BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
            CAROL COOLEY,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :       File No. 914323
 
            BLACK HAWK COUNTY,            :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            UNITED STATES FIDELITY AND    :
 
            GUARANTY COMPANY,             :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a contested case proceeding upon the petition 
 
            in arbitration of claimant Carol Cooley against her former 
 
            employer, Black Hawk County, and its insurance carrier, 
 
            United States Fidelity and Guaranty Company.  Ms. Cooley 
 
            sustained an abdominal injury while lifting a care facility 
 
            resident on April 3, 1989, and now seeks benefits under the 
 
            Iowa Workers' Compensation Act.
 
            
 
                 A hearing was accordingly held in Waterloo, Iowa on 
 
            October 29, 1993.  The record consists of claimant's 
 
            exhibits 1-8, defendants' exhibits A-F and the testimony of 
 
            claimant, Shirley Olson, Rosanne Rennie, Christine Baker, 
 
            Eloise Dawson and Wesley Skyles.
 
            
 
                                      ISSUES
 
            
 
                 The parties have stipulated to the following:
 
            
 
                    1.  Claimant sustained injury arising out of 
 
                    and in the course of employment on April 3, 
 
                    1989;
 
            
 
                    2.  The injury caused temporary disability, 
 
                    the extent of which is no longer in dispute;
 
            
 
                    3.  Permanent disability, if any, should be 
 
                    compensated industrially;
 
            
 
                    4.  Claimant was single and entitled to one 
 
                    exemption at the time of hearing;
 
            
 
                    5.  Medical treatment and the cost thereof 
 
                    was fair and reasonable.
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            Issues presented for resolution include:
 
            
 
                    1.  Whether the injury caused permanent 
 
                    disability;
 
            
 
                    2.  The extent of claimant's industrial 
 
                    disability, if any;
 
            
 
                    3.  Determination of the proper rate of 
 
                    compensation; and,
 
            
 
                    4.  Entitlement to medical benefits.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The undersigned deputy industrial commissioner finds:
 
            
 
                 Carol Cooley, 46 years of age, is a 1966 high school 
 
            graduate.  Although she has taken no college courses, Ms. 
 
            Cooley has taken technical school courses as a machinist, 
 
            nurses' aide, and in pharmacology.  Although the machinist 
 
            course was a year long, she has never worked in that trade.
 
            
 
                 Ms. Cooley has work experience as a waitress, janitor 
 
            and nurses' aide.  With brief interruption, she worked at a 
 
            Waterloo care facility operated by Black Hawk County from 
 
            February 1977 until her injury, and then briefly as a social 
 
            worker assistant.  
 
            
 
                 Ms. Cooley has a very lengthy and complex medical 
 
            history.  Due to osteoporosis, she has suffered numerous 
 
            fractures of brittle bones.  Most of these have been 
 
            extremity fractures, but claimant sustained two fractured 
 
            thoracic vertebrae in 1977 after going over a bump riding in 
 
            a dune buggy.   Claimant has long suffered from rheumatoid 
 
            arthritis, has suffered a collapsed lung, and has heart 
 
            problems.
 
            
 
                 Of particular interest here, claimant also has an 
 
            extensive history of abdominal surgery.  She underwent three 
 
            gastric bypasses in the early 1980's, the first of which 
 
            resulted in severe infection and a major ventral hernia.  
 
            This was eventually repaired with installation of a mesh 
 
            material along with multiple surgical repairs and removal of 
 
            necrotic tissue.  In 1985, excess skin was removed along 
 
            with the mesh material.  Claimant was at this time returned 
 
            to work with no medical restrictions.
 
            
 
                 The work injury occurred while claimant and another 
 
            nurses' aide were lifting a heavy patient into a wheelchair.  
 
            The patient slipped so that claimant took all the weight on 
 
            herself.  She suffered an immediate "ripping" sensation 
 
            diagnosed as a repeat ventral hernia.
 
            
 
                 This set off an incredible string of surgical repairs 
 
            when the hernia failed to heal properly.  In 1989, claimant 
 
            had a total of five surgical procedures resulting from the 
 
            original hernia.  And, she was bedridden from June 3 until 
 
            August 8, during which time her arthritic condition 
 
            substantially worsened for lack of exercise and general 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            movement.
 
            
 
                 Claimant's treating physician was Robert L. Savereide, 
 
            M.D.  In a letter dated January 21, 1992, Dr. Savereide 
 
            rated impairment resulting from the ventral hernia at 30 
 
            percent of the body.  Dr. Savereide also imposed 
 
            restrictions against any lifting and pointed out that 
 
            claimant could only sit for short periods of time, probably 
 
            no longer than 30-45 minutes.
 
            
 
                 Although Dr. Savereide expressed no opinion as to 
 
            whether additional restrictions should be imposed due to 
 
            arthritis, he noted that inactivity will aggravate arthritis 
 
            and opined that claimant's lengthy inactivity because of the 
 
            infected abdominal wound "no doubt was a factor in making 
 
            her arthritis more disabling."  This is the only medical 
 
            opinion of record as to whether a causal nexus exists 
 
            between the stipulated work injury and claimant's current 
 
            arthritic condition.  Dr. Savereide continued:
 
            
 
                 Since I operated on her in April 1989, Carol has 
 
                 been unable to work.  She is unable to do any 
 
                 lifting whatsoever and cannot sit for long periods 
 
                 of time.  I law saw her January 15, 1992 and she 
 
                 said whenever she bends over the upper portion of 
 
                 her abdominal wall where she had the original mesh 
 
                 bulges out and gives her discomfort.  I had her 
 
                 try wearing a girdle for support and this has not 
 
                 helped and still causes pain.
 
            
 
            (Claimant's Exhibit 4)
 
            
 
                 In another letter dated August 24, 1993, Dr. Savereide 
 
            said that all of his care was related to the initial 
 
            recurrent ventral hernia, along with prescriptions for 
 
            various antibiotics prescribed to treat abscesses secondary 
 
            to the hernia repair surgery.  Dr. Savereide continued that 
 
            claimant was totally disabled because of her multiple 
 
            medical problems, including the hernia and recurrent 
 
            abscesses and aggravation of arthritis.
 
            
 
                 James E. Crouse, M.D., who saw claimant for evaluation 
 
            in 1991, pointed out that claimant's hernia was inoperable 
 
            because of the previous multiple problems requiring 
 
            grafting.  He concluded that based on claimant's entire 
 
            condition, including an unrelated right foot injury 
 
            subsequent to her work injury, restricted her to light and 
 
            sedentary work, with lifting no more than ten pounds 
 
            occasionally, only light weight documents frequently, and 
 
            with restricted sitting and standing.  Claimant cannot do 
 
            heavy repetitive work using her hands and cannot engage in 
 
            climbing, crawling, stooping or kneeling.
 
            
 
                 Defendants argue that Dr. Savereide's letter of 
 
            December 5, 1990 establishes that claimant was "now 
 
            completely healed."  The phrase is interpreted here as 
 
            referring to the actual surgical wound, not the condition 
 
            for which surgery was repeatedly performed.  In any event, 
 
            the letter is early and is superseded by Dr. Savereide's 
 
            later opinions.
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            
 
                 Following her multiple surgical procedures, claimant 
 
            was unable to return to work as a nurses' aide.  However, 
 
            she did accept work as an assistant social worker, and 
 
            remained so employed until taking advantage of an early 
 
            retirement program effective January 9, 1991.  This was most 
 
            fortuitous to claimant, who had already planned to leave, 
 
            due to continuing abdominal and arthritic pain.  She last 
 
            worked on December 13, 1990.
 
            
 
                 Claimant detailed how limited she is in current 
 
            activities due to constant pain, indicating that she spends 
 
            roughly three-quarters of her day either in bed or in a 
 
            recliner.  Shirley Olson, former director of nurses for 
 
            Black Hawk County, testified that while claimant was 
 
            formerly a good employee who could do everything her job 
 
            required without limitation, claimant was in constant pain 
 
            and had difficulty moving after her return as a social 
 
            worker assistant.  She was seen in tears and with her head 
 
            down on her desk.  She was unable to stand as straight as 
 
            formerly.  Olson herself agreed with claimant's decision to 
 
            resign employment.  Rosanne Rennie, an LPN and long time 
 
            friend of claimant, did not see Ms. Cooley work after the 
 
            injury, but noted that her arthritic problems were not 
 
            disabling before August 1989, and that she was limited in 
 
            her activities when the two women lived together for a time 
 
            in 1992.  Christine Baker, a social worker, saw claimant in 
 
            tears on multiple occasions.  She recalled claimant telling 
 
            her that she suffered from arthritis, but was unable to 
 
            remember if the hernia problem was specified.
 
            
 
                 Claimant was paid an hourly wage of $6.63 (including a 
 
            15 cent shift differential) and was paid biweekly.  During 
 
            the pay period comprising the 13th and 14th weeks preceding 
 
            injury, claimant worked 72 hours of straight time and 10 
 
            hours of overtime.  The record does not show which hours 
 
            were worked in which of those two weeks.
 
            
 
                         ANALYSIS AND CONCLUSIONS OF LAW
 
            
 
                 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 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).
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury is a proximate 
 
            cause of the disability on which the claim is based.  A 
 
            cause is proximate if it is a substantial factor in bringing 
 
            about the result; it need not be the only cause.  A 
 
            preponderance of the evidence exists when the causal 
 
            connection is probable rather than merely possible.  
 
            Blacksmith v. All-American, Inc., 290 N.W.2d 348 (Iowa 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            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).
 
            
 
                 Prior to the subject work injury, claimant had a 
 
            history of ventral hernia repair and of arthritis, but no 
 
            medical restrictions and without inability to work due to 
 
            attendant pain.  Claimant now has medical restrictions 
 
            specific to the subject hernia injury, and clearly has 
 
            established causal nexus in that regard.  Dr. Savereide has 
 
            opined without expert contradiction that the forced 
 
            inactivity during the multiple surgical repairs aggravated 
 
            the arthritic condition, which works together with the 
 
            hernia problem to cause claimant's current inability to 
 
            engage in gainful employment.
 
            
 
                 Total disability does not mean a state of absolute 
 
            helplessness.  Permanent total disability occurs where the 
 
            injury wholly disables the employee from performing work 
 
            that the employee's experience, training, education, 
 
            intelligence and physical capacities would otherwise permit 
 
            the employee to perform.  See McSpadden v. Big Ben Coal Co., 
 
            288 N.W.2d 181 (Iowa 1980); Diederich v. Tri-City Ry. Co., 
 
            219 Iowa 587, 258 N.W. 899 (1935).
 
            
 
                 A finding that claimant could perform some work despite 
 
            claimant's physical and educational limitations does not 
 
            foreclose a finding of permanent total disability, however.  
 
            See Chamberlin v. Ralston Purina, File No. 661698 (App. 
 
            October 29, 1987); Eastman v. Westway Trading Corp., II Iowa 
 
            Industrial Commissioner Report 134 (App. 1982).
 
            
 
                 Based on the opinion of Dr. Savereide, buttressed in 
 
            part by the opinion of Dr. Crouse, this decision concludes 
 
            that due to pain and medical restrictions resulting from the 
 
            hernia injury and arthritic sequelae, claimant is currently 
 
            foreclosed from engaging in any gainful employment.  She is 
 
            accordingly entitled to permanent total disability benefits.  
 
            They shall be awarded effective December 14, 1990, after Ms. 
 
            Cooley left work due to the fortuitous early departure 
 
            program.
 
            
 
                 The disputed medical bills attached to the hearing 
 
            report all relate to Dr. Savereide's treatment for the 
 
            hernia repair and subsequent abscesses at the surgical site.  
 
            Causal connection to the work injury has been established.  
 
            As Dr. Savereide was the primary treating physician, the 
 
            authorization defense fails.  Claimant shall be awarded 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            $2,753.68 pursuant to the hearing report attachment.
 
            
 
                 The parties also dispute the rate of compensation.  
 
            Under section 85.36(6), the weekly earnings of an employee 
 
            who is paid on an hourly basis are computed by dividing by 
 
            13 those earnings, not including overtime or premium pay, 
 
            earned in the last completed period of 13 consecutive 
 
            calendar weeks immediately preceding the injury.  Although 
 
            claimant was paid every two weeks, she was not paid on a 
 
            biweekly pay basis under section 85.36(2), because she 
 
            worked and was paid overtime.  Claimant was paid on an 
 
            hourly basis for hours worked during two-week pay periods.
 
            
 
                 Because the 13th and 14th weeks are impossible to 
 
            distinguish, weekly earnings in this case are appropriately 
 
            determined by dividing by 14 claimant's gross wages during 
 
            the 14 weeks preceding injury.  Under 343 IAC 4.2, overtime 
 
            hours are included at the straight time rate in determining 
 
            gross weekly earnings.  Claimant worked 572.6 hours 
 
            (including such miscellaneous wages as sick pay) during 
 
            those 14 weeks, or an average 40.9 hours per week.  
 
            Multiplication by $6.63 yields a product of $271.67, which 
 
            is hereby found to be claimant's average weekly wage.  The 
 
            parties have stipulated to a marital status of single and 
 
            entitlement to one exemption.  The rate tables published by 
 
            the commissioner show that an individual so situated is 
 
            entitled to a compensation rate of $168.08.
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Defendants shall pay permanent total disability 
 
            benefits at the rate of one hundred sixty-eight and 08/100 
 
            dollars ($168.08) per week commencing December 14, 1990 and 
 
            continuing during such time as claimant remains under a 
 
            total industrial disability.
 
            
 
                 All accrued weekly benefits shall be paid in a lump sum 
 
            together with statutory interest.
 
            
 
                 Defendants shall pay the medical expenses set forth on 
 
            the hearing report attachment totalling two thousand seven 
 
            hundred fifty-three and 68/100 dollars ($2,753.68).
 
            
 
                 Costs are assessed to defendants.
 
            
 
                 Signed and filed this ____ day of March, 1994.
 
            
 
            
 
            
 
            
 
                                          
 
                                        ________________________________
 
                                          DAVID R. RASEY
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr Robert C Andres
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            Attorney at Law
 
            PO Box 2634
 
            600 First National Building
 
            Waterloo Iowa 50704-2634
 
            
 
            Mr Mark W Fransdal
 
            Mr David R Mason
 
            Attorneys at Law
 
            315 Clay Street
 
            PO Box 627
 
            Cedar Falls Iowa 50613
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                               1804; 2206
 
                                               Filed March 25, 1994
 
                                               DAVID R. RASEY
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
           
 
                                          
 
            CAROL COOLEY,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :       File No. 914323
 
            BLACK HAWK COUNTY,            :
 
                                               A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            UNITED STATES FIDELITY AND    :
 
            GUARANTY COMPANY,             :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
            
 
            1804; 2206
 
            Claimant, with history of poor healing from previous 
 
            abdominal hernia and multiple gastric bypasses, suffered 
 
            recurrent hernia while lifting patient as a nurse's aide.
 
            Poor healing resulted in five successive surgical procedures 
 
            on the hernia.  Forced bedrest during this time greatly 
 
            aggravated preexisting but controlled arthritis.
 
            The hernia and arthritic condition together caused permanent 
 
            total disability.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            CLARUS WAYNE TIBBETS,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 914352
 
            MID-CONTINENT BOTTLERS,       :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            ROYAL INSURANCE,              :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                                   INTRODUCTION
 
            
 
                 This is a hearing in arbitration brought by Clarus 
 
            Wayne Tibbets, claimant, against Mid-Continent Bottlers, 
 
            employer, and Royal Insurance Company, insurance carrier, 
 
            for benefits as the result of an alleged injury which 
 
            occurred on March 29, 1989.  A hearing was held in Waterloo, 
 
            Iowa, on January 30, 1992, and the case was fully submitted 
 
            at the close of the hearing.  Claimant was represented by 
 
            Robert D. Fulton.  Defendants were represented by Philip H. 
 
            Dorff.  The record consists of the testimony of Clarus Wayne 
 
            Tibbets, claimant; Tina (Tibbets) Bigelow, claimant's 
 
            daughter; Charles F. Kohrs, claimant's supervisor; Jeffrey 
 
            C. Elgin, vice president and general manager; and joint 
 
            exhibits 1 through 17 and 19 through 24.  Both parties 
 
            presented a brief description of disputes attached to the 
 
            prehearing report.  Defendants submitted an excellent 
 
            hearing brief at the time of the hearing.  The deputy 
 
            ordered a transcript of the hearing.  Both attorneys 
 
            submitted excellent posthearing briefs.
 
            
 
                                      issues
 
            
 
                 The parties submitted that following issues for 
 
            determination at the time of the hearing:
 
            
 
                 Whether claimant sustained an injury on March 29, 1989, 
 
            which arose out of and in the course of employment with 
 
            employer;
 
            
 
                 Whether the injury was the cause of permanent 
 
            disability;
 
            
 
                 Whether claimant is entitled to temporary or permanent 
 
            disability, and if so, the nature and extent of benefits to 
 
            which he is entitled;
 
            
 
                 Whether claimant is entitled to medical benefits; and
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
                 Whether claimant is entitled to certain costs attached 
 
            to the prehearing report.
 
            
 
                                preliminary matter
 
            
 
                 The issue of whether claimant is entitled to medical 
 
            benefits is not designated as an issue on the hearing 
 
            assignment order; however, the prehearing deputy designated 
 
            medical benefits under Iowa Code section 85.27 as a hearing 
 
            issue on her prehearing conference notes and the parties 
 
            designated it as a disputed issue on the prehearing report.  
 
            Therefore, it is apparent that the prehearing deputy and 
 
            both parties intended that claimant's entitlement to medical 
 
            benefits was intended to be designated as a hearing issue in 
 
            this case and this decision will determine that issue.
 
            
 
                 The parties agreed and the notes of the prehearing 
 
            deputy show that the issue of whether claimant is an odd-lot 
 
            employee was waived at the time of the prehearing 
 
            conference.  Therefore, this issue will not be addressed in 
 
            this decision.
 
            
 
                                 findings of fact
 
            
 
                                      injury
 
            
 
                 It is determined that claimant sustained an injury of a 
 
            myocardial infarction on March 29, 1989, which arose out of 
 
            and in the course of employment with employer.
 
            
 
                 Claimant, born June 5, 1933, was 55 years old at the 
 
            time of his myocardial infarction.  Claimant is a 28-year 
 
            career employee of employer.  He started to work for 
 
            employer in January of 1961, at age 27, and continued to 
 
            work there as a vendor-repairman for over 28 years until his 
 
            myocardial infarction on March 29, 1989.  As a 
 
            vendor-repairman he repaired and serviced pop dispensers and 
 
            pop machines.  Claimant described it as heavy work requiring 
 
            the use of his arms, chest and back.  Claimant testified 
 
            that the big pop machines weigh between 100 and 1000 pounds.  
 
            He related that his duties require him to repair, fill, 
 
            move, load and unload, and set up these machines (transcript 
 
            page 28).  He also handles premix dispensers which weighed 
 
            approximately 60 to 65 pounds and postmix dispensers which 
 
            weighed approximately 75 pounds (tr. pp. 30 & 31).  At the 
 
            time of his myocardial infarction, he was unloading an 
 
            800-pound can dispenser which is probably seven-foot tall 
 
            (tr. p. 59l joint exhibit 17-1 & 17-2).  The video and 
 
            photographs show that it is a very large machine (jt. ex. 
 
            24).  Charles Kohrs, claimant's supervisor, testified that 
 
            this vendor weighed approximately 750 pounds (tr. p. 225).  
 
            
 
                 A handwritten job description prepared by Kohrs dated 
 
            June 7, 1989, lists ten job duties and concludes that parts 
 
            or all of the above duties require hard, physical labor 
 
            (exs. 5-2; 15-41).  A typed job description on employer's 
 
            letterhead stationary, which is undated and unsigned, but, 
 
            nevertheless, appears to be the authentic work of the 
 
            employer, shows the approximate weight of items handled as 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            follows:  
 
            
 
                 1)  Vendors: empty - 460 lbs. to 800 lbs.
 
                 2)  Postmix equipment: 120 lbs. to 240 lbs.
 
                 3)  Premix equipment:  50 lbs. to 150 lbs.
 
                 4)  Postmix tank:  60 lbs. to 70 lbs.
 
                 5)  Premix tank:  55 lbs. to 65 lbs.
 
                 6)  CO2 tank:  55 lbs. to 70 lbs.
 
                 7)  Case of 24 cans:  22 lbs. to 25 lbs.
 
            
 
                 The final paragraph of this job description describes 
 
            claimant's duties at the Uni-Dome.  "The Uni-Dome consists 
 
            of 17 fountain locations plus 10 vending machines.  The 
 
            Uni-Dome on all locations has from one (1) to approximately 
 
            one hundred (100) steps up and down.  All product and 
 
            fountain equipment has to be carried from vehicle to each 
 
            location."  (ex. 15-40).
 
            
 
                 Claimant testified that on Monday, March 27, 1989, that 
 
            he had some discomfort in his chest which he thought was 
 
            indigestion (tr. pp. 49-50).  He had the same feeling on 
 
            Tuesday, March 28, 1989, but it would come and go (tr. pp. 
 
            51-52).  He did not consider it serious enough to report to 
 
            either his wife at home or to anyone at work (tr. pp. 49-52 
 
            & 57).  On Wednesday morning, March 29, 1989, claimant, with 
 
            an assistant, Brad Watkins, serviced dispensers at the ball 
 
            park.  Together they carried in approximately 30 premix 
 
            tanks by hand (tr. pp. 130-131).  Claimant testified that he 
 
            did not have any indigestion problems on Wednesday morning 
 
            (tr. pp. 57 & 132).
 
            
 
                 After lunch, however, he and Watkins were unloading and 
 
            setting up and installing this 750 to 800-pound can 
 
            dispensing pop machine at a new location when claimant 
 
            encountered severe chest pains (tr. pp. 58-93).  Claimant 
 
            testified that he walked the machine by pushing on one 
 
            corner and then another by himself from behind the cab of 
 
            the pickup truck to the tailgate (tr. p. 75).  Claimant 
 
            testified "It was heavy work.  The vendors are heavy and 
 
            they are hard to move around."  (Tr., p. 176)  At that time 
 
            he felt sharper pain in his chest but kept going in order to 
 
            get the job done (tr. p. 76).  The hydraulic tailgate lifted 
 
            the machine to the ground and Watkins and claimant tipped it 
 
            onto a two-wheel cart and placed it in position against the 
 
            building.  Tipping the machine on the cart was a strenuous 
 
            effort for even two men (tr., pp. 80-89).  Claimant walked 
 
            around the truck for relief from the chest pains and told 
 
            Watkins that he was not feeling good (tr. p. 94).  When they 
 
            returned to the plant claimant was hurting real bad.  He had 
 
            real bad chest pains and told Bill Hudson, the plant 
 
            manager, he was going home.  At home he told his wife he was 
 
            real sick and to call a doctor who instructed them to bring 
 
            claimant to the doctor's office and hospital (tr. pp. 96 & 
 
            97).
 
            
 
                 At the hospital, John R. Moes, M.D., admitted claimant 
 
            noting that his chest pain of the last day or two became 
 
            worse upon lifting a pop dispenser (ex. 7, p. 7).  Dr. Moes 
 
            then turned the treatment of claimant over to Albert M. 
 
            Dolan, M.D., his associate, who was the family physician 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            that has treated claimant for approximately some 30 years.  
 
            Dr. Dolan then called in Ankineedu Kavuru, M.D., a 
 
            cardiologist.  Dr. Kavuru's final impression was inferior 
 
            and lateral wall infarction (exs. 7-17 & 7-21).
 
            
 
                 Dr. Dolan was claimant's primary treating physician for 
 
            the myocardial infarction and Dr. Kavuru only treated 
 
            claimant while he was hospitalized and later administered 
 
            three stress tests.
 
            
 
                 Dr. Dolan acknowledged that claimant had coronary 
 
            artery disease prior to the myocardial infarction which had 
 
            been previously undiagnosed and that this arteriosclerotic 
 
            condition was not caused by claimant's employment (ex 2. pp. 
 
            16-23).  Nevertheless, he felt that the strenuous physical 
 
            exertion of moving this heavy machine was the causative 
 
            factor for causing the heart attack to come on at that time 
 
            (ex. 2, pp. 15-16).  Dr. Dolan said his opinion was based 
 
            not only from his experience in a medical practice, but 
 
            also, from his experience as a coroner and a medical 
 
            examiner for Black Hawk County for many years (ex. 2, p. 
 
            23).
 
            
 
                 Dr. Dolan explained that forms he completed for 
 
            nonoccupational group income disability benefits which 
 
            showed that the condition was not caused by work was an 
 
            oversight on his part.  He further explained that when he 
 
            was confronted with the direct question of causal 
 
            connection, he replied, "Yes, I do feel that the exertion 
 
            and the physical activity was sufficient enough that it 
 
            would have brought on the heart attack."  (ex. 2, p. 83).  
 
            Dr. Dolan added, "The physical activity, the stress that he 
 
            was experiencing at the time while working on this pop 
 
            vending machine, that that brought on the actual heart 
 
            attack at that time."  (ex. 2, p. 83).
 
            
 
                 In a letter to claimant's counsel on June 18, 1990, Dr. 
 
            Dolan wrote, "I feel the physical exertion required to move 
 
            a pop dispensing machine certainly would be responsible for 
 
            precipitating an acute myocardial infarction in Mr. 
 
            Tibbets." (ex. 3, p. 3).
 
            
 
                 Dr. Kavuru, the cardiologist, wrote to claimant's 
 
            counsel on January 22, 1991:
 
            
 
                 Mr. Clarus Tibbets was seen by me when he was 
 
                 hospitalized at Covenant Medical Center when he 
 
                 came in with a history of chest pain since Monday.  
 
                 Patient was entered into the hospital on 
 
                 Wednesday.  Patient had been having some symptoms 
 
                 of burning since Monday but on Wednesay [sic] he 
 
                 did move the pop machine which contributed to him 
 
                 having the heart attack.
 
            
 
                 When a person is having chest discomfort, if he 
 
                 does any heavy exertion that can contribute 
 
                 significantly in causing the heart attack.
 
            
 
            (exhibit 4, page 1)
 
            
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
                 Donald D. Brown, M.D., a cardiologist at the University 
 
            of Iowa, did not personally examine claimant, but examined 
 
            the records in this case at the request of defendants and 
 
            concluded as follows, "Based on the review of these records 
 
            I believe that in all medical probability his work did not 
 
            precipitate his acute myocardial infarction which occurred 
 
            on March 29, 1989." (ex. 9).  In his deposition, Dr. Brown, 
 
            a board certified cardiologist and professor at the 
 
            University of Iowa, testified that the basis for his 
 
            decision was not necessarily based on claimant's situation 
 
            in particular, but he made the following broad general 
 
            statement.  "I think most importantly there is little or no 
 
            evidence to suggest that physical activity, per se., is the 
 
            precipitating factor in almost any case for a heart attack 
 
            or acute myocardial infarction." (ex. 8, p. 10).
 
            
 
                 David W. Kabel, M.D., another cardiologist, reviewed 
 
            the records for claimant and gave an evaluation on December 
 
            10, 1991.  Dr. Kabel wrote:
 
            
 
                 ...and while he was at work attempting to left 
 
                 [sic] a very heavy pop machine, he suddenly 
 
                 developed excruciating chest pain. The diagnosis 
 
                 was acute myocardial infarction and according to 
 
                 enzyme results, it apparently occurred at the time 
 
                 when his symptoms worsened while at work.  The 
 
                 temporal relationship of sudden strenuous physical 
 
                 activity to the acute myocardial infarction is 
 
                 obvious.
 
            
 
            (exhibit 1-1)
 
            
 
                 Dr. Kabel acknowledged that Dr. Brown's view was that 
 
            heavy physical activity has nothing to do with the onset of 
 
            acute myocardial infarction but stated that there are some 
 
            recent studies to contradict this.  Dr. Kabel referred to a 
 
            study that found acute myocardial infarction was five times 
 
            more likely at the time of or within two hours of strenuous 
 
            activity.  
 
            
 
                 Dr. Kabel then stated, "If strenuous physical activity 
 
            were not potentially harmful to patients with ischemic heart 
 
            disease, we would not advise them against such activity when 
 
            they are known to have heart disease." (ex. 1, p. 1).
 
            
 
                 The evidence from Dr. Kavuru, Dr. Kabel and Dr. Dolan 
 
            is preferred over the testimony of Dr. Brown.  It is more 
 
            realistic and comports best with all of the other evidence 
 
            in this case.  In addition, Dr. Kavuru and Dr. Dolan were 
 
            treating physicians.  Rockwell Graphic Systems, Inc. v. 
 
            Prince, 366 N.W.2d 187, 192.  The treating physician has a 
 
            better opportunity to form his expert opinion than the one 
 
            time examiner of defendants, and in this case Dr. Brown did 
 
            not examine claimant.  Lemon v. Georgia Pacific Corp., I 
 
            Iowa Indus. Comm'r Rep. 204, 205 (Appeal Dec. January 29, 
 
            1981); Clement v. Southland Corporation, I Iowa Indus. 
 
            Comm'r Rep. 56, 58 (filed June 24, 1981).
 
            
 
                 The evidence of Dr. Kavuru, Dr. Kabel and Dr. Dolan 
 
            supplies medical causation or causation in fact that the 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            unusually strenuous work that claimant was performing at the 
 
            time of the heart attack was the cause of the heart attack.  
 
            Legal causation is provided by the fact that moving a 750 to 
 
            800 pound pop machine is greater exertion than the exertion 
 
            of claimant or most other typical persons in non-employment 
 
            life.
 
            
 
                 Iowa Code section 85.3(1); McDowell v. Town of 
 
            Clarksville, 241 N.W.2d 904 (Iowa 1976); Musselman v. 
 
            Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967); 
 
            Guyon v. Swift and Co., 229 Iowa 625, 295 N.W. 185 (1940); 
 
            Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974); 
 
            Briar Cliff College v. Campolo, 360 N.W.2d 91 (Iowa 1984); 
 
            1A Larson's Workman Compensation, section 38.83; Alexander 
 
            v. Great Plains Bag Co., file number 768340 (filed August 3, 
 
            1988) (aff'd August 27, 1991).
 
            
 
                 The industrial commissioner recently held that where a 
 
            43-year-old 165-pound male with preexisting heart disease 
 
            sustained a myocardial infarction in the process of lifting 
 
            and carrying two containers weighing 90 pounds, that 
 
            represented unusual employment exertion regardless of the 
 
            actual pounds lifted and carried for the reason that 
 
            claimant was lifting and carrying more than one-half of his 
 
            own body's weight  Weinzweig v. Weinzweig Food Products, 
 
            Inc., file number 785837 (Appeal Decision October 29, 1991).  
 
            A direct comparison cannot be made with moving a 750 to 
 
            800-pound pop machine which is approximately seven feet high 
 
            and three feet by two feet square by pushing on its corners 
 
            and walking it.  It should be noted, however, that this pop 
 
            machine was about four and one-half times claimant's weight 
 
            of 175 pounds.  Nevertheless, there should be no dispute 
 
            that the work claimant was performing was unusually 
 
            strenuous employment exertion imposed upon his preexisting 
 
            diseased condition greater than the exertion of 
 
            nonemployment life of this employee or any typical employee.  
 
            Briar Cliff College, 360 N.W.2d 91; Sondag, 220 N.W.2d 903; 
 
            1A Larson section 38.83.
 
            
 
                 Wherefore, from the foregoing evidence, it is 
 
            determined that claimant sustained a myocardial infarction 
 
            on March 29, 1989, which arose out of and in the course of 
 
            employment with employer.
 
            
 
                 Claimant admitted that he did not think his chest pain 
 
            on March 29, 1989, was a heart attack nor did he think he 
 
            had a workers' compensation claim because he was only doing 
 
            the same work that he had always done.  It was not until 
 
            after he was denied twice for social security disability and 
 
            saw Gerald Martin the attorney that he realized that he 
 
            might have a workers' compensation claim.
 
            
 
                 The video showed two men unloading a vendor purportedly 
 
            in the same manner that claimant was performing at the time 
 
            of his myocardial infarction (ex. 24).  Brad Watkins was not 
 
            a witness in this case nor was any evidence from him 
 
            submitted as an exhibit.  Consequently claimant's version of 
 
            how the vendor was unloaded is uncontroverted, 
 
            uncontradicted, unrebutted and unrefuted.
 
            
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
                causal connection-entitlement-temporary disability
 
            
 
                 It is determined that claimant is entitled to 68.286 
 
            weeks of healing period benefits from March 29, 1989, the 
 
            date of the myocardial infarction, through June 19, 1990, 
 
            the last date in which claimant can be determined to have 
 
            shown some improvement in phase three of the cardiac 
 
            rehabilitation program prescribed by the treating physician.
 
            
 
                 The parties stipulated that the heart attack was the 
 
            cause of temporary disability. 
 
            
 
                 Claimant's counsel proposed that healing period ended 
 
            on September 12, 1989, based on a letter from Dr. Dolan 
 
            bearing that same date.  However, there is no letter from 
 
            Dr.Dolan in the entire record dated September 12, 1989, nor 
 
            is there an office note from Dr. Dolan on that date (ex. 3, 
 
            p. 32).  There is a letter on September 22, 1989, but it 
 
            does not address the end of healing period (ex. 3-5).  
 
            
 
                 Healing period ends when, () claimant returns to work; 
 
            () when claimant obtains maximum medical improvement or () 
 
            when claimant can return to substantially similar work.  
 
            Iowa Code section 85.34(1).  The letter of September 22, 
 
            1989, does not address any of these three points in time.
 
            
 
                 Claimant's counsel asserted that healing period ended 
 
            when Dr. Dolan determined that claimant was permanently and 
 
            totally disabled.  Dr. Dolan determined that status on 
 
            October 12, 1989 (ex. 3-7).  However, in the case of 
 
            permanent total disability, there is no healing period; 
 
            benefits begin typically with the date of injury.  
 
            Furthermore, it is determined that claimant in this case is 
 
            not permanently and totally disabled within the context of 
 
            the Iowa workers' compensation law.  It is determined, 
 
            however, that claimant is not able to return to his former 
 
            employment as a vendor repairman.  Moreover, claimant is not 
 
            able to return to employment substantially similar to the 
 
            employment in which he was engaged at the time of the 
 
            injury.  Iowa Code section 85.34(1).  Therefore, the healing 
 
            period terminated at the time that claimant attained maximum 
 
            medical improvement which according to the statute is the 
 
            date that it is medically indicated that significant 
 
            improvement from the injury is not anticipated.  Iowa Code 
 
            section 85.34(1).
 
            
 
                 The reports of Dr. Dolan for the nonoccupational group 
 
            income disability benefits based on the forms he completed 
 
            on April 4, 1989 (jt. ex. 3, p. 15); June 12, 1989 (jt. ex. 
 
            3, p. 13); June 22, 1989 (jt. ex. 3, p. 10); August 7, 1989 
 
            (jt. ex. 3, p. 9); are inconclusive, confusing and provide 
 
            no guidance on the end of healing period as provided for in 
 
            Iowa Code section 85.34(1).
 
            
 
                 As a result of claimant's myocardial infarction Dr. 
 
            Dolan prescribed three phases of cardiac rehabilitation.  
 
            Claimant is awarded healing period benefits as long as he 
 
            continued to participate in this cardiac rehabilitation and 
 
            as long as the records show that he continued to show 
 
            improvement. 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            
 
                 On August 2, 1989, Carla Christenson, R.N., cardiac 
 
            rehabilitation staff nurse, reported to Dr. Dolan that 
 
            claimant's attendance was 100 percent on that date and that 
 
            he had attended 19 out of a possible 19 sessions.  His 
 
            walking had attained 4.3 METs (ex. 6).
 
            
 
                 On August 21, 1989, Candace J. Steele, R.N., B.S.N., 
 
            cardiac rehabilitation coordinator wrote to Dr. Dolan that 
 
            claimant's attendance was 100 percent and that walking had 
 
            attained approximately seven METs.  Thus, improvement was 
 
            still being recorded.  Steel concluded, "Though his 
 
            endurance has increased over the course of his rehab my 
 
            concern is that the upper extremity isometric work that is 
 
            involved in his job is much too strenuous for him at this 
 
            time."  (ex. 5, p. 1).  
 
            
 
                 It should be noted that even if claimant is foreclosed 
 
            from his previous employment and even similar employments, 
 
            he is nevertheless entitled to treatment and healing period 
 
            benefits until he has attained maximum medical improvement 
 
            which had still not been recorded as of August 21, 1989.  
 
            (Iowa Code section 85.34(1))
 
            
 
                 On October 9, 1989, Steele wrote to Dr. Dolan that 
 
            claimant's attendance was still 100 percent his walking had 
 
            increased to "7-8 METs."  He had maintained his current 
 
            weight of 171 pounds for several weeks.  She said that 
 
            claimant had made steady progress in phase two and meets the 
 
            criteria for progression into phase three she stated that 
 
            she felt he would benefit from further cardiac 
 
            rehabilitation (ex. 5, p. 3).  
 
            
 
                 On October 12, 1989, Dr. Dolan noted with approval that 
 
            claimant was doing well and should plan on phrase three (ex. 
 
            3-32).  On November 9, 1989, he note that claimant had been 
 
            in phrase three for two to three weeks and that it was 
 
            helping him and that he should continue with phase three 
 
            (ex. 3-33).  On April 19, 1990, Dr. Dolan recorded that 
 
            claimant continued in the rehabilitation program at UNI and 
 
            was getting stronger.  On June 5, 1990, Dr. Dolan recorded 
 
            that claimant was till going to UNI and was scheduled for 
 
            another stress test on June 11, 1990.  On July 19, 1990, Dr. 
 
            Dolan noted that claimant is still in rehab and generally 
 
            doing good.
 
            
 
                 On August 16, 1990, Dr. Dolan noted that claimant was 
 
            off the prescribed rehabilitation program but was doing 
 
            exercises at home.  Dr. Dolan's notes fail to record any 
 
            significant improvement after that date (ex. 3, pp. 36 & 
 
            37).
 
            
 
                 In his deposition testimony on December 18, 1991, Dr. 
 
            Dolan verified, "that the cardiac rehabilitation at the 
 
            Uni-Dome seemed to be helping some and that claimant was to 
 
            continue it.  He verified that claimant did continue it and 
 
            was doing good with it until he discontinued the program 
 
            sometime between July 19, 1990 and August 16, 1990.  He did 
 
            not know why claimant quit going because he did not receive 
 
            any information from the rehabilitation specialist at that 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            time (ex. 2, pp. 73 & 74).
 
            
 
                 Thus it is determined that claimant is entitled to 
 
            healing period benefits through July 19, 1990.
 
            
 
                 A employee who suffers a work-caused myocardial 
 
            infarction and who is prescribed cardiac rehabilitation by 
 
            the treating physician should be allowed healing period 
 
            benefits as long as the program shows that claimant is 
 
            receiving some improvement.  The record shows that claimant 
 
            was prescribed cardiac rehabilitation by Dr. Dolan and that 
 
            he continued in the program and continued to show 
 
            improvement at least through July 19, 1990 Wherefore, it is 
 
            determined that claimant is entitled to healing period 
 
            benefits from the date of the injury, March 29, 1989, 
 
            through July 19, 1990, the last date on which it can be 
 
            established that claimant was continuing in the cardiac 
 
            rehabilitation program and showing improvement Iowa Code 
 
            section 85.34(1).  This is a period of 68.286 weeks of 
 
            healing period benefits. 
 
            
 
                 The opinion of Dr. Brown that claimant should be fully 
 
            recovered in four to eight weeks is not based on the facts 
 
            of this case and tends to fall into the category of his 
 
            other opinions that one size fits all (ex., pp. 35 and 36).
 
            
 
                causal connection-entitlement-permanent disability
 
            
 
                 It is determined that claimant has sustained a 60 
 
            percent industrial disability to the body as a whole and is 
 
            entitled to 300 weeks of permanent partial disability 
 
            benefits.
 
            
 
                 It is further determined that claimant is not 
 
            permanently and totally disabled under the workers' 
 
            compensation law of the State of Iowa.
 
            
 
                 The same evidence which established causation between 
 
            the employment and the myocardial infarction also 
 
            establishes that the myocardial infarction was the cause of 
 
            permanent disability.
 
            
 
                 While a claimant is not entitled to compensation for 
 
            the results of a preexisting injury or disease, the mere 
 
            existence at the time of a subsequent injury is not a 
 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
 
            preexisting condition or disability that is aggravated, 
 
            accelerated, worsened or lighted up so that it results in 
 
            disability, claimant is entitled to recover.  Nicks v. 
 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
 
            (1962).
 
            
 
                 Defendants are not liable for the preexisting coronary 
 
            artery disease but they are responsible for the fact that 
 
            the myocardial infarction caused permanent impairment and 
 
            substantial permanent disability.
 
            
 
                 The parties stipulated that in the event that the 
 
            injury is determined to be a cause of permanent disability 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            that the type of permanent disability is industrial 
 
            disability to the body as a whole.
 
            
 
                 Dr. Kabel presented the best evidence of permanent 
 
            impairment in this case, wrote to claimant's counsel on 
 
            December 10, 1991:
 
            
 
                 With respect to Mr. Tibbets disability 
 
                 determination, he certainly would qualify as a 
 
                 Class II impairment under the classification of 
 
                 coronary heart disease.  This is catagory [sic] 
 
                 6.2 of the AMA guidelines of disability.  He fits 
 
                 the criteria in that he had a documented 
 
                 myocardial infarction, and was on medication 
 
                 afterwards in order to maintain him in a symptom 
 
                 free state.  By these criteria, he certainly 
 
                 qualifies for disability.
 
            
 
            (exhibit 1, page 1)
 
            
 
                 The Guides to the Evaluation of Permanent Impairment, 
 
            third edition, published by the American Medical Association 
 
            in section 6.2, "Coronary Artery Disease," pages 126 and 
 
            129, indicate that a Class II impairment of the whole person 
 
            is a permanent physical impairment of between 15 to 25 
 
            percent. Example one on page 127 is somewhat similar to 
 
            claimant's situation because the diagnosis is recent 
 
            inferior wall myocardial infarction and the Guides indicate 
 
            that the impairment is 20 percent impairment of the whole 
 
            person.
 
            
 
                 Dr. Kavuru did not supply an impairment rating but did 
 
            perform stress tests on three different dates over the 
 
            period of approximately one year (ex. 4, pp. 2, 4.2, 4.3 & 
 
            4.4).  On a standard form attending physicians report which 
 
            Dr. Kavuru partially completed on May 4, 1989, he did not 
 
            answer the question what, if any, permanent impairment will 
 
            result? (ex. 4, p. 5).  In all probability it was much too 
 
            early to make such a determination.
 
            
 
                 The evaluating cardiologist for defendants, Dr. Brown, 
 
            stated, "Based on the treadmill test reports, I do not find 
 
            any evidence of significant disability as judged by the work 
 
            capacity demonstrated therein." (ex. 9; ex. 8, pp. 19 & 20; 
 
            ex. 8, deposition ex. 2).  Dr. Brown said he reviewed the 
 
            treadmill tests using classical criteria and could not find 
 
            on the tracings any EKG changes which he would read as 
 
            positive for myocardial ischemia.  In each case claimant 
 
            reached a level of exertion known as stage three which is 
 
            equivalent to ten minutes of physical activity METs (ex. 8, 
 
            pp. 20 & 21).  Dr. Brown felt that claimant could perform 
 
            his job duties as a vendor repairman for employer after the 
 
            heart attack and that the only restriction that he would 
 
            impose would be the restriction from exposure to severe 
 
            inclimate weather, but he suggested that for anybody 
 
            claimant's age or even younger ages (ex. 8, pp. 27 & 28 & 29 
 
            & 31 & 32).  Dr. Brown also thought claimant was able to 
 
            return to work at all of his former duties with employer in 
 
            about four to eight weeks after the heart attack (ex. 8, pp. 
 
            35 & 36).
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            
 
                 The stress test administered by Dr. Kavuru on June 1, 
 
            1989, was reported as a positive stress test at 97 percent 
 
            of the maximal rate (ex. 4, p. 4).  The test performed on 
 
            August 29, 1989, was also reported as probably a positive 
 
            test (ex. 4-3).  The test performed on June 11, 1990, was 
 
            also reported as probably a positive exercise test (ex. 4, 
 
            p. 2).
 
            
 
                 Dr. Dolan, the treating noncardiologist physician, 
 
            testified that he believed that claimant was permanently and 
 
            totally disabled as a result of the myocardial infarction 
 
            (ex. 2, p. 15) (1) because claimant has never recovered 
 
            sufficiently to do the work that he had done previously (ex. 
 
            2, p. 38), (2) because the cardiac rehabilitation people 
 
            reported tiredness and fatigue associated with increased 
 
            physical activity (ex. 2, p. 38) and (3) because Dr. Kavuru 
 
            obtained positive stress tests on all three occasions (ex. 
 
            2, p. 39).  Also claimant reported to Dr. Dolan on December 
 
            12, 1989, that he got leg cramps with walking one-half to 
 
            one mile with a very brisk pace (ex. 2, p. 39).  On January 
 
            4, 1990, Dr. Dolan reported that claimant reported that cold 
 
            weather caused him problems (ex. 2, p. 40).  On April 19, 
 
            1990, Dr. Dolan reported that the claimant said that he was 
 
            doing good on the exercise program at UNI and was getting 
 
            stronger but at times still got short of breath going up and 
 
            down steps, doing yard work or sawing wood (ex. 2, p. 40).
 
            
 
                 Dr. Dolan admitted that there was no evidence of angina 
 
            (ex. 2, p. 41).  Nor did any of Dr. Kavuru's stress tests 
 
            indicate angina (ex. 2, p. 42).  Dr. Dolan agreed that 
 
            claimant attained ten METs on the stress test and that this 
 
            was a good number (ex. 2, p. 43).  The main evidence of 
 
            disability according to Dr. Dolan was shortness of breath 
 
            and lack of physical endurance (ex. 2, p. 44).  Dr. Dolan 
 
            said that stress tests are not conclusive nor is coronary 
 
            angiography, because many people who have normal results on 
 
            those tests have a heart attack a short time later (ex. 2, 
 
            p. 45).Dr. Dolan, the treating doctor, said he relied more 
 
            on what the patient told him then what the stress test 
 
            disclosed (ex. 2, pp. 45 & 46).  His concern was that 
 
            claimant is not a person who bounces back and overcomes 
 
            physical disabilities.  Experience tells him which patients 
 
            can bounce back and overcome their adversities and which 
 
            people do not have the physical ability to do that (ex. 2, 
 
            p. 47).  He said claimant had a certain amount of normal 
 
            fear that he might have another heart attack and this also 
 
            plays into a person's inability to work (ex. 2, p. 48).
 
            
 
                 Dr. Dolan indicated that claimant was foreclosed from 
 
            his former employment because he was not capable of the 
 
            physical labor involved in the type of work that he was 
 
            doing at the time of the myocardial infarction (ex. 2, p. 
 
            53).
 
            
 
                 Even though Dr. Dolan is not a cardiologist some 
 
            respect and weight must be placed upon the fact that he was 
 
            claimant's physician for 30 years.  He was his primary 
 
            treating physician responsible for claimant's recovery from 
 
            this heart attack or failure to recover from it, or perhaps 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            worse as Dr. Dolan suggested he might have another heart 
 
            attack because claimant still experienced shortness of 
 
            breath and pains in his legs with just the normal activities 
 
            of walking and lifting.
 
            
 
                 Claimant has not had any cardiac catheterization, 
 
            angiography, angioplasty (balloon procedure), nor has he had 
 
            any open heart surgery or bypass surgery or surgical 
 
            intervention of any kind (ex. 2, p. 54).  Claimant is taking 
 
            Cardizem prescribed by Dr. Kavuru and Lopressor and Zorpin 
 
            prescribed by Dr. Dolan (ex. 2, pp. 55 & 56).
 
            
 
                 Dr. Dolan concluded at the time of his deposition on 
 
            December 18, 1991, shortly before hearing that claimant's 
 
            condition was generally stable.  His blood pressure was 
 
            doing fine.  His arthritis had flared up again.  He did not 
 
            think claimant was capable of physical work (ex. 2, p. 57) 
 
            and that he is not intelligent enough to perform book work 
 
            (ex. 2, p. 58).  He  could perform a very sedentary type of 
 
            job without any undue physical stress (ex. 2, p. 58).  Dr. 
 
            Dolan would restrict claimant from strenuous physical 
 
            activity, in particular shoveling snow or activity outside 
 
            in cold weather (ex. 2, pp. 58 & 59 & 62 & 63).  Dr. Dolan 
 
            testified that he recommended that claimant apply for social 
 
            security because claimant had no income and he did not feel 
 
            that claimant could go back to work (ex. 2, p. 68).
 
            
 
                 In a letter to Jerald Martin, attorney, for the purpose 
 
            of his social security disability application Dr. Dolan 
 
            mentioned these restrictions:
 
            
 
                 He must avoid extremes in temperature, especially 
 
                 cold and wind.  Because of his allergies he must 
 
                 avoid dust and fumes.  He cannot do work requiring 
 
                 any rapid repedative [sic] activities, climbing, 
 
                 excessive walking, and stooping are beyond his 
 
                 physical capabilities.  He should not lift over 15 
 
                 to 20 pounds because of his cardiac condition and 
 
                 previous back injury associated with his work with 
 
                 pop dispensers.
 
            
 
            (exhibit 3-2)
 
            
 
                 From the foregoing evidence it is determined that 
 
            claimant is not permanently and totally disabled as 
 
            determined by Dr. Dolan, but claimant is no longer able to 
 
            perform very heavy, heavy or medium work.  Previously he 
 
            performed very heavy and heavy work.  Now he is restricted 
 
            to light or sedentary work. 
 
            
 
                 Therefore, claimant is foreclosed from his prior 
 
            occupation of vendor repairman and many of the duties listed 
 
            in the various job descriptions for that job.  Claimant is 
 
            foreclosed from his 28-year plus career employment as a 
 
            vendor repairman which has been his only real employment 
 
            during his entire adult working lifetime from age 27 to age 
 
            55.  This constitutes a substantial industrial disability.  
 
            Michael v. Harrison County, Thirty-fourth Biennial Report 
 
            of the Industrial Commissioner 218, 220 (Appeal Decision 
 
            January 30, 1979); Rohrberg v. Griffin Pipe Products Co., I 
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            Iowa Industrial Commissioner Report 282 (1984).
 
            
 
                 It is determined that claimant is not permanently and 
 
            totally disabled because there is light work and sedentary 
 
            work which claimant could perform in the competitive labor 
 
            market if he chooses to do so.  It is determined that Dr. 
 
            Brown's conclusion that claimant could return to his old job 
 
            as described in the job descriptions placed in evidence is 
 
            unrealistic, and contrary to the weight of evidence in this 
 
            case.
 
            
 
                 It is determined that Dr. Kabel's impairment rating of 
 
            somewhere between 15 and 25 percent is correct and further 
 
            that claimant fits the approximate general description of a 
 
            person with an inferior wall infarction in the AMA Guides 
 
            who was entitled to a 20 percent permanent physical 
 
            impairment rating.
 
            
 
                 Claimant's age increases his industrial disability 
 
            because the injury occurred at or near the peak point of his 
 
            earnings career.  Becke v. Turner-Busch, Inc., Thirty-fourth 
 
            Biennial Report of the Industrial Commissioner 34 (Appeal 
 
            Decision  1979); Walton v. B & H Tank Corp., II Iowa 
 
            Industrial Commissioner Report 426 (1981); McCoy v. 
 
            Donaldson Company, Inc., file numbers 782670 & 805200 
 
            (Appeal Decision 1989).
 
            
 
                 Claimant's eighth grade education with a GED obtained 
 
            in the navy coupled with the fact that claimant has had no 
 
            formal education or training other than employer training 
 
            for his various jobs also increases his industrial 
 
            disability.  Claimant is capable of retraining but as Dr. 
 
            Dolan pointed out many of the sedentary jobs rely on 
 
            intellectual abilities and claimant's chances for these jobs 
 
            would be considerably limited based upon his 28-year history 
 
            of semi-skilled heavy manual labor without any other 
 
            education or formal training.  Therefore, even though 
 
            claimant is retrainable the number of opportunities is 
 
            somewhat limited. Conrad v. Marquette School, Inc., IV Iowa 
 
            Industrial Commissioner Report 74, 89 (1984).
 
            
 
                 Claimant testified that Dr. Dolan told him he could 
 
            return to work light duty in June of 1989 and he reported 
 
            this to the plant manager Hudson and to his supervisor Kohrs 
 
            on two or more occasions but he was told that the company 
 
            did not have anything like that available (tr. pp. 152 & 
 
            183).  Claimant testified that 75 percent of the work was 
 
            not real strenuous, but when he wanted light duty the 
 
            employer did not offer him the 75 percent that was not 
 
            strenuous (tr. p. 173).  On the contrary, claimant testified 
 
            he was told there was no job that he could do for employer 
 
            (tr. p. 174).  Claimant testified that when he first 
 
            discussed this matter with Hudson and Kohrs, they said that 
 
            they would try to find a job for him but later he was told 
 
            there was no job for him.  Claimant testified that Kohrs 
 
            told him there was no job for him (tr. p. 195).
 
            
 
                 Neither party introduced any evidence from Hudson on 
 
            this point.  Kohrs testified that he did not remember 
 
            whether this occurred or not.
 

 
            
 
            Page  14
 
            
 
            
 
            
 
            
 
            
 
                 Defendants' counsel and Kohrs covered this matter in 
 
            the following words:
 
            
 
                 Q.  What I need to know, do you remember Mr. 
 
                 Tibbets coming to you and asking if there would be 
 
                 work available for him of a lighter-duty nature at 
 
                 Mid-Continent?
 
            
 
                 A.  I don't remember.  
 
            
 
                 Q.  Did you ever tell him, Mr. Kohrs, that there 
 
                 wouldn't be a job for him at Mid-Continent?
 
            
 
                 A.  I don't remember ever doing that.
 
            
 
                 ....
 
            
 
                 Q.  Did Mr. Hudson ever communicate to you that 
 
                 Mr. Tibbets had come in and Mr. Hudson told him 
 
                 that there wouldn't be any work for him at 
 
                 Mid-Continent?
 
            
 
                 A.  I don't remember such a -- such a thing.
 
            
 
                 
 
            (tr. pp. 233 & 234).  
 
            
 
                 Kohrs verified that he made the handwritten job 
 
            description (tr. p. 237; ex. 15-41).  Kohrs testified that 
 
            he never saw a light duty release in writing from any doctor 
 
            (tr. p. 244).  Kohrs testified that claimant was honest, you 
 
            could rely on what he said and that he would not 
 
            deliberately mislead (tr. p. 235).  He said claimant was a 
 
            reliable employee (tr. p. 240) and always did a full days 
 
            work (tr. p. 244).
 
            
 
                 Jeffrey C. Elgin, employer's vice president and general 
 
            manager, testified that it was their philosophy to return an 
 
            employee to work as soon as possible and to accommodate 
 
            employees within their limitations (tr. pp. 250 & 251).  He 
 
            added that he never saw a light duty slip in writing from 
 
            Dr. Dolan or Dr. Kavuru (tr. p. 250).  If claimant had 
 
            brought in such a slip they would have consulted their own 
 
            doctor to find out what duties he could do (tr. pp. 258 & 
 
            259).  Elgin stated that employer requested return to work 
 
            information from Dr. Dolan on two different occasions (ex. 
 
            15-87 and ex. 15-88) but they never did receive a reply (tr. 
 
            pp. 253-255).  The next thing he new claimant retired in 
 
            October of 1989 (tr. p. 58).  Claimant testified that he had 
 
            a written release for light duty but he doesn't know what he 
 
            did with it.  However, he distinctly recalls talking to 
 
            Kohrs and Hudson about returning to work with light duty 
 
            restrictions (tr. pp. 106 & 107).  Claimant testified that 
 
            he was told that they didn't think there was anything he 
 
            could do but they would talk to the bosses in Cedar Rapids 
 
            and find out. Later he was told that there was nothing for 
 
            him to do.
 
            
 
                 A.  They said in Cedar Rapids there was nothing 
 

 
            
 
            Page  15
 
            
 
            
 
            
 
            
 
                 that I could do, that they couldn't find no job 
 
                 for me to do.
 
            
 
                 Q.  Did they indicate whether you had a job there 
 
                 anymore?
 
            
 
                 A.  No.  They just said if I couldn't do my full 
 
                 job, you know, I more or less couldn't come back.
 
            
 
                 Q.  All right.  At that time was there a job 
 
                 description created regarding what your duties 
 
                 were and how difficult they were and such?
 
            
 
                 A.  Yes.
 
            
 
            (Tr., pp. 109 and 110)
 
            
 
                 At the bottom of the job description it states that 
 
            part of all of the above requires hard physical labor (tr. 
 
            p. 111, ex. 15, p. 41).
 
            
 
                 Claimant's testimony that he tried to return to work on 
 
            light duty in June of 1989 was not controverted, 
 
            contradicted, rebutted or refuted by any other evidence.  
 
            There is no testimony from Hudson.  Kohrs did not remember 
 
            anything one way or the other.
 
            
 
                 Although Dr. Dolan's report about claimant's disability 
 
            for the nonoccupational group disability income plan were 
 
            quite confusing (ex. 3, pp. 3-15, 3-13, 3-10 & 3-9) the 
 
            report dated June 12, 1989 (ex. 3-13) does contain the word 
 
            "light work" this tends to corroborate claimant's testimony 
 
            that Dr. Dolan told him in June that he could perform light 
 
            work and that as a result he talked to Hudson and Kohrs to 
 
            try to obtain it.  The reports of June 22, 1989 and August 
 
            7, 1989 do have a note at the bottom requesting Dr. Dolan to 
 
            provide an update on claimant's condition with an estimate 
 
            of when he can return to work (exs. 3-9 & 3-10) This tends 
 
            to corroborate Elgin's testimony that they did make an 
 
            effort to try to determine claimant's return to work status.
 
            
 
                 In any event, if defendants wish to mitigate industrial 
 
            disability by providing light work the burden is on the 
 
            employer and insurance carrier to seek out and provide light 
 
            duty to the claimant.  The claimant has no duty to seek out 
 
            the employer and request light duty within his physical 
 
            limitations and restrictions.  Morris v. Mike Brooks, Inc., 
 
            file number 891286 (filed July 12, 1991).
 
            
 
                 Nancy A. Tibbets, claimant's wife, testified by 
 
            deposition on February 8, 1991, that claimant had no 
 
            intention of retiring until the normal retirement age of 
 
            approximately age 63 or age 65 (ex. 22, p. 18).
 
            
 
                 The social security records introduced into evidence 
 
            show that claimant filed an application on August 21, 1989 
 
            and was denied benefits initially on December 19, 1989 and 
 
            after reconsideration was denied again on March 7, 1990.  He 
 
            refiled again on March 16, 1990 and was awarded benefits on 
 
            August 20, 1990 after claimant was represented by counsel, 
 

 
            
 
            Page  16
 
            
 
            
 
            
 
            
 
            Attorney Jerald Martin (exs. 16-6 & 16-1). It was determined 
 
            that claimant became disabled on March 29, 1989 and that his 
 
            benefits would begin after the five-month waiting period in 
 
            September of 1989 (tr. 16-2 & 16-2).
 
            
 
                 Claimant was awarded social security disability 
 
            benefits on the basis that he was an individual of advanced 
 
            age with the equivalent of a high school education that was 
 
            unable to return to his past work and did not have any 
 
            transferable skills to the light work to which he was 
 
            restricted (ex. 16-8).  However this particular standard is 
 
            not subscribed to by the industrial commissioner or this 
 
            deputy to determine permanent total disability.
 
            
 
                 Although claimant may be limited to light or sedentary 
 
            work, and is further limited by the fact that he does not 
 
            have the intellectual tools for academic retraining for many 
 
            jobs, nevertheless he does have transferable mechanical 
 
            skills and can do or be trained to do several manual tasks 
 
            of a light and sedentary nature.  He performs woodworking at 
 
            the present time at home since this injury.  Shortly prior 
 
            to the injury he assisted an electrician in a part-time 
 
            moonlight type of employment.
 
            
 
                 Wherefore, based upon (1) that claimant has sustained a 
 
            myocardial infarction which affected the inferior wall of 
 
            his heart (2) which was rated by Dr. Kabel, a cardiologist, 
 
            at between 15 to 25 percent based upon the AMA Guides (3) 
 
            which has foreclosed claimant from returning to his 
 
            previously performed heavy work as shown in the job 
 
            descriptions (4) at age 55 near the peak of his earnings 
 
            career and (5) based upon claimant's eighth grade education 
 
            with a GED without any further education or training (6) 
 
            that claimant's entire adult working life has been devoted 
 
            to semi-skilled manual labor as a vendor repairman (7) that 
 
            claimant was a 28-year career employee of employer (8) that 
 
            employer did not offer claimant an opportunity to return to 
 
            work within any limitations or restrictions that might be 
 
            prescribed by his treating physicians and (9) the fact that 
 
            employer did not offer claimant any vocational 
 
            rehabilitation, nor did claimant seek any on his own behalf, 
 
            (10) and all of the evidence in this case and (11) all of 
 
            the factors used to determine industrial disability, 
 
            Peterson v. Truck Haven Cafe, Inc., vol. 1, no. 3 State of 
 
            Iowa Industrial Commissioner Decisions 654, 658 (Appeal 
 
            Decision February 28, 1985); Christensen v. Hagen, Inc., 
 
            vol. I, no. 3, State of Iowa Industrial Commissioner 
 
            Decisions 529 (Appeal Decision March 26, 1985) and (12) 
 
            based upon agency expertise [Iowa Administrative Procedure 
 
            Act 17A.14(5)] it is determined that claimant has sustained 
 
            a 60 percent industrial disability to the body as a whole 
 
            and is entitled to 300 weeks of workers' compensation 
 
            permanent partial disability benefits.
 
            
 
                                 medical benefits
 
            
 
                 The parties stipulated that the provider of medical 
 
            services and supplies would testify that the fees charged 
 
            were reasonable and that the treatment was reasonable and 
 
            necessary treatment for the alleged work injury.  It is now 
 

 
            
 
            Page  17
 
            
 
            
 
            
 
            
 
            determined that the following medical expenses were caused 
 
            by this work injury:
 
            
 
            Medical Associates (Doctors Dolan and Moes)   $ 1,110.75 
 
            (ex. 10)
 
            Ankineedu Kavuru, M.D.                          1,353.00 
 
            (ex. 11)
 
            Covenant Medical Center                         8,091.64 
 
            (ex. 12)
 
            Evansdale Pharmacy                              1,162.15
 
            
 
                                          TOTAL           $11,717.54
 
            
 
                 Defendants actually owe for the Evansdale Pharmacy 
 
            statement on exhibit 13-2 but the copy entered into evidence 
 
            is not readable and therefore no numerical allowance can be 
 
            made for that item.
 
            
 
                                      costs
 
            
 
                 The parties stipulated on the prehearing report that 
 
            the actual payment of claimant's costs has been made.
 
            
 
                 Claimant is entitled to (1) the industrial 
 
            commissioner's filing fee of $65, (2) $150 of the Cardiology 
 
            Specialist's consultation and medical report charge in the 
 
            amount of $300 (Dr. Kabel), (3) the deposition charge for 
 
            Dr. Brown in the amount of $84.60, (4) the deposition charge 
 
            for Dr. Dolan in the amount of $108.10, (5) a medical report 
 
            from Medical Associates in the amount of $20, and (6) the 
 
            photography development charges for pictures introduced into 
 
            evidence in the amount of $8.88.  These allowable costs 
 
            total $436.58.  The Covenant Medical records charge in the 
 
            amount of $5 and the medical records of Dr. Kavuru in the 
 
            amount of $50 are all trial preparation expenses for 
 
            claimant for which no allowance is made.  No allowance is 
 
            made for the deposition of Nancy and Clarus Tibbets in the 
 
            amount of $180.55 because they were available to testify at 
 
            the hearing in person and depositions of the claimant and 
 
            claimant's spouse are typically considered to be trial 
 
            preparation expenses.  There is some consideration that 
 
            could be made for Mrs. Tibbets' deposition because she was 
 
            excused to return home after the hearing began and her 
 
            deposition was introduced into evidence, but since the 
 
            separate charge for her deposition is not known no specific 
 
            amount can be allowed.
 
            
 
                                conclusions of LAW
 
            
 
                 Wherefore, based upon the foregoing and following 
 
            principles of law these conclusions of law are made:
 
            
 
                 That claimant sustained an injury of a myocardial 
 
            infarction on March 29, 1989 which arose out of and in the 
 
            course of employment with employer.  Iowa Code section 
 
            85.3(1); McDowell v. Town of Clarksville, 241 N.W.2d 904 
 
            (Iowa 1976), Musselman v. Central Telephone Co., 261 Iowa 
 
            352, 154 N.W.2d 128 (1967); Guyon v. Swift and Co., 229 Iowa 
 
            625, 295 N.W. 185 (1940); Sondag v. Ferris Hardware, 220 
 
            N.W.2d 903 (Iowa 1974); Briar Cliff College v. Campolo, 360 
 

 
            
 
            Page  18
 
            
 
            
 
            
 
            
 
            N.W.2d 91 (Iowa 1984); 1A Larson's Workman Compensation, 
 
            section 38.83; Alexander v. Great Plains Bag Co., file 
 
            number 768340 (filed August 3, 1988) (aff'd  August 27, 
 
            1991).
 
            
 
                 That claimant is entitled to 68.286 weeks of healing 
 
            period benefits for the period from March 29, 1989 through 
 
            July 19, 1990.  Iowa Code section 85.34(1).
 
            
 
                 That the injury was the cause of permanent disability.  
 
            Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 
 
            (1965); Lindahl v. L.O. Boggs Co., 236 Iowa 296 18 N.W.2d 
 
            607 (1945).
 
            
 
                 That claimant sustained a 60 percent industrial 
 
            disability to the body as a whole and is entitled to 300 
 
            weeks of permanent partial disability benefits.  Iowa Code 
 
            section 85.34(2)(u).
 
            
 
                 That the injury was the cause of medical treatment and 
 
            claimant is entitled to $11,717.54 in reasonable medical 
 
            expenses.  Iowa Code section 85.27.
 
            
 
                 That claimant is entitled to $436.58 in costs as 
 
            defined above.  Rule 343 IAC 4.33.
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 That defendants pay to claimant sixty-eight point two 
 
            eight six (68.286) weeks of healing period benefits at the 
 
            stipulated rate of two hundred eleven and 36/100 dollars 
 
            ($211.36) per week for the period from March 29, 1989 
 
            through July 19, 1990 in the total amount of fourteen 
 
            thousand four hundred thirty-two and 93/100 dollars 
 
            ($14,432.93) commencing on March 29, 1989.
 
            
 
                 That defendants pay to claimant three hundred (300) 
 
            weeks of permanent partial disability benefits based upon a 
 
            sixty (60) percent industrial disability to the body as a 
 
            whole at the stipulated rate of two hundred eleven and 
 
            36/100 dollars ($211.36) per week in the total amount of 
 
            sixty-three thousand four hundred eight dollars ($63,408) 
 
            commencing on July 20, 1990.
 
            
 
                 That defendants are entitled to a credit in the amount 
 
            of five thousand one hundred forty-eight dollars ($5148) for 
 
            nonoccupational group health plan income disability benefits 
 
            paid to claimant prior to hearing.
 
            
 
                 That all accrued benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue pursuant to Iowa Code section 
 
            85.30.
 
            
 
                 That defendants pay to claimant or the provider or 
 
            medical services eleven thousand seven hundred seventeen and 
 
            54/100 dollars ($11,717.54) in medical expenses as itemized 
 
            above.
 

 
            
 
            Page  19
 
            
 
            
 
            
 
            
 
            
 
                 That defendants are entitled to a credit in the amount 
 
            of nine thousand two hundred twenty-six and 81/100 dollars 
 
            ($9,226.81) for medical expenses paid on claimant's behalf 
 
            prior to hearing under an employee nonoccupational group 
 
            health plan.
 
            
 
                 That the costs of this action, including the attendance 
 
            of the court reporter at hearing and the transcript of the 
 
            hearing as well as four hundred twenty-seven and 70/100 
 
            ($436.58) in costs as itemized above are to be paid by 
 
            defendants pursuant to Iowa Code sections 86.40, 86.19(1) 
 
            and rule 343 IAC 4.33.
 
            
 
                 That defendants file claim activity reports as 
 
            requested by this agency pursuant to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of February, 1992.
 
            
 
            
 
            
 
                                          ______________________________
 
                                          WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Robert D. Fulton
 

 
            
 
            Page  20
 
            
 
            
 
            
 
            
 
            Attorney at Law
 
            600 First National Bldg
 
            Waterloo, Iowa  50704-2634
 
            
 
            Mr. Philip H. Dorff, Jr.
 
            Attorney at Law
 
            2700 Grand Ave. STE 111
 
            Des Moines, Iowa  50312
 

 
            
 
            Page  21
 
            
 
            
 
            
 
            
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                                          51107 1108 51401 1402.20 
 
                                          1402.30 2202 1802 1803 1804 
 
                                          52501 52700 52907
 
                                          Filed February 28, 1992
 
                                          Walter R. McManus, Jr.
 
            
 
                           before the iowa industrial 
 
                                   commissioner
 
            ____________________________________________________________
 
                                          :
 
            CLARUS WAYNE TIBBETS,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 914352
 
            MID-CONTINENT BOTTLERS,       :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            ROYAL INSURANCE,              :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            51107 1108 51401 1402.20 1402.30 2202
 
            Twenty-four percent of claimant's work as a vendor repairman 
 
            of pop dispensers and pop machines was considered to be 
 
            heavy (over 50 pounds) or very heavy (over 100 pounds).  The 
 
            (1) treating physician (who was a general practitioner), (2) 
 
            a treating cardiologist, and (3) an evaluating cardiologist 
 
            for claimant opined that unusually strenuous physical 
 
            exertion at the time of claimant's myocardial infarction was 
 
            the factual or medical cause of claimant's heart attack.   
 
            The deputy determined that moving a 750 to 800-pound pop 
 
            machine by walking it by pushing on one corner and then the 
 
            other from near the cab of a pickup truck to the tailgate of 
 
            the truck constituted exertion greater than claimant or any 
 
            other person would typically encounter in nonemployment 
 
            life.  It was determined that the employment was the cause 
 
            of an injury (myocardial infarction) that arose out of and 
 
            in the course of employment.
 
            Defendants' evaluator, a board certified cardiologist and 
 
            professor at the University of Iowa, subscribed to the 
 
            theory that there was no scientific evidence that strenuous 
 
            physical exertion has anything to do with myocardial 
 
            infarction.  Claimant's doctors were preferred over 
 
            defendants' board certified cardiologist.
 
            
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
            1802
 
            It was determined that claimant was entitled to healing 
 
            period benefits during a cardiac rehabilitation program as 
 
            long as the record demonstrated significant improvement from 
 
            the program.
 
            Although defendants' evaluator said that claimant could 
 
            return to his former employment in four to eight weeks, in 
 
            what appeared to be another "one size fits all" medical 
 
            opinion, it was determined that claimant was entitled to 
 
            healing period benefits from the date of the injury until it 
 
            could be determined from the medical evidence that no 
 
            significant improvement was anticipated.  It was determined 
 
            that this occurred when claimant discontinued phase III of 
 
            cardiac rehabilitation and at that same time the medical 
 
            record failed to disclose any further significant 
 
            improvement.
 
            
 
            1803
 
            Claimant was awarded 60 percent industrial disability.  
 
            Defendants' evaluator said claimant had no disability.  
 
            Claimant's cardiologist evaluator placed claimant in Class 
 
            II of the AMA Guides which allows for a permanent physical 
 
            impairment of between 15 percent and 25 percent.  
 
            Claimant was age 55 and had an eighth grade education with a 
 
            GED but no additional education or training.  He was a 
 
            28-year plus career employee of employer who had done 
 
            nothing but semi-skilled, heavy manual labor for all of his 
 
            adult life for one employer.  He suffered an inferior wall 
 
            myocardial infarction.  He was foreclosed from returning to 
 
            his former employment or substantially similar employment.  
 
            He was restricted to light or sedentary work, but was not 
 
            suited for intellectual work, but was suited for manual 
 
            types of work.
 
            It is the duty of the employer to seek out the employee and 
 
            make an offer of light work if employer wished to mitigate 
 
            industrial disability.  There is no duty on the employee to 
 
            seek out employer and to attempt to return to work light 
 
            duty once the doctor takes claimant off work and later 
 
            states that claimant can no longer return to his former 
 
            employment.
 
            
 
            1804
 
            The Social Security Administration found that claimant was 
 
            not capable of gainful employment because he was a person of 
 
            advanced age foreclosed from his former employment and 
 
            restricted to light and sedentary work but had no 
 
            transferable skills for such work.  The industrial 
 
            commissioner does not follow this same standard.  Claimant 
 
            was trainable for sedentary manual types of work.  He did 
 
            have transferable mechanical, woodworking and electrical 
 
            skills.  Claimant followed his treating physician's advice 
 
            and applied for and received social security disability 
 
            benefits and his regular company retirement plan and made no 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            effort to find other work.
 
            
 
            52501 52700
 
            Claimant awarded medical treatment in the amount of 
 
            $11,717.54.  One page of pharmacy bills could not allowed 
 
            because the machine copy was so faint it was not readable.
 
            
 
            52907
 
            Claimant awarded some costs and others were disallowed on 
 
            conventional rules basically set out in rule 343 IAC 4.33.
 
            
 
 
            
 
          
 
            
 
            
 
            
 
                      BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
           
 
            PETER J. GOODRICH,    
 
                        
 
                 Claimant,   
 
                        
 
            vs.         
 
                                                File No. 914987
 
            SCHAFBUCH FARMS, INC.,     
 
                                                  A P P E A L
 
                 Employer,   
 
                                                D E C I S I O N
 
            and         
 
                        
 
            ALLIED GROUP INSURANCE,    
 
                        
 
                 Insurance Carrier,    
 
                 Defendants.      
 
            ____________________________________________________________
 
            
 
            The record, including the transcript of the hearing before 
 
            the deputy and all exhibits admitted into the record, has 
 
            been reviewed de novo on appeal.
 
            
 
                                      ISSUES
 
            
 
            Those portions of the proposed agency decision pertaining to 
 
            issues not raised on appeal are adopted as a part of this 
 
            appeal decision.  Defendants state the following issues on 
 
            appeal:
 
               
 
               1.  Whether Deputy O'Malley's award of 25% industrial 
 
            disability is excessive in light of the applicable factors 
 
            to be considered with respect to that issue including, inter 
 
            alia, the fact that Claimant is working three jobs whihc 
 
            provide him greater income than he was earning at the time 
 
            of his injury.
 
               
 
               2.  Whether Deputy Industrial Commissioner O'Malley erred 
 
            in ordering the Respondents to pay disputed section 85.27 
 
            benefits.
 
            Claimant states the following issues on cross-appeal:
 
               
 
               I.  Whether Deputy O'Malley's award of 25% industrial 
 
            disability is excessive in light of the fact that the deputy 
 
            found analysis of the industrial disability factors augured 
 
            for a substantial award of industrial disability.
 
               
 
               II.  Whether Deputy O'Malley's award of 25% industrial 
 
            disability is, in fact, insufficient in light of the fact 
 
            that claimant had also suffered an actual loss of earnings. 
 
               
 
               III. Whether Deputy O'Malley's award of $134.82 as 85.27 
 
            medical benefits was supported by substantial evidence.
 
            
 
                             FINDINGS OF FACT
 
            
 
            The findings of fact contained in the proposed agency 
 
            decision filed March 24, 1993 are adopted as set forth 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            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.
 
            
 
                 Claimant is a 37-year-old high school graduate who has 
 
            had no other formal education.  He testified in person and 
 
            also through his deposition on July 18, 1991, which 
 
            deposition was continued and taken up again on November 15, 
 
            1991.  Claimant has been in the manual labor field since 
 
            graduating from high school.  Claimant farmed and raised 
 
            livestock upon his high school graduation and did this until 
 
            January of 1979.  Claimant then began working for defendant 
 
            employer in March of 1979.  His duties included general farm 
 
            labor involving planting and harvesting crops, caring for 
 
            livestock, welding and repairing machinery, and general 
 
            farming duties.  He worked on a salary six days a week, 7:00 
 
            a.m. to 6:00 p.m., and received various fringe benefits such 
 
            as insurance, use of a house, feed facilities, was given two 
 
            hogs a year and a two acre pasture to use.  Claimant 
 
            indicated that notwithstanding his supposedly 7:00 a.m. to 
 
            6:00 p.m. hours, he usually, depending on the season, worked 
 
            longer and it appears he was working a minimimum 60 hour 
 
            week.  Claimant's salary, not including the fringe benefits 
 
            mentioned above, was $13,000 per year.
 
            
 
                 Prior to March 1989, claimant did odd jobs such as 
 
            welding for people for no pay, but those he did help would 
 
            help him if there was something he needed to have done.
 
            
 
                 On March 6, 1989, defendant employer changed claimant's 
 
            pay arrangement from a salary to an hourly wage at $5.00 per 
 
            hour and reduced the number of hours he was to work per week 
 
            from 60 to 40 or less.  Claimant's health insurance benefits 
 
            were changed in January 1989 from a total employer paid 
 
            family insurance to a $62 per month employee contribution.  
 
            Claimant's other non-cash benefits were also reduced or 
 
            eliminated.
 
            
 
                 Claimant began a second job on March 6, 1989, with 
 
            Grinnell Mutual Reinsurance Company (hereinafter referred to 
 
            as Grinnell Mutual) as a janitor at $5.00 per hour with his 
 
            family medical insurance premiums paid by the employer.  
 
            Claimant said he had hoped to continue working 30 to 40 
 
            hours a week with defendant employer in addition to his 40 
 
            hour job at Grinnell Mutual.  Claimant also intended to 
 
            continue to dabble on his own with some livestock.
 
            
 
                 Claimant described his injury on March 18, 1989, in 
 
            which he hurt his back.  There is no dispute claimant 
 
            incurred a work injury that resulted in claimant incurring a 
 
            healing period, some temporary partial disability and 
 
            certain permanent disability. *****
 
            
 
                 Claimant acknowledged that from and including 1986 to 
 
            the present, he only had a profit from his personal 
 
            livestock and farming ventures in the year 1986.  He 
 
            emphasized why he didn't have profits in the other post-1986 
 
            years.
 
            
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
                 Claimant testified he cannot care for livestock today 
 
            and is not able to do all that is necessary on a day-to-day 
 
            basis.  He tried raising or help raise livestock in the 
 
            winter of 1990 and this convinced him of his inability to 
 
            return to that type of work or lifestyle.  He has no 
 
            livestock currently.
 
            
 
                 Claimant explained the reasons for obtaining the 
 
            Grinnell Mutual job.  He indicated defendant employer wanted 
 
            claimant to get his own medical insurance and due to health 
 
            problems with his younger child and the need to have 
 
            continuous coverage for her.  This created a problem.  Mrs. 
 
            Schafbuch, vice president and secretary-treasurer of 
 
            defendant employer, indicated in her testimony that 
 
            defendant employer would not have dropped claimant's 
 
            insurance even though it was obviously discussed that people 
 
            would have to get their own insurance.  It then appeared 
 
            because of health conditions of the major family member of 
 
            defendant employer that it was important to try and keep a 
 
            group insurance plan but that the cost of insurance would 
 
            then be placed, at least in part, on the employees.  It 
 
            appeared at that time the only non-family employee of the 
 
            company was, in fact, the claimant.  Claimant agreed that if 
 
            there was not the discussion as to the insurance changing by 
 
            defendant employer, he would not have been looking for a job 
 
            with Grinnell Mutual.
 
            
 
                 Claimant last worked for defendant employer around 
 
            April 16, 1989.  He currently works approximately 40 hours 
 
            per week for Moorman Manufacturing Company selling feed and 
 
            makes approximately $175 to $180 net per week and began this 
 
            job on July 1, 1990.  He is also working at Grinnell Mutual 
 
            at $6.21 per hour currently, approximately 40 hours per 
 
            week.  He began that job on March 6, 1989.  He also is 
 
            currently working at a part-time job at Farmer Nick's on 
 
            weekends, mainly Sunday, for around seven hours at $4.65 per 
 
            hour minimum wage.
 
            
 
                 Claimant stated he is currently working a total of 80 
 
            to 90 hours per week at his three jobs, but doesn't know how 
 
            much longer he will be able to keep up the pace.  He said he 
 
            needs the money to live and support his family and to help 
 
            pay for his son's college education.
 
            
 
                 Claimant was questioned as to his appointment made in 
 
            1990 with a Dr. Wehr, a certain drug bill with Cunningham 
 
            Drug, and an x-ray bill.  Claimant indicated these bills 
 
            were either a follow-up or drugs prescribed pursuant to 
 
            visits to the doctor which resulted from his March 18, 1989 
 
            work injury.  Claimant indicated he was never free from pain 
 
            since his March 1989 injury, but he did aggravate his 
 
            condition while mopping at his Grinnell Mutual employment.  
 
            He explained he never had a new injury.
 
            
 
                 Claimant was asked as to his degenerative arthritis 
 
            which appeared in his medical record.  Claimant testified he 
 
            was having no problems or symptoms prior to March 18, 1989.
 
            
 
                 Claimant acknowledged he has worked at Grinnell Mutual 
 
            since his accident to the present except for the time he was 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            off getting his epidural injections, his healing periods and 
 
            temporary partial disability periods.
 
            
 
                 Claimant said he has been working his part-time job on 
 
            weekends currently, mostly on Sunday, at Farmers Nick's 
 
            since September 28, 1989.
 
            
 
                 Claimant agreed his pay at Grinnell Mutual is not 
 
            restricted due to his March 1989 injury, except he said he 
 
            did not get his six month or one year 5 percent raise.  
 
            Claimant said he saw Daniel J. McGuire, M.D., at his 
 
            attorney's direction, as he was having some physical 
 
            complaints.  R.R. Reschly, M.D., had moved and claimant 
 
            thought he should get another evaluation as he was having 
 
            shoulder pain also.
 
            
 
                 Claimant currently does not intend to give up his three 
 
            jobs.  It is obvious ***** that working approximately ninety 
 
            hours per week and sleeping approximately five hours is 
 
            going to catch up with claimant.
 
            
 
                 Elaine Schafbuch testified that there is not a position 
 
            available with defendant employer now and that the family 
 
            can handle any work that needs to be done.
 
            
 
                 Dr. Reschly's records reflect that conservative 
 
            treatment was used on claimant before the conclusions made 
 
            for claimant to have surgery for his herniated disc.  
 
            Claimant had an L4-5 diskectomy on July 25, 1989 (Joint 
 
            Exhibit 2, page 3; Joint Exhibit 5, page 16).
 
            
 
                 The parties are disputing $134.82 in medical bills 
 
            based on allegations they are not causally connected or 
 
            authorized.  The prescription costs of $53.82 from 
 
            Cunningham Drug on April 28 and June 23, 1990 are from 
 
            prescriptions prescribed by Dr. Reschly, who was the 
 
            authorized treating physician.  The x-rays taken May 4, 
 
            1990, and references in the notes to this effect, are in Dr. 
 
            Reschly's records of May 4, 1990 (Jt. Ex. 1, p. 5).  He also 
 
            indicates claimant should get x-rays again in one year.  
 
            Defendants contend these bills are caused by claimant's work 
 
            at Grinnell Mutual and not his injury in March 1989.  
 
            Defendants also relate them to a preexisting degenerative 
 
            arthritic condition.  There is no evidence claimant was 
 
            having any active symptomatic arthritic effects in his body 
 
            or any medical condition effecting his work prior to March 
 
            18, 1989.  Whatever part claimant's arthritis is now playing 
 
            was materially aggravated, lighted up, worsened and 
 
            activated by claimant's March 1989 injury.  Claimant's 
 
            November 21, 1990 limited exam in the amount of $24 is also 
 
            found to be the result of his March 1989 injury.  Defendants 
 
            shall pay for the 85.27 benefits that are in dispute, 
 
            totaling $134.82 ($57.00, $53.82, and $24.00).
 
            
 
                 On May 25, 1990, Dr. Reschly opined claimant had an 8 
 
            percent permanent impairment to his body as a whole due to 
 
            his back injury (Jt. Ex. 1, p. 5; Jt. Ex. 2, p. 5).
 
            
 
                 On August 19, 1991, Dr. McGuire evaluated claimant (Jt. 
 
            Ex. 6, p. 1-6) and opined claimant had a 10 percent 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            permanent impairment to his body as a whole (Jt. Ex. 6, p. 
 
            3).  He also complimented claimant on how motivated he was.  
 
            He placed no permanent restriction on the claimant.  He also 
 
            noted claimant's right shoulder pain complaint.  He 
 
            indicated later in his report that claimant could farm but 
 
            should not lift weight greater than 70 to 100 pounds on a 
 
            repetitive basis.  He did note claimant did not mention 
 
            shoulder complaints in his prior history or statements (Jt. 
 
            Ex. 6, p. 6).  Joint exhibit 7 is a physical therapist 
 
            report and functional capacity test.
 
            
 
                 Joint exhibit 8 is the rehabilitation consultant's 
 
            report.  This report does a good job of setting out and 
 
            classifying claimant's work at the time of his injury and 
 
            the current employment of the claimant.
 
            
 
                 Overwhelming undisputed evidence shows claimant's labor 
 
            of love has been up to his March 18, 1989 injury in the 
 
            farming and outdoor occupations and those areas that are 
 
            directly associated with farming.
 
            
 
                 Claimant is highly motivated and this motivation has 
 
            been recognized by others in the record.  It is hard to 
 
            believe claimant will be able to continue at the pace he is 
 
            currently working, which consists of 80 to 90 hours, two 
 
            full-time and one part-time job.  The human desire to 
 
            survive and the honorable desire to care for those who he 
 
            loves and for which he has responsibility results in 
 
            claimant punishing himself for the benefit of others.  
 
            Claimant needs his family health insurance paid and 
 
            continued in relation to a job.  He has a young child who 
 
            needs ongoing medical treatment because of a brain tumor the 
 
            child had removed at age 3.  Claimant's hourly wages at 
 
            these jobs are currently on the low pay scale ranging from 
 
            minimum up to $6.21 per hour.
 
            
 
                 Dr. Reschly, claimant's original treating physician, 
 
            did not put in writing any specific weight restrictions on 
 
            the claimant.  Claimant indicated he understood he was not 
 
            to lift over 50 pounds.  The rehabilitation consultant made 
 
            reference in his report that claimant was instructed by Dr. 
 
            Reschly not to lift over 50 pounds (Jt. Ex. 8, p. 2).  It 
 
            would appear that this came from the claimant when giving 
 
            his history and not from any particular document that the 
 
            rehabilitation consultant has seen or is in the record of 
 
            this case.  *****
 
            
 
                 Claimant should not be punished for his high 
 
            motivation, just like a person should not be rewarded for 
 
            low motivation.  Claimant should not be expected to work two 
 
            full-time jobs.  The rehabilitation consultant indicates 
 
            claimant would not be able to return to the physical demands 
 
            of farming, and that it is unreasonable to expect that 
 
            claimant will be able to maintain two full jobs and one 
 
            part-time job.
 
            
 
                 The rehabilitation consultant also indicated that if 
 
            claimant resigned the Grinnell Mutual job and invested more 
 
            time in the Moorman Feed job, which is a commission paid 
 
            job, claimant would increase his income from the feed 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            salesman job which could possibly offset the loss of income 
 
            as a janitor-custodian at Grinnell Mutual (Jt. Ex. 8, p. 5).
 
            
 
                 The words "could possibly" are of importance.  The 
 
            rehabilitation counselor did not go the extra mile to see if 
 
            that was a probability and not a mere possibility, and what 
 
            would the insurance consequences be on claimant's family.  
 
            The reason for claimant going to Grinnell Mutual in the 
 
            first place was based on claimant's need for a continuous 
 
            family health insurance coverage.  Claimant indicated that 
 
            Moorman Manufacturing has medical insurance but claimant did 
 
            not know if there was a period of no coverage for prior 
 
            sicknesses or total exclusion as to coverage concerning a 
 
            prior sickness or ongoing condition as claimant's daughter 
 
            has.  *****
 
            
 
                 *****
 
            
 
                 Claimant is not able to continue in the occupation he 
 
            has known all of his adult working life.  Claimant's injury 
 
            has resulted in claimant losing the ability to continue on 
 
            in operating or helping others operate a farm and doing all 
 
            the things that go along with general farming or even 
 
            specialized farming and raising of livestock.  Claimant is 
 
            unable to even on a small scale dabble in raising livestock 
 
            and taking care of them on a day-to-day basis.  Claimant has 
 
            in these respects a loss of earning capacity.
 
            
 
                 The evidence indicates that claimant is making as much 
 
            money now as he was at the time of his injury.  This, of 
 
            course, is due to the high motivation of the claimant and 
 
            his ability to keep more than one job as he was doing prior 
 
            to his March 18, 1989 injury.  How long claimant can 
 
            continue doing this is a good question.  The fact is, 
 
            claimant is working and therefore currently has no loss of 
 
            income for the most part.  ***** Claimant's education and 
 
            intelligence as indicated by the rehabilitation consultant 
 
            would prevent claimant from rising up concerning his 
 
            employment with the Grinnell Mutual as experience and more 
 
            education would be necessary.  The medical evidence 
 
            indicates claimant has an 8 to 10 percent permanent 
 
            impairment to his body as a whole.  ***** From the overall 
 
            record that seems logical.  Claimant has had a diskectomy at 
 
            L4-5.  This alone has weakened claimant's body as a whole 
 
            and his back.
 
            
 
                 Defendants indicate that claimant has a degenerative 
 
            disc condition and arthritis.  The fact is and the evidence 
 
            is very clear, whatever claimant had at the time of his 
 
            March 18, 1989 injury was not in any way affecting 
 
            claimant's work nor were there any symptoms or evidence of 
 
            medical problems as to any arthritic or degenerative problem 
 
            claimant had.  ***** Any degenerative arthritic condition 
 
            claimant had was inactive and that his March 18, 1989 injury 
 
            materially aggravated, lighted up and worsened any latant 
 
            arthritic degenerative condition that claimant had.
 
            
 
                 Taking into consideration claimant's medical and work 
 
            history prior to and after his March 18, 1989 injury; his 
 
            age; intelligence; motivation; location of his injury; 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            length of healing period; severity of his injury; functional 
 
            impairment; and the fact that his income is as much as it 
 
            was at the time of his injury; the fact that claimant is 
 
            working two full-time jobs and one part-time job; and 
 
            working at least 80 to 90 hours per week.  Claimant 
 
            currently has a 25 percent industrial disability.
 
            
 
                 The only remaining issue is whether the vocational 
 
            rehabilitation report in the amount of $824.75 and the 
 
            physical therapist report in the amount of $693.70, both 
 
            totaling $1,518.45, are considered costs under 343 IAC 4.33.  
 
            Said rule refers to the reasonable cost of obtaining no more 
 
            than two doctors or practitioner reports.  Iowa 
 
            Administrative Code section 343-4.17 describes who medical 
 
            practitioners are and persons engaged in physical or 
 
            vocational rehabilitation for evaluation or rehabilitation 
 
            are included therein.  Therefore, defendants are responsible 
 
            for $150 towards the rehabilitation consultant's fee of 
 
            $824.75 and defendants are responsible for $150 payment 
 
            towards the fee of Thomas Gallo, P.T., in the amount of 
 
            $693.70.  The remaining balances are the obligations of the 
 
            claimant.
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
            The conclusions of law contained in the proposed agency 
 
            decision filed March 24, 1992 are adopted as final agency 
 
            action.
 
            
 
            WHEREFORE, the decision of the deputy is affirmed.
 
            
 
                                       ORDER
 
            
 
            THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay unto claimant one hundred 
 
            twenty-five (125) weeks of permanent partial disability 
 
            benefits at the stipulated rate of one hundred ninety-four 
 
            and 03/100 dollars ($194.03) per week with payments 
 
            beginning September 28, 1989.
 
            
 
                 That defendants shall pay accrued weekly benefits in a 
 
            lump sum and shall receive credit against the award for 
 
            weekly benefits previously paid.  Defendants have previously 
 
            paid all healing period benefits and temporary partial 
 
            disability benefits, all of which was stipulated by the 
 
            parties.  The parties further stipulated that the defendants 
 
            had paid forty (40) weeks of permanent partial disability 
 
            benefits.  The parties further agreed that all these 
 
            benefits (54.714 weeks) previously paid were paid at a rate 
 
            of one hundred sixty-nine and 78/100 dollars ($169.78) and 
 
            that defendants will be paying the difference between that 
 
            rate and the stipulated rate of one hundred ninety-four and 
 
            03/100 dollars ($194.03).
 
            
 
                 That defendants shall pay one hundred fifty dollars 
 
            ($150.00) towards the bill of the rehabilitation consultant, 
 
            and one hundred fifty dollars ($150.00) toward the bill of 
 
            Thomas Gallo, the physical therapist
 
            
 
                 That defendants shall pay the Grinnell General Hospital 
 
            x-ray bill of fifty-seven dollars ($57.00), the Cunningham 
 
            drug bill of fifty-three and 82/100 dollars ($53.82), and 
 
            the Grinnell Family Care, P.C., bill of twenty-four dollars 
 
            ($24.00), all of which total one hundred thirty-four and 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            82/100 dollars ($134.82).
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            That defendants shall pay the costs of the appeal including 
 
            the transcription of the hearing. 
 
            
 
                 That defendants shall file an activity report upon 
 
            payment of this award as required by this agency, pursuant 
 
            to rule 343 IAC 3.1.
 
            
 
            Signed and filed this ____ day of June, 1993.
 
            
 
            
 
            
 
            
 
                                       ________________________________
 
                                               BYRON K. ORTON
 
                                          INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Ms. C. Jean Pendleton
 
            Attorney at Law
 
            1022 Broad St.
 
            Grinnell, Iowa 50112
 
            
 
            Mr. David L. Jenkins
 
            Attorney at Law
 
            801 Grand Ave., Ste 3700
 
            Des Moines, Iowa 50309
 
            
 
 
            
 
 
 
             
 
 
 
 
 
                                                 1803; 2907
 
                                                 Filed June 30, 1993
 
                                                 Byron K. Orton
 
            
 
                      BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
           
 
            PETER J. GOODRICH,    
 
                        
 
                 Claimant,   
 
                        
 
            vs.         
 
                                                  File No. 914987
 
            SCHAFBUCH FARMS, INC.,     
 
                                                    A P P E A L
 
                 Employer,   
 
                                                  D E C I S I O N
 
            and         
 
                        
 
            ALLIED GROUP INSURANCE,    
 
                        
 
                 Insurance Carrier,    
 
                 Defendants.      
 
            ____________________________________________________________
 
            
 
            1803
 
            Thirty-seven year old claimant awarded 25 percent industrial 
 
            disability.  Claimant had a diskectomy at L4-5.  Claimant's 
 
            injury foreclosed him from farming or raising livestock on a 
 
            day-to-day basis like claimant had done all of his adult 
 
            work life prior to his injury.
 
            
 
            Claimant is working two full-time jobs and one part-time at 
 
            $5 to $6.21 per hour in order to support his family (80-90 
 
            hours per week).  Claimant is highly motivated and working 
 
            beyond expected capacity considering his condition.
 
            
 
            2907
 
            Held under rules 343 IAC 4.33 and 4.17, that a 
 
            rehabilitation consultant and a physical therapist are 
 
            practitioners and therefore $150 of each practitioner's 
 
            report are costs and taxed as such.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            PETER J. GOODRICH,            :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 914987
 
            SCHAFBUCH FARMS, INC.,        :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            ALLIED GROUP INSURANCE,       :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This case came on for hearing on March 18, 1992, at Des 
 
            Moines, Iowa.  This is a proceeding in arbitration wherein 
 
            claimant seeks compensation for permanent partial disability 
 
            benefits as a result of an alleged injury occurring on March 
 
            18, 1989.  The record in the proceedings consists of the 
 
            testimony of the claimant, Elaine Schafbuch; and joint 
 
            exhibits 1 through 19.
 
            
 
                                      issues
 
            
 
                 The issues for resolution are:
 
            
 
                 .  The extent of claimant's permanent disability and 
 
            whether claimant is entitled to additional permanent 
 
            disability benefits;
 
            
 
                 .  Claimant's entitlement to 85.27 medical benefits, 
 
            the issues being causal connection and authorization as to 
 
            an x-ray, doctor and drug bill totaling $134.82; and,
 
            
 
                 .  Whether costs include a vocational rehabilitation 
 
            report bill and functional capacity bill rendered in this 
 
            case.
 
            
 
                                 findings of fact
 
            
 
                 The undersigned deputy, having heard the testimony and 
 
            considered all the evidence, finds that:
 
            
 
                 Claimant is a 37-year-old high school graduate who has 
 
            had no other formal education.  He testified in person and 
 
            also through his deposition on July 18, 1991, which 
 
            deposition was continued and taken up again on November 15, 
 
            1991.  Claimant has been in the manual labor field since 
 
            graduating from high school.  Claimant farmed and raised 
 
            livestock upon his high school graduation and did this until 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            January of 1979.  Claimant then began working for defendant 
 
            employer in March of 1979.  His duties included general farm 
 
            labor involving planting and harvesting crops, caring for 
 
            livestock, welding and repairing machinery, and general 
 
            farming duties.  He worked on a salary six days a week, 7:00 
 
            a.m. to 6:00 p.m., and received various fringe benefits such 
 
            as insurance, use of a house, feed facilities, was given two 
 
            hogs a year and a two acre pasture to use.  Claimant 
 
            indicated that notwithstanding his supposedly 7:00 a.m. to 
 
            6:00 p.m. hours, he usually, depending on the season, worked 
 
            longer and it appears he was working a minimimum 60 hour 
 
            week.  Claimant's salary, not including the fringe benefits 
 
            mentioned above, was $13,000 per year.
 
            
 
                 Prior to March 1989, claimant did odd jobs such as 
 
            welding for people for no pay, but those he did help would 
 
            help him if there was something he needed to have done.
 
            
 
                 On March 6, 1989, defendant employer changed claimant's 
 
            pay arrangement from a salary to an hourly wage at $5.00 per 
 
            hour and reduced the number of hours he was to work per week 
 
            from 60 to 40 or less.  Claimant's health insurance benefits 
 
            were changed in January 1989 from a total employer paid 
 
            family insurance to a $62 per month employee contribution.  
 
            Claimant's other non-cash benefits were also reduced or 
 
            eliminated.
 
            
 
                 Claimant began a second job on March 6, 1989, with 
 
            Grinnell Mutual Reinsurance Company (hereinafter referred to 
 
            as Grinnell Mutual) as a janitor at $5.00 per hour with his 
 
            family medical insurance premiums paid by the employer.  
 
            Claimant said he had hoped to continue working 30 to 40 
 
            hours a week with defendant employer in addition to his 40 
 
            hour job at Grinnell Mutual.  Claimant also intended to 
 
            continue to dabble on his own with some livestock.
 
            
 
                 Claimant described his injury on March 18, 1989, in 
 
            which he hurt his back.  There is no dispute claimant 
 
            incurred a work injury that resulted in claimant incurring a 
 
            healing period, some temporary partial disability and 
 
            certain permanent disability. The undersigned will not go 
 
            into facts unless they have an effect on the resolution of 
 
            disputed issues.
 
            
 
                 Claimant acknowledged that from and including 1986 to 
 
            the present, he only had a profit from his personal 
 
            livestock and farming ventures in the year 1986.  He 
 
            emphasized why he didn't have profits in the other post-1986 
 
            years.
 
            
 
                 Claimant testified he cannot care for livestock today 
 
            and is not able to do all that is necessary on a day-to-day 
 
            basis.  He tried raising or help raise livestock in the 
 
            winter of 1990 and this convinced him of his inability to 
 
            return to that type of work or lifestyle.  He has no 
 
            livestock currently.
 
            
 
                 Claimant explained the reasons for obtaining the 
 
            Grinnell Mutual job.  He indicated defendant employer wanted 
 
            claimant to get his own medical insurance and due to health 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            problems with his younger child and the need to have 
 
            continuous coverage for her.  This created a problem.  Mrs. 
 
            Schafbuch, vice president and secretary-treasurer of 
 
            defendant employer, indicated in her testimony that 
 
            defendant employer would not have dropped claimant's 
 
            insurance even though it was obviously discussed that people 
 
            would have to get their own insurance.  It then appeared 
 
            because of health conditions of the major family member of 
 
            defendant employer that it was important to try and keep a 
 
            group insurance plan but that the cost of insurance would 
 
            then be placed, at least in part, on the employees.  It 
 
            appeared at that time the only non-family employee of the 
 
            company was, in fact, the claimant.  Claimant agreed that if 
 
            there was not the discussion as to the insurance changing by 
 
            defendant employer, he would not have been looking for a job 
 
            with Grinnell Mutual.
 
            
 
                 Claimant last worked for defendant employer around 
 
            April 16, 1989.  He currently works approximately 40 hours 
 
            per week for Moorman Manufacturing Company selling feed and 
 
            makes approximately $175 to $180 net per week and began this 
 
            job on July 1, 1990.  He is also working at Grinnell Mutual 
 
            at $6.21 per hour currently, approximately 40 hours per 
 
            week.  He began that job on March 6, 1989.  He also is 
 
            currently working at a part-time job at Farmer Nick's on 
 
            weekends, mainly Sunday, for around seven hours at $4.65 per 
 
            hour minimum wage.
 
            
 
                 Claimant stated he is currently working a total of 80 
 
            to 90 hours per week at his three jobs, but doesn't know how 
 
            much longer he will be able to keep up the pace.  He said he 
 
            needs the money to live and support his family and to help 
 
            pay for his son's college education.
 
            
 
                 Claimant was questioned as to his appointment made in 
 
            1990 with a Dr. Wehr, a certain drug bill with Cunningham 
 
            Drug, and an x-ray bill.  Claimant indicated these bills 
 
            were either a follow-up or drugs prescribed pursuant to 
 
            visits to the doctor which resulted from his March 18, 1989 
 
            work injury.  Claimant indicated he was never free from pain 
 
            since his March 1989 injury, but he did aggravate his 
 
            condition while mopping at his Grinnell Mutual employment.  
 
            He explained he never had a new injury.
 
            
 
                 Claimant was asked as to his degenerative arthritis 
 
            which appeared in his medical record.  Claimant testified he 
 
            was having no problems or symptoms prior to March 18, 1989.
 
            
 
                 Claimant acknowledged he has worked at Grinnell Mutual 
 
            since his accident to the present except for the time he was 
 
            off getting his epidural injections, his healing periods and 
 
            temporary partial disability periods.
 
            
 
                 Claimant said he has been working his part-time job on 
 
            weekends currently, mostly on Sunday, at Farmers Nick's 
 
            since September 28, 1989.
 
            
 
                 Claimant agreed his pay at Grinnell Mutual is not 
 
            restricted due to his March 1989 injury, except he said he 
 
            did not get his six month or one year 5 percent raise.  
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            Claimant said he saw Daniel J. McGuire, M.D., at his 
 
            attorney's direction, as he was having some physical 
 
            complaints.  R.R. Reschly, M.D., had moved and claimant 
 
            thought he should get another evaluation as he was having 
 
            shoulder pain also.
 
            
 
                 Claimant currently does not intend to give up his three 
 
            jobs.  It is obvious to the undersigned that working 
 
            approximately ninety hours per week and sleeping 
 
            approximately five hours is going to catch up with claimant.
 
            
 
                 Elaine Schafbuch testified that there is not a position 
 
            available with defendant employer now and that the family 
 
            can handle any work that needs to be done.
 
            
 
                 Dr. Reschly's records reflect that conservative 
 
            treatment was used on claimant before the conclusions made 
 
            for claimant to have surgery for his herniated disc.  
 
            Claimant had an L4-5 diskectomy on July 25, 1989 (Joint 
 
            Exhibit 2, page 3; Joint Exhibit 5, page 16).
 
            
 
                 The parties are disputing $134.82 in medical bills 
 
            based on allegations they are not causally connected or 
 
            authorized.  The prescription costs of $53.82 from 
 
            Cunningham Drug on April 28 and June 23, 1990 are from 
 
            prescriptions prescribed by Dr. Reschly, who was the 
 
            authorized treating physician.  The x-rays taken May 4, 
 
            1990, and references in the notes to this effect, are in Dr. 
 
            Reschly's records of May 4, 1990 (Jt. Ex. 1, p. 5).  He also 
 
            indicates claimant should get x-rays again in one year.  
 
            Defendants contend these bills are caused by claimant's work 
 
            at Grinnell Mutual and not his injury in March 1989.  
 
            Defendants also relate them to a preexisting degenerative 
 
            arthritic condition.  There is no evidence claimant was 
 
            having any active symptomatic arthritic effects in his body 
 
            or any medical condition effecting his work prior to March 
 
            18, 1989.  Whatever part claimant's arthritis is now playing 
 
            was materially aggravated, lighted up, worsened and 
 
            activated by claimant's March 1989 injury.  Claimant's 
 
            November 21, 1990 limited exam in the amount of $24 is also 
 
            found to be the result of his March 1989 injury.  The 
 
            undersigned therefore finds that defendants shall pay for 
 
            the 85.27 benefits that are in dispute, totaling $134.82 
 
            ($57.00, $53.82, and $24.00).
 
            
 
                 On May 25, 1990, Dr. Reschly opined claimant had an 8 
 
            percent permanent impairment to his body as a whole due to 
 
            his back injury (Jt. Ex. 1, p. 5; Jt. Ex. 2, p. 5).
 
            
 
                 On August 19, 1991, Dr. McGuire evaluated claimant (Jt. 
 
            Ex. 6, p. 1-6) and opined claimant had a 10 percent 
 
            permanent impairment to his body as a whole (Jt. Ex. 6, p. 
 
            3).  He also complimented claimant on how motivated he was.  
 
            He placed no permanent restriction on the claimant.  He also 
 
            noted claimant's right shoulder pain complaint.  He 
 
            indicated later in his report that claimant could farm but 
 
            should not lift weight greater than 70 to 100 pounds on a 
 
            repetitive basis.  He did note claimant did not mention 
 
            shoulder complaints in his prior history or statements (Jt. 
 
            Ex. 6, p. 6).  Joint exhibit 7 is a physical therapist 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            report and functional capacity test.
 
            
 
                 Joint exhibit 8 is the rehabilitation consultant's 
 
            report.  This report does a good job of setting out and 
 
            classifying claimant's work at the time of his injury and 
 
            the current employment of the claimant.
 
            
 
                 Overwhelming undisputed evidence shows claimant's labor 
 
            of love has been up to his March 18, 1989 injury in the 
 
            farming and outdoor occupations and those areas that are 
 
            directly associated with farming.
 
            
 
                 Claimant is highly motivated and this motivation has 
 
            been recognized by others in the record.  It is hard to 
 
            believe claimant will be able to continue at the pace he is 
 
            currently working, which consists of 80 to 90 hours, two 
 
            full-time and one part-time job.  The human desire to 
 
            survive and the honorable desire to care for those who he 
 
            loves and for which he has responsibility results in 
 
            claimant punishing himself for the benefit of others.  
 
            Claimant needs his family health insurance paid and 
 
            continued in relation to a job.  He has a young child who 
 
            needs ongoing medical treatment because of a brain tumor the 
 
            child had removed at age 3.  Claimant's hourly wages at 
 
            these jobs are currently on the low pay scale ranging from 
 
            minimum up to $6.21 per hour.
 
            
 
                 Dr. Reschly, claimant's original treating physician, 
 
            did not put in writing any specific weight restrictions on 
 
            the claimant.  Claimant indicated he understood he was not 
 
            to lift over 50 pounds.  The rehabilitation consultant made 
 
            reference in his report that claimant was instructed by Dr. 
 
            Reschly not to lift over 50 pounds (Jt. Ex. 8, p. 2).  It 
 
            would appear that this came from the claimant when giving 
 
            his history and not from any particular document that the 
 
            rehabilitation consultant has seen or is in the record of 
 
            this case.  It would not be surprising to the undersigned 
 
            that that would be a reasonable limit in light of the nature 
 
            of claimant's injury, impairment and the job history he had 
 
            while in treatment with Dr. Reschly.
 
            
 
                 Claimant should not be punished for his high 
 
            motivation, just like a person should not be rewarded for 
 
            low motivation.  Claimant should not be expected to work two 
 
            full-time jobs.  The rehabilitation consultant indicates 
 
            claimant would not be able to return to the physical demands 
 
            of farming, and that it is unreasonable to expect that 
 
            claimant will be able to maintain two full jobs and one 
 
            part-time job.
 
            
 
                 The rehabilitation consultant also indicated that if 
 
            claimant resigned the Grinnell Mutual job and invested more 
 
            time in the Moorman Feed job, which is a commission paid 
 
            job, claimant would increase his income from the feed 
 
            salesman job which could possibly offset the loss of income 
 
            as a janitor-custodian at Grinnell Mutual (Jt. Ex. 8, p. 5).
 
            
 
                 The words "could possibly" are of importance.  The 
 
            rehabilitation counselor did not go the extra mile to see if 
 
            that was a probability and not a mere possibility, and what 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            would the insurance consequences be on claimant's family.  
 
            The reason for claimant going to Grinnell Mutual in the 
 
            first place was based on claimant's need for a continuous 
 
            family health insurance coverage.  Claimant indicated that 
 
            Moorman Manufacturing has medical insurance but claimant did 
 
            not know if there was a period of no coverage for prior 
 
            sicknesses or total exclusion as to coverage concerning a 
 
            prior sickness or ongoing condition as claimant's daughter 
 
            has.  The undersigned is not going to speculate.  If the 
 
            undersigned was to speculate, it would be more logical to 
 
            presume claimant would not be able to keep his current work 
 
            pace of 80 to 90 hours per week and two full-time and one 
 
            part-time job.  The current law covers the results of a 
 
            change in circumstances and sets out claimant's remedies if 
 
            there is a change in circumstances from the time of this 
 
            March 18, 1989 hearing.  The undersigned is not speculating 
 
            and is not considering in the decision the possibility or 
 
            probability of claimant reducing his work to 40 hours a week 
 
            or less from 80 to 90 hours per week or keeping one job and 
 
            resigning from the second full-time job or part-time job.
 
            
 
                 It appears claimant should not rock the boat if he is 
 
            able to continue with his current job situation as long as 
 
            he can. That would seem to be the best rather than giving up 
 
            a job and hoping to get more hours at another job (Jt. Ex. 
 
            A, p. 6-8).  With the economy the way it is and with the 
 
            obvious unavailability of jobs as shown by the 
 
            rehabilitation consultant's report of March 13, 1992, and 
 
            the availability of jobs considering claimant's injury, 
 
            skills and education, would warrant claimant keeping his 
 
            current job status.  This is even more so with his permanent 
 
            impairment and location of his injury.
 
            
 
                 Claimant is not able to continue in the occupation he 
 
            has known all of his adult working life.  Claimant's injury 
 
            has resulted in claimant losing the ability to continue on 
 
            in operating or helping others operate a farm and doing all 
 
            the things that go along with general farming or even 
 
            specialized farming and raising of livestock.  Claimant is 
 
            unable to even on a small scale dabble in raising livestock 
 
            and taking care of them on a day-to-day basis.  Claimant has 
 
            in these respects a loss of earning capacity.
 
            
 
                 The evidence indicates that claimant is making as much 
 
            money now as he was at the time of his injury.  This, of 
 
            course, is due to the high motivation of the claimant and 
 
            his ability to keep more than one job as he was doing prior 
 
            to his March 18, 1989 injury.  How long claimant can 
 
            continue doing this is a good question.  The fact is, 
 
            claimant is working and therefore currently has no loss of 
 
            income for the most part.  The claimant is basically 
 
            operating on a premise which is actually contrary to what 
 
            the undersigned believes are the doctor's correct analysis 
 
            and opinions rendered in this case as to claimant's 
 
            condition and impairment and what he should do and what he 
 
            should not do.  The undersigned is not going to penalize 
 
            claimant because of this motivation.  It does not appear 
 
            that he is hurting himself physically by doing this at the 
 
            current time.  Claimant's education and intelligence as 
 
            indicated by the rehabilitation consultant would prevent 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            claimant from rising up concerning his employment with the 
 
            Grinnell Mutual as experience and more education would be 
 
            necessary.  The medical evidence indicates claimant has an 8 
 
            to 10 percent permanent impairment to his body as a whole.  
 
            The undersigned finds that claimant is restricted from doing 
 
            the things he was doing prior to his injury.  The 
 
            undersigned does believe claimant when he testified the 
 
            doctor indicated to him he should not lift over 50 pounds.  
 
            From the overall record that seems logical.  Claimant has 
 
            had a diskectomy at L4-5.  This alone has weakened 
 
            claimant's body as a whole and his back.
 
            
 
                 Defendants indicate that claimant has a degenerative 
 
            disc condition and arthritis.  The fact is and the evidence 
 
            is very clear, whatever claimant had at the time of his 
 
            March 18, 1989 injury was not in any way affecting 
 
            claimant's work nor were there any symptoms or evidence of 
 
            medical problems as to any arthritic or degenerative problem 
 
            claimant had.  The undersigned finds that any degenerative 
 
            arthritic condition claimant had was inactive and that his 
 
            March 18, 1989 injury materially aggravated, lighted up and 
 
            worsened any latant arthritic degenerative condition that 
 
            claimant had.
 
            
 
                 Taking into consideration claimant's medical and work 
 
            history prior to and after his March 18, 1989 injury; his 
 
            age; intelligence; motivation; location of his injury; 
 
            length of healing period; severity of his injury; functional 
 
            impairment; and; the fact that his income is as much as it 
 
            was at the time of his injury; the fact that claimant is 
 
            working two full-time jobs and one part-time job; and 
 
            working at least 80 to 90 hours per week, the undersigned 
 
            finds that claimant currently has a 25 percent industrial 
 
            disability.
 
            
 
                 The only remaining issue is whether the vocational 
 
            rehabilitation report in the amount of $824.75 and the 
 
            physical therapist report in the amount of $693.70, both 
 
            totaling $1,518.45, are considered costs under 343 IAC 4.33.  
 
            Said rule refers to the reasonable cost of obtaining no more 
 
            than two doctors or practitioner reports.  Iowa 
 
            Administrative Code section 343-4.17 describes who medical 
 
            practitioners are and persons engaged in physical or 
 
            vocational rehabilitation for evaluation or rehabilitation 
 
            are included therein.  Therefore, the undersigned finds that 
 
            defendants are responsible for $150 towards the 
 
            rehabilitation consultant's fee of $824.75 and defendants 
 
            are responsible for $150 payment towards the fee of Thomas 
 
            Gallo, P.T., in the amount of $693.70.  The remaining 
 
            balances are the obligations of the claimant.
 
            
 
                                conclusions of law
 
            
 
                 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 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            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).
 
            
 
                 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 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).
 
            
 
                 Apportionment of disability between a preexisting 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            condition and an injury is proper only when some 
 
            ascertainable portion of the ultimate industrial disability 
 
            existed independently before an employment-related 
 
            aggravation of disability occurred.  Bearce v. FMC Corp., 
 
            465 N.W.2d 531 (Iowa 1991); Varied Enterprises, Inc. v. 
 
            Sumner, 353 N.W.2d 407 (Iowa 1984).
 
            
 
                 The burden of showing that disability is attributable 
 
            to a preexisting condition is placed upon the defendant.  
 
            Where evidence to establish a proper apportionment is 
 
            absent, the defendant is responsible for the entire 
 
            disability that exists.  Bearce, 465 N.W.2d at 536-37; 
 
            Sumner, 353 N.W.2d at 410-11.
 
            
 
                 Our supreme court has stated many times that a claimant 
 
            may recover for a work connected aggravation of a 
 
            preexisting condition.  Almquist v. Shenandoah Nurseries, 
 
            218 Iowa 724, 254 N.W. 35 (1934).  See also Auxier v. 
 
            Woodward State Hosp. Sch., 266 N.W.2d 139 (Iowa 1978); Gosek 
 
            v. Garmer and Stiles Co., 158 N.W.2d 731 (Iowa 1968); Barz 
 
            v. Oler, 257 Iowa 508, 133 N.W.2d 704 (1965); Olson v. 
 
            Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 
 
            (1963); Yeager v. Firestone Tire & Rubber Co., 253 Iowa 369, 
 
            112 N.W.2d 299 (1961); Ziegler v. United States Gypsum Co., 
 
            252 Iowa 613, 106 N.W.2d 591 (1960).
 
            
 
                 An employer takes an employee subject to any active or 
 
            dormant health impairments, and a work connected injury 
 
            which more than slightly aggravates the condition is 
 
            considered to be a personal injury.  Ziegler, 252 Iowa 613, 
 
            620, 106 N.W.2d 591, and cases cited.
 
            
 
                 It is further concluded that:
 
            
 
                 Claimant incurred a work injury on March 18, 1989, 
 
            which caused claimant to have a diskectomy at L4-L5 and 
 
            resulted in claimant being unable to perform the duties and 
 
            obligations normally required of general farming and raising 
 
            livestock, which work capacities claimant had prior to his 
 
            March 18, 1989 work injury.
 
            
 
                 Claimant's March 18, 1989 work injury caused claimant 
 
            to incur permanent impairment and certain work restrictions 
 
            restricting or preventing him from performing the work that 
 
            he has done all of his adult life prior to his work injury.  
 
            Claimant is currently working approximately 80 to 90 hours 
 
            per week, encompassing two full-time jobs and one part-time 
 
            job and currently does not have a loss of income as a result 
 
            of his March 18, 1989 work injury.
 
            
 
                 Claimant is a highly motivated individual and such 
 
            motivation has caused him to work beyond the normal number 
 
            of hours per week and especially when taking into 
 
            consideration the medical testimony.
 
            
 
                 Any preexisting arthritic or degenerative condition 
 
            claimant had prior to March 18, 1989, was latant and 
 
            inactive and was not affecting claimant's work in any 
 
            respect nor were there any symptoms evident until claimant's 
 
            March 18, 1989 injury, at which time said work injury 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            materially aggravated, lighted up and worsened any 
 
            preexisting arthritic degenerative condition claimant may 
 
            have had.
 
            
 
                 The drug bill, the x-ray bill and examination bill 
 
            incurred by claimant which total $134.82 are causally 
 
            connected to and are a result of claimant's March 18, 1989 
 
            injury and are to be paid by the defendants.
 
            
 
                 A consultant's report and a physical therapist report 
 
            are reports of practitioners under Iowa Administrative Code 
 
            section 343-4.33 and the definition of a practitioner as set 
 
            out in 343-4.17 and that defendants are responsible for 
 
            payment of $150 toward each of the particular practitioner 
 
            report charges.
 
            
 
                                      order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendants shall pay unto claimant one hundred 
 
            twenty-five (125) weeks of permanent partial disability 
 
            benefits at the stipulated rate of one hundred ninety-four 
 
            and 03/100 dollars ($194.03) per week with payments 
 
            beginning September 28, 1989.
 
            
 
                 That defendants shall pay accrued weekly benefits in a 
 
            lump sum and shall receive credit against the award for 
 
            weekly benefits previously paid.  Defendants have previously 
 
            paid all healing period benefits and temporary partial 
 
            disability benefits, all of which was stipulated by the 
 
            parties.  The parties further stipulated that the defendants 
 
            had paid forty (40) weeks of permanent partial disability 
 
            benefits.  The parties further agreed that all these 
 
            benefits (54.714 weeks) previously paid were paid at a rate 
 
            of one hundred sixty-nine and 78/100 dollars ($169.78) and 
 
            that defendants will be paying the difference between that 
 
            rate and the stipulated rate of one hundred ninety-four and 
 
            03/100 dollars ($194.03).
 
            
 
                 That defendants shall pay one hundred fifty dollars 
 
            ($150.00) towards the bill of the rehabilitation consultant, 
 
            and one hundred fifty dollars ($150.00) toward the bill of 
 
            Thomas Gallo, the physical therapist
 
            
 
                 That defendants shall pay the Grinnell General Hospital 
 
            x-ray bill of fifty-seven dollars ($57.00), the Cunningham 
 
            drug bill of fifty-three and 82/100 dollars ($53.82), and 
 
            the Grinnell Family Care, P.C., bill of twenty-four dollars 
 
            ($24.00), all of which total one hundred thirty-four and 
 
            82/100 dollars ($134.82).
 
            
 
                 That defendants shall pay interest on benefits awarded 
 
            herein as set forth in Iowa Code section 85.30.
 
            
 
                 That defendants shall pay the costs of this action, 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 That defendants shall file an activity report upon 
 
            payment of this award as required by this agency, pursuant 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of March, 1992.
 
            
 
            
 
                                          ______________________________
 
                                          BERNARD J. O'MALLEY
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies to:
 
            
 
            C Jean Pendleton
 
            Attorney at Law
 
            1022 Broad St
 
            Grinnell IA 50112
 
            
 
            David L Jenkins
 
            Attorney at Law
 
            801 Grand Ave  Ste 3700
 
            Des Moines IA 50309
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                          1803; 2907
 
                                          Filed March 24, 1992
 
                                          Bernard J. O'Malley
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            PETER J. GOODRICH,            :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 914987
 
            SCHAFBUCH FARMS, INC.,        :
 
                                          :     A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            ALLIED GROUP INSURANCE,       :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            1803
 
            Thirty-seven year old claimant awarded 25% industrial 
 
            disability.  Claimant had a diskectomy at L4-5.  Claimant's 
 
            injury foreclosed him from farming or raising livestock on a 
 
            day-to-day basis like claimant had done all of his adult 
 
            work life prior to his injury.
 
            Claimant is working two full-time jobs and one part-time at 
 
            $5 to $6.21 per hour in order to support his family (80-90 
 
            hours per week).  Claimant is highly motivated and working 
 
            beyond expected capacity considering his condition.  It is 
 
            very questionable whether claimant can continue at his 
 
            present pace, but deputy did not speculate as to claimant's 
 
            future.  Likewise, deputy did not dock claimant for his high 
 
            motivation just like one doesn't award one for low 
 
            motivation.
 
            
 
            2907
 
            Held under 343-4.33 and 343-4.17, that a rehabilitation 
 
            consultant and a physical therapist are practitioners and 
 
            therefore $150 of each practitioner's report are costs and 
 
            taxed as such.