits.
 
            
 
                                 findings of fact
 
            
 
                 The deputy, having heard the testimony and considered 
 
            all the evidence, finds:
 
            
 
                 Claimant is 43 years old.  He has been employed by the 
 
            Department of Public Safety as an Iowa Highway Patrolman 
 
            since March of 1977.  Prior to his employment with the 
 
            Highway Patrol, claimant had been employed as a police 
 
            officer with the Des Moines Police Department.  He had also 
 
            served in the U.S. Marine Corps.  At the time of the 
 
            hearing, claimant was an active member of the Iowa National 
 
            Guard, he had his own part-time janitorial service and he 
 
            maintained apartments for rent which he owned in part.
 
            
 
                 On February 3, 1989, while parked in his patrol car, 
 
            claimant was struck from behind by another vehicle.  
 
            Claimant's head was bent down as he was writing a citation.  
 
            When he was struck from behind, he hit his head against his 
 
            steering wheel.  He felt a popping in his neck and pain in 
 
            his lower back.  Claimant declined medical treatment at that 
 
            time.
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 On February 7, 1989, claimant sought medical treatment 
 
            from his personal physician, Steve Nelson, M.D.  Dr. Nelson 
 
            diagnosed claimant's condition as:  "1) Hyperextension 
 
            injury to his neck.  2) Musculoskeletal lower back strain."
 
            
 
                 Dr. Nelson prescribed physical therapy.  X-rays were 
 
            ordered.  The x-rays revealed no evidence of fracture or 
 
            dislocation.  Only mild degenerative changes were observed.  
 
            Dr. Nelson referred claimant to Behrouz Rassekh, M.D., a 
 
            neurosurgeon.  Dr. Rassekh opined:
 
            
 
                 He sustained flexion and extension injury.  He had 
 
                 some low back pain as well as the neck pain.  He 
 
                 continued to have the neck pain with pain in the 
 
                 cervico-dorsal [sic] junction with no radicular 
 
                 pain.
 
            
 
                 On examination, the patient does have some 
 
                 tenderness at the left of the spinous process of 
 
                 C7-D1 with some grinding sensation but no 
 
                 neurological deficit.
 
            
 
                 I do believe this patient has sustained soft 
 
                 tissue injury with musculoligamentous injury.  He 
 
                 was advised to use local heat and cervical collar 
 
                 on prn basis....
 
            
 
            (Exhibit I, page 6)
 
            
 
                 Claimant continued to treat with Dr. Rassekh.  As of 
 
            June 2, 1989, claimant had a normal examination.  
 
            Consequently, Dr. Rassekh released claimant to return to 
 
            work on June 8, 1989, and he released claimant to 
 
            participate in National Guard Camp but not to participate in 
 
            physical activities while at the camp.
 
            
 
                 In his deposition, Dr. Rassekh testified:
 
            
 
                 A.   Here again is the same problem as we talk 
 
                      about permanent injury.  If you say he will 
 
                      have some discomfort for a long time, the 
 
                      answer -- off and on, the answer is yes.  
 
                      Would he have any deformity or any injury 
 
                      which we can see, no.  But he will have -- 
 
                      continue to have recurrent symptom for a 
 
                      longer period of time, recurrent problem of 
 
                      neck discomfort and low back pain as a result 
 
                      of that injury.
 
            
 
                 Q.   And along those lines, are you able to say 
 
                      when these symptoms, this pain will cease?
 
            
 
                 A.   No.  That's why usually as result of soft 
 
                      tissue injury in the case of Mr. Sourbier I 
 
                      had estimate he will have a permanent -- a 5 
 
                      percent partial permanent disability as a 
 
                      result of that injury due to recurring neck 
 
                      problem and discomfort.
 
            
 
                 Q.   That was my next, question, Doctor.
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            
 
                           What percentage of permanency, if any, 
 
                      in the nature of disability to the body as a 
 
                      whole did he suffer?
 
            
 
                 A.   That was as we discussed and I think on the 
 
                      basis of recurring pain, even though we have 
 
                      no evidence of a significant bony injury or 
 
                      any physical evidence, just the fact of 
 
                      recurring pain and certain limitation of the 
 
                      motion, I have given him 5 percent partial 
 
                      permanent disability.
 
            
 
                 Q.   Doctor, the next opinion question I have is 
 
                      what type of restrictions can Steve expect to 
 
                      have on his daily activities --
 
            
 
                 A.   Usually none.
 
            
 
                 Q.   Excuse me, Doctor.  -- as a result of the 
 
                      injuries he sustained on February 3rd of 
 
                      1989?
 
            
 
                 A.   At the time when he's symptom free, there is 
 
                      no restriction I will impose on him.  But as 
 
                      a general rule, I will suggest he avoid 
 
                      repetitive motion of the neck, looking upward 
 
                      and downward and -- and those kind of motion, 
 
                      lifting, heavy, very heavy, over 75 or 80 
 
                      pounds weight.
 
            
 
            (Ex. 3, p. 22, line 16 to p. 24, line 3)
 
            
 
                 Pursuant to a request from defendant, claimant was 
 
            examined by Frank P. LaMarte, M.D., at Back Care, Inc.  Dr. 
 
            LaMarte diagnosed claimant's condition as:
 
            
 
                 1. Occasional mild low back pain by history.  
 
                    Probably secondary to myofascial strain.  
 
                    Normal back examination at this time.
 
            
 
                 2. Neck pain, etiology unknown.  Currently being 
 
                    evaluated Dr. Rassekh.
 
            
 
                 Claimant engaged in therapy at Back Care, Inc., for 
 
            approximately two weeks.  Dr. LaMarte prescribed home 
 
            exercises.
 
            
 
                                conclusions of law
 
            
 
                 The issue before this deputy is the nature and extent 
 
            of any permanent partial disability.
 
            
 
                 If a claimant contends he has industrial disability he 
 
            has the burden of proving his injury results in an ailment 
 
            extending beyond the scheduled loss.  Kellogg v. Shute and 
 
            Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 667 (1964).
 
            
 
                 Functional impairment is an element to be considered in 
 
            determining industrial disability which is the reduction of 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            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
 
            ability.  See Peterson v. Truck Haven Cafe, Inc., (Appeal 
 
            Decision, February 28, 1985);  Christensen v. Hagen, Inc., 
 
            (Appeal Decision, March 26, l985).
 
            
 
                 A claimant's industrial disability may be diminished by 
 
            his failure to accept offered employment consistent with his 
 
            impairment.  Johnson v. Chamberlain Mfg. Corporation, I Iowa 
 
            Industrial Commissioner Report 166 (Appeal Decision, October 
 
            31, 1984)
 
            
 
                 In the case at hand, Dr. Rassekh, the treating 
 
            physician, has determined claimant has a five percent 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            functional impairment rating.  The physician bases his 
 
            rating on claimant's subjective complaints of pain and some 
 
            reduced range of motion.  X-rays are within the normal 
 
            range.  Dr. Rassekh has imposed only the most minimum of 
 
            restrictions.  Claimant is precluded from lifting 75 to 80 
 
            pounds.  Such weight restrictions should not unduly affect 
 
            claimant's ability to perform his duties as a state highway 
 
            patrolman or as a medic in the National Guard.  Riding in an 
 
            automobile aggravates claimant's neck and back.  Claimant is 
 
            unable to vacuum when he is engaged in his part-time 
 
            janitorial position.  He has had to hire someone else to 
 
            perform this function.
 
            
 
                 Claimant has returned to his position as a highway 
 
            patrolman.  He has not had an actual loss of earnings as a 
 
            trooper.  He has maintained at least satisfactory 
 
            performance ratings.  His prospects for continued employment 
 
            are excellent.  His association with the Iowa National Guard 
 
            is not in jeopardy at this time.
 
            
 
                 After reviewing the above, in light of agency 
 
            expertise, it is the determination of the undersigned that 
 
            claimant has a ten percent permanent partial disability.  He 
 
            is entitled to weekly benefits for 50 weeks commencing on 
 
            June 8, 1989, the date Dr. Rassekh released claimant to 
 
            return to work and the date Dr. Rassekh released claimant to 
 
            attend camp with the Iowa National Guard.
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Defendant is to pay fifty (50) weeks of permanent 
 
            partial disability benefits from June 8, 1989 at the 
 
            corrected stipulated rate of three hundred forty-six and 
 
            10/100 dollars ($346.10) per week.
 
            
 
                 Interest shall be paid pursuant to section 85.30.
 
            
 
                 Defendant shall receive credit for all benefits paid 
 
            and not previously credited.
 
            
 
                 Costs of the action shall be assessed to defendant 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 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, 1991.
 
            
 
            
 
            
 
            
 
            
 
                                          ______________________________               
 
            MICHELLE A. McGOVERN
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            Copies To:
 
            
 
            Mr. Richard B. Maher
 
            Attorney at Law
 
            P O Box 1526
 
            Council Bluffs  IA  51502
 
            
 
            Ms. Joanne Moeller
 
            Assistant Attorney General
 
            Hoover Bldg
 
            Des Moines  IA  50319
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                           5-1803
 
                           Filed April 18, 1991
 
                           MICHELLE A. McGOVERN
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            STEVE SOURBIER,               :
 
                                          :         File No. 911942
 
                 Claimant,                :
 
                                          :      A R B I T R A T I O N
 
            vs.                           :
 
                                          :         D E C I S I O N
 
            STATE OF IOWA,                :
 
                                          :
 
                 Employer,                :
 
                 Defendant.               :
 
            ___________________________________________________________
 
            
 
            
 
            
 
            5-1803
 
            Claimant was awarded a 10 percent permanent partial 
 
            disability for a work related auto accident.