BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                     
 
         JIMMIE LEE KING,      
 
                     
 
              Claimant,   
 
                     
 
         vs.         
 
                                                File No. 917366
 
         UNIVERSITY OF NORTHERN IOWA,    
 
                                                  A P P E A L
 
              Employer,   
 
                                                D E C I S I O N
 
         and         
 
                     
 
         STATE OF IOWA,   
 
                     :
 
              Insurance Carrier,    
 
              Defendants.      
 
         _________________________________________________________________
 
         The record, including the transcript of the hearing before the 
 
         deputy and all exhibits admitted into the record, has been 
 
         reviewed de novo on appeal.  The decision of the deputy filed 
 
         September 30, 1992 is affirmed and is adopted as the final 
 
         agency action in this case.
 
         
 
         Claimant shall pay the costs of the appeal, including the 
 
         preparation of the hearing transcript.
 
         
 
         Signed and filed this ____ day of September, 1993.
 
         
 
         
 
         
 
         
 
                                     ________________________________
 
                                            BYRON K. ORTON
 
                                      INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Jay P. Roberts
 
         Attorney at Law
 
         P.O. Box 178
 
         Waterloo, Iowa 50704
 
         
 
         Mr. Stephen Moline
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Bldg.
 
         Des Moines, Iowa 50319
 
         
 
 
         
 
       
 
       
 
 
 
                                          1802; 1803; 4100; 4000.2
 
                                          Filed September 21, 1993
 
                                          Byron K. Orton
 
         
 
                        BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
                     
 
         JIMMIE LEE KING,      
 
                     
 
              Claimant,   
 
                     
 
         vs.         
 
                                                 File No. 917366
 
         UNIVERSITY OF NORTHERN IOWA,    
 
                                                  A P P E A L
 
              Employer,   
 
                                                 D E C I S I O N
 
         and         
 
                     
 
         STATE OF IOWA,   
 
                     
 
              Insurance Carrier,    
 
              Defendants.      
 
         _________________________________________________________________
 
         
 
         1802
 
         Claimant's healing period found to end on date claimant's 
 
         treating physician released to return to return to work without 
 
         restrictions even though claimant subsequently was unable to 
 
         return to work.  Medical records indicated that claimant did not 
 
         progress in terms of healing beyond the point of the original 
 
         full release to return to work.
 
         
 
         1803; 4100
 
         Forty four year old female, high school graduate who could not 
 
         return to former work as a custodian awarded 40 percent permanent 
 
         partial disability benefits.  Claimant who had numerous non-work 
 
         related health problems not found to be an odd-lot employee.  
 
         Record established that claimant potentially had some 
 
         transferable skills.  Claimant had not meaningfully sought work 
 
         since her inability to return to employment with employer, 
 
         however.
 
         
 
         4000.2
 
         Claimant not found entitled to additional benefits for 
 
         unreasonable delay in commencement or unreasonable termination of 
 
         benefits.  Physician released claimant to return to work without 
 
         restrictions.  Claimant underwent hysterectomy subsequent to the 
 
         work release and prior to attempting a work return.  Claimant 
 
         attempted a work return and self assessed as unable to perform 
 
         the work.  Held that under the circumstances presented, claim was 
 
         fairly debatable.
 
         
 
 
            
 
            
 
            
 
            
 
            
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                                          :
 
            JIMMIE LEE KING,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 917366
 
            UNIVERSITY OF NORTHERN IOWA,  :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            STATE OF IOWA,                :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by the 
 
            claimant, Jimmie Lee King, against her self-insured 
 
            employer, the University of Northern Iowa, to recover 
 
            benefits under the Iowa Workers' Compensation Act as a 
 
            result of an injury sustained on April 26, 1989.  This 
 
            matter came on for hearing before the undersigned deputy 
 
            industrial commissioner at Waterloo, Iowa on August 26, 
 
            1992.  A first report of injury has been filed.  The record 
 
            consists of the testimony of claimant, Roger Marquart, 
 
            Claratine Jackson and Rayford Bagsby, Sr., as well of 
 
            claimant's exhibits 1-6 and defendants' exhibits A-F.
 
            
 
                                      ISSUES
 
            
 
                 Pursuant to the hearing assignment order, the hearing 
 
            report and the oral stipulations of the parties, the parties 
 
            have stipulated to the following:
 
            
 
                 1.  That claimant's gross weekly wage was $295.00 and 
 
            that she was married and entitled to six exemptions at the 
 
            time of her injury resulting in a weekly rate of 
 
            compensation of $208.94;
 
            
 
                 2.  That claimant did receive an injury arising out of 
 
            and in the course of her employment on April 26, 1989; and
 
            
 
                 3.  That a causal relationship exists between a period 
 
            of temporary total or healing period disability and that 
 
            defendants have paid claimant 12.2 weeks of temporary total 
 
            or healing period disability at the appropriate rate.
 
            
 
     
 
            
 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            Issues remaining to be decided are:
 
            
 
                 1.  Whether a causal relationship exists between 
 
            claimant's injury and claimed disability;
 
            
 
                 2.  Whether claimant is an odd-lot worker under Guyton 
 
            doctrine;
 
            
 
                 3.  The nature and extent of claimant's disability;
 
            
 
                 4.  Whether claimant is entitled to additional benefits 
 
            under section 86.13, unnumbered paragraph 4, for 
 
            unreasonable delay in commencement of benefits or 
 
            unreasonable denial of benefits; and,
 
            
 
                 5.  Whether defendants are entitled to a credit for 
 
            long-term disability payments made to claimant from 
 
            September 7, 1989 through April 29, 1991.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The deputy, having heard the testimony and considered 
 
            the evidence finds:
 
            
 
                 Claimant is a 44-year old married lady who has worked 
 
            primarily as a custodian.  She has had work experience as a 
 
            commercial sewing machine operator and sewing inspector, 
 
            however.  Claimant worked as a custodian at the University 
 
            of Northern Iowa from 1978 to her April 1989 injury.  Her 
 
            duties involved vacuuming, sweeping, cleaning bathrooms, 
 
            washing windows, stripping floors, mopping and waxing.  
 
            Additionally claimant would on occasion have to pick up 
 
            objects weighing 60-80 pounds, move furniture and lift bags 
 
            of trash weighing from 20-30 pounds into outside commercial 
 
            dumpsters up to 100 feet away from her work site.  Eighty 
 
            pound barrels of trash also had to be lifted into the 
 
            dumpsters on occasions.
 
            
 
                 Claimant injured her right hip with a strained rectus 
 
            femoralis muscle on approximately May 29, 1984.  Jitu D. 
 
            Kothari, M.D., treated her for that injury.  On November 6, 
 
            1986, claimant experienced acute back pain when she tried to 
 
            pick up a container and throw its contents into a dumpster.  
 
            Dr. Kothari noted that she was tender throughout the left 
 
            lower spine and had restricted range of motion particularly 
 
            as to regards forward and right and lateral bending.  
 
            Claimant's pain then decreased with complete bed rest.  She 
 
            was returned to light duty work with restrictions on 
 
            bending, twisting, and lifting with the low back.  She was 
 
            not to lift greater than 20 pounds.  As of November 20, 
 
            1986, claimant was doing her regular job.  Dr. Kothari had 
 
            prescribed a back brace which claimant used intermittently 
 
            from November 1986 until her April 29, 1989 injury.
 
            
 
                 On April 29, 1989, claimant experienced "pins and 
 
            needles" in the back and leg as she tried to lift an 80 
 
            pound barrel of trash into a dumpster.  She immediately saw 
 
            H. N. Basu, M.D., who placed her off work for one week with 
 
            bed rest.  When claimant did not improve, Dr. Basu 
 
            hospitalized her at Allen Memorial Hospital.  Claimant then 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            had complaints of low back pain with radiation into the 
 
            right leg.  Right leg raising was positive.  Claimant had no 
 
            sensory or motor defects of the lower extremity.  X-rays and 
 
            CAT scan of lumbar spine of May 9, 1989 were interpreted as 
 
            within normal limits although claimant had minimal central 
 
            bulging at L5-S1 considered of no significance and spina 
 
            bifida at L5-S1.  A subsequent MRI of December 31, 1991, was 
 
            interpreted as showing posterior bulging of the L4 disc with 
 
            dehydration.  Dr. Kothari saw claimant on May 19, 1989.  He 
 
            then released claimant for light duty work as of May 22, 
 
            1989, with restrictions of no lifting of greater than 20 
 
            pounds and no frequent bending, twisting or turning with the 
 
            low back.  On July 20, 1989, Dr. Kothari released claimant 
 
            to regular duty work as of July 24, 1989.  Claimant 
 
            underwent a hysterectomy on July 27, 1989.  The hysterectomy 
 
            and period of recovery subsequent to the hysterectomy 
 
            resulted in an inability to work unrelated to claimant's 
 
            back injury.  On October 17, 1989, Dr. Kothari reported that 
 
            claimant had attempted to return to work but had not 
 
            tolerated work on account of her back pain.  He then 
 
            reported that her long-term prognosis for a return to 
 
            gainful employment was not good.
 
            
 
                 On January 20, 1990, Dr. Kothari reported restrictions 
 
            of no lifting of more than 20 pounds and no repetitive 
 
            bending and twisting and turning of her lower back.  
 
            Claimant was to do no prolonged sitting, standing or 
 
            walking.  Dr. Kothari reported that she was not able to work 
 
            as a custodian.  On January 25, 1991, Dr. Kothari decreased 
 
            claimant's restrictions to no lifting of greater than 10-15 
 
            pounds, no frequent back bending, twisting or turning and no 
 
            prolonged periods of sitting, standing and walking.  He 
 
            again reported that her prognosis for gainful employment was 
 
            not good.  On July 30, 1991, Dr. Kothari assigned claimant a 
 
            six percent permanent partial impairment and diagnosed 
 
            chronic recurrent lumbosacral strain related to her work 
 
            injury and also chronic neck pain.
 
            
 
                 Per Dr. Basu's notes, claimant has had migraine 
 
            headaches since she was approximately 12 years old and as of 
 
            July 15, 1991, was having headaches two or three times per 
 
            week with two to three severe episodes in that past year.  
 
            
 
                 Claimant received long-term disability benefits from 
 
            the Principal from September 7, 1989 through April 29, 1991.  
 
            During that period she underwent vocational assessment with 
 
            Dawn L. Palma and Lois Sanchez, M.A., C.I.R.S. of The 
 
            Principal.  Palma and Sanchez reported that claimant had 
 
            maximum low back lifting of 20 pounds and maximum repetitive 
 
            lifting of 10 pounds placing her in a light work category.  
 
            They believed that claimant could perform the jobs of 
 
            telephone answering service operator, customer service 
 
            clerk, cashier, food and beverage checker, alternations 
 
            tailor, salesclerk and teacher aide.  Palma and Sanchez 
 
            conducted a labor market survey which indicated that such 
 
            jobs are available in the Waterloo, Iowa area.
 
            
 
                 Claimant apparently attempted a return to work 
 
            subsequent to her injury.  She reported that her manager 
 
            sent her home as she had a 20 pound lifting restriction and 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            he did not wish her to work with less than a 25 pound 
 
            lifting capacity.  In the course of the Principal vocational 
 
            assessment, claimant applied for a job with Goodwill 
 
            Industries.  She did not pass the required math test in that 
 
            she did not complete the math portion of the test.  She was 
 
            also unable to lift 40 pounds and reported her back injury.  
 
            Claimant reported she was not hired for the cash register 
 
            job.  Claimant reported that she sought employment as a 
 
            sitter with the elderly but was unable to secure that 
 
            position in that it involved bending and lifting.  Claimant 
 
            has not sought employment since April 1991.  Claimant 
 
            reported that she is never pain free and that both her upper 
 
            and lower back and her legs and arms hurt continuously.  She 
 
            has been treated for depression.  Beyond her loss of income, 
 
            claimant has had marital problems and a series of family 
 
            deaths as life stressors.
 
            
 
                 Vocational rehabilitation specialist Roger Marquart 
 
            also assessed claimant vocationally.  He reported that 
 
            claimant was not of an advanced age and, therefore, is was 
 
            not unrealistic for her to switch occupations.  He indicated 
 
            that as she has a high school education but no further 
 
            training it is questionable if she could return to school 
 
            given her extended time away from school.  Marquart agreed 
 
            that claimant could not return to her past relevant work as 
 
            it involved unskilled labor with lifting of 50 to 100 
 
            pounds.  He described claimant as motivated but having no 
 
            transferable skills.  Marquart questioned whether claimant 
 
            could do light duty work given her restrictions on prolonged 
 
            sitting, standing and body movement.  Marquart opined it was 
 
            unrealistic to believe claimant could be placed in the jobs 
 
            listed in the Principal's vocational assessment.  He opined 
 
            it is very difficult to secure full time competitive 
 
            employment for individuals like claimant.  He agreed, 
 
            however, the jobs exist that claimant could do although it 
 
            is extremely questionable that those jobs are available to 
 
            claimant.  He stated one would only know if one knocked on 
 
            employers' doors to see if the job was out there.
 
            
 
                 It is expressly found that the labor market survey 
 
            conducted by vocational specialists Palma and Sanchez 
 
            indicated jobs are available that might be within claimant's 
 
            physical capacities.  It is further found that claimant's 
 
            failure to seek such jobs makes it impossible to assess 
 
            whether such jobs are available to claimant within the 
 
            Waterloo, Iowa area.
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 Our first concern is whether a causal relationship 
 
            exists between claimant's claimed disability and her work 
 
            injury.
 
            
 
                 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 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            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).
 
            
 
                 Dr. Kothari has related claimant's chronic recurrent 
 
            lumbosacral strain to her work injury.  There is little 
 
            question that claimant was in a healing period until July 
 
            24, 1989, which healing period directly related to April 29, 
 
            1989 work injury.  A more difficult question exists as to 
 
            whether claimant remained in a healing period directly 
 
            related to her work injury after Dr. Kothari's regular duty 
 
            release of July 24, 1989.  The record reflects that claimant 
 
            underwent a hysterectomy in this period.  It also reflects 
 
            that she attempted a regular duty return to work and was not 
 
            able to tolerate it.  As of January 20, 1990, Dr. Kothari 
 
            had placed work restrictions on claimant and indicated she 
 
            would not be able to work as a custodian.  He decreased her 
 
            lifting restriction as of January 25, 1991.  Section 
 
            85.34(1) provides that healing period benefits are payable 
 
            to an injured worker who has suffered permanent partial 
 
            disability until (1) the worker has returned to work; (2) 
 
            the worker is medically capable of returning to 
 
            substantially similar employment; or (3) the worker has 
 
            achieved maximum medical recovery.  The healing period can 
 
            be considered the period during which there is a reasonable 
 
            expectation of improvement of the disabling condition.  See 
 
            Armstrong Tire & Rubber Co. v. Kubli, 312 N.W.2d 60 (Iowa 
 
            Ct. App. 1981).  Healing period benefits can be interrupted 
 
            or intermittent.  Teel v. McCord, 394 N.W.2d 405 (Iowa 
 
            1986).  All the above suggests that claimant's condition did 
 
            not improve significantly after July 24, 1989, and that 
 
            there was no reasonable expectation of improvement 
 
            subsequent to that date.  Claimant is found to have 
 
            established a causal relationship between her work injury 
 
            and a period of healing period disability running from her 
 
            date of injury on April 29, 1989 to July 24, 1989.
 
            
 
                 We reach the question of the nature and extent of 
 
            claimant's permanent disability entitlement including the 
 
            question of whether claimant is an odd-lot worker under the 
 
            Guyton doctrine.
 
            
 
                 In Guyton v. Irving Jensen Co., 373 N.W.2d 101 (Iowa 
 
            1985), the Iowa court formally adopted the "odd-lot 
 
            doctrine."  Under that doctrine a worker becomes an odd-lot 
 
            employee when an injury makes the worker incapable of 
 
            obtaining employment in any well-known branch of the labor 
 
            market.  An odd-lot worker is thus totally disabled if the 
 
            only services the worker can perform are "so limited in 
 
            quality, dependability, or quantity that a reasonably stable 
 
            market for them does not exist."  Guyton, 373 N.W.2d at 105.
 
            
 
                 The burden of persuasion on the issue of industrial 
 
            disability always remains with the worker.  When a worker 
 
            makes a prima facie case of total disability by producing 
 
            substantial evidence that the worker is not employable in 
 
            the competitive labor market, the burden to produce evidence 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            of suitable employment shifts to the employer, however.  If 
 
            the employer fails to produce such evidence and if the trier 
 
            of fact finds the worker does fall in the odd-lot category, 
 
            the worker is entitled to a finding of total disability.  
 
            Guyton, 373 N.W.2d at 106.  Even under the odd-lot 
 
            doctrine, the trier of fact is free to determine the weight 
 
            and credibility of evidence in determining whether the 
 
            worker's burden of persuasion has been carried, and only in 
 
            an exceptional case would evidence be sufficiently strong as 
 
            to compel a finding of total disability as a matter of law.  
 
            Guyton, 373 N.W.2d at 106.
 
            
 
                 Since claimant has an impairment to the body as a 
 
            whole, an industrial disability has been sustained.  
 
            Industrial disability was defined in Diederich v. Tri-City 
 
            Ry. Co., 219 Iowa 587, 258 N.W.2d 899 (1935) as follows: "It 
 
            is therefore plain that the legislature intended the term 
 
            'disability' to mean 'industrial disability' or loss of 
 
            earning capacity and not a mere 'functional disability' to 
 
            be computed in the terms of percentages of the total 
 
            physical and mental ability of a normal man."
 
            
 
                 Functional impairment is an element to be considered in 
 
            determining industrial disability which is the reduction of 
 
            earning capacity, but consideration must also be given to 
 
            the injured employee's age, education, qualifications, 
 
            experience, motivation, loss of earnings, severity and situs 
 
            of the injury, work restrictions, inability to engage in 
 
            employment for which the employee is fitted and the 
 
            employer's offer of work or failure to so offer.  Olson v. 
 
            Goodyear Serv. Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963); 
 
            McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980); 
 
            Barton v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 
 
            (1961).
 
            
 
                 Compensation for permanent partial disability shall 
 
            begin at the termination of the healing period.  
 
            Compensation shall be paid in relation to 500 weeks as the 
 
            disability bears to the body as a whole.  Section 85.34.
 
            
 
                 We are not persuaded that claimant is totally disabled 
 
            under the odd-lot doctrine.  Vocational specialists Palma 
 
            and Sanchez identified employment for which claimant may be 
 
            suited.  Vocational specialist Marquart, while opining that 
 
            it likely would be very difficult to secure full time 
 
            competitive employment for claimant, indicated that the only 
 
            way to know if jobs were available for claimant would be to 
 
            knock on potential employers' doors to see if the jobs were 
 
            available.  The Principal vocational specialists did perform 
 
            a labor market survey and informed claimant of a number of 
 
            available jobs.  The evidence shows that claimant did not 
 
            avail herself to seek the great majority of those jobs.  
 
            Without some meaningful effort on claimant's part to secure 
 
            employment and the subsequent failure to secure employment 
 
            after a meaningful effort, it cannot be said that claimant 
 
            is totally disabled on account of her work injury and her 
 
            work related impairment and restrictions.  The work injury 
 
            and related restrictions place claimant in the light work 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            category only.  They do not preclude claimant from 
 
            employment.  Likewise, claimant has a high school education.  
 
            Correspondence of claimant to the Principal in evidence 
 
            suggests that claimant would not have a problem 
 
            educationally in functioning in a number of jobs within the 
 
            light category.  Likewise, claimant has past relevant work 
 
            experience as an industrial machine sewer.  It has not been 
 
            shown that claimant's physical limitations and work related 
 
            disability would preclude her seeking and finding employment 
 
            utilizing those skills.  Hence, it cannot be said that 
 
            claimant is a worker who can perform only services that are 
 
            so limited in quality, dependability or quantity that no 
 
            reasonably stable market for them exists.
 
            
 
                 We consider the nature and extent of claimant's 
 
            permanent partial disability entitlement.
 
            
 
                 Claimant has a variety of disabling conditions not 
 
            related to her work injury.  These include her right torsal 
 
            tunnel entrapment, her migraine headaches, her depression, 
 
            and symptomatic sequalae of her hysterectomy.  While these 
 
            may well impact on claimant's current employability, they 
 
            cannot be said to be conditions for which defendants bear 
 
            liability.  On the other hand, claimant does have severe 
 
            limitations on lifting, bending, twisting, stooping and on 
 
            prolonged standing, sitting and walking which relate to her 
 
            work injury and which preclude her returning to work in her 
 
            previous job.  Additionally, the employer did not 
 
            accommodate claimant in providing her with work within her 
 
            restrictions.  Indeed, the employer has refused to give 
 
            claimant any work subsequent to her injury.  Claimant is at 
 
            an age where retraining may be possible but is not as 
 
            probable to be successful as retraining might well be for a 
 
            younger worker of similar education and intelligence.  
 
            Claimant's motivation is somewhat questionable.  Claimant's 
 
            unfortunate perception of herself as wholly disabled appears 
 
            to have prevented her from taking reasonable and appropriate 
 
            steps towards rehabilitation.  As noted above claimant's 
 
            failure to attempt either wholehearted rehabilitation or 
 
            wholehearted jobseeking makes assessment of what work may be 
 
            available to claimant difficult.  It appears, however, that 
 
            jobs identified which might be available to claimant and 
 
            which claimant potentially could perform would be jobs 
 
            paying at or slightly better than minimum wage.  Claimant 
 
            was earning $295.00 per week at the time of her injury.  
 
            That amount appears fairly reflective of her earnings 
 
            capacity at the time of the injury.  Under the scenario 
 
            currently presented, claimant has sustained a loss of 
 
            earnings capacity related to her work injury of 
 
            approximately 40 percent for which she is entitled to 
 
            permanent partial disability benefits of 40 percent of the 
 
            body as a whole equaling 200 weeks of benefits.  As claimant 
 
            appears to have reached maximum medical improvement as of 
 
            July 23, 1989, such benefits shall commence on July 24, 
 
            1989.
 
            
 
                 We reach the question of claimant's entitlement to 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            penalty benefits.  
 
            
 
                 Section 86.13 permits an award of up to 50 percent of 
 
            the amount of benefits delayed or denied if a delay in 
 
            commencement or termination of benefits occurs without 
 
            reasonable or probable cause or excuse.  The standard for 
 
            evaluating the reasonableness of defendants' delay in 
 
            commencement or termination is whether the claim is fairly 
 
            debatable.  Where a claim is shown to be fairly debatable, 
 
            defendants do not act unreasonably in denying payment.  See 
 
            Stanley v. Wilson Foods Corp., File No. 753405 (App. August 
 
            23, 1990); Seydel v. Univ. of Iowa Physical Plant, File No. 
 
            818849 (App. November 1, 1989).
 
            
 
                 As noted the standard is whether the claim can be 
 
            fairly debated.  In this instance, claimant's treating 
 
            physician had released claimant to work without restrictions 
 
            in July 1989.  Claimant on her work return subjectively 
 
            assess as unable to perform the work and was subsequently 
 
            off work with intermittent medical follow-up.  Given the 
 
            earlier full release, defendants could reasonably question 
 
            whether claimant's then reported difficulties related to the 
 
            work injury.  Likewise, given claimant's other medical 
 
            problems including her intervening non-work related 
 
            hysterectomy, defendants could reasonably question whether 
 
            claimant's inability to work related to the work injury.  
 
            Given such, it must be said that claimant's claim to 
 
            permanent benefit entitlement was fairly debatable such that 
 
            defendants did not act unreasonably in denying payment.  
 
            Claimant has not shown an entitlement to additional benefits 
 
            under section 86.13, unnumbered paragraph 4
 
            
 
                 We reach the question of entitlement of credit for 
 
            long-term disability benefits defendants have paid claimant.
 
            
 
                 Pursuant to section 85.38(2), defendants are entitled 
 
            to a credit for such benefits if the benefits would not have 
 
            been paid or would not have been payable if rights for 
 
            recovery existed under the workers' compensation law.  A 
 
            review of the Principal file in evidence demonstrates that 
 
            the long-term disability benefits are paid for 
 
            non-occupational conditions and not for work related 
 
            conditions.  Hence, defendants are entitled to a credit for 
 
            amounts paid under the long-term disability plan for the 
 
            times stipulated to by the parties, that is, from September 
 
            7, 1989 through April 29, 1991.
 
            
 
                           
 
            
 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
                                   ORDER
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Defendants pay claimant permanent partial disability 
 
            benefits for two hundred (200) weeks at the rate of two 
 
            hundred eight and 94/100 dollars ($208.94) with those 
 
            benefits to commence on July 24, 1989.
 
            
 
                 Defendants pay claimant healing period benefits at the 
 
            rate of two hundred eight and 94/100 dollars ($208.94) from 
 
            her injury date through July 23, 1989.
 
            
 
                 Defendants receive credit for long-term disability 
 
            benefits paid claimant from September 7, 1989 through April 
 
            29, 1991.
 
            
 
                 Defendants receive credit for any workers' compensation 
 
            benefits previously paid.
 
            
 
                 Defendants pay accrued amounts in a lump sum.
 
            
 
                 Defendants pay interest pursuant to Iowa Code section 
 
            85.30 as amended.
 
            
 
                 Defendants pay costs pursuant to rule 343 IAC 4.33.
 
            
 
                 Defendants file claim activity reports as ordered by 
 
            the agency.
 
            
 
                 Signed and filed this ____ day of September, 1992.
 
            
 
            
 
            
 
            
 
                                          
 
                                       ________________________________
 
                                          HELENJEAN M. WALLESER
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr Jay P Roberts
 
            Attorney at Law
 
            620 Lafayette Street
 
            PO Box 178
 
            Waterloo Iowa 50704
 
            
 
            Mr Stephen Moline
 
            Assistant Attorney General
 
            Tort Claims Division
 
            Hoover State Office Building
 
            Des Moines Iowa 50319
 
            
 
 
            
 
 
 
 
 
 
 
                                               1802; 1803; 4100; 4000.2
 
                                               Filed September 30, 1992
 
                                               HELENJEAN M. WALLESER
 
 
 
                      BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                      
 
            JIMMIE LEE KING,    
 
                      
 
                 Claimant, 
 
                      
 
            vs.       
 
                                                     File No. 917366
 
            UNIVERSITY OF NORTHERN IOWA,  
 
                                                 A R B I T R A T I O N
 
                 Employer, 
 
                                                     D E C I S I O N
 
            and       
 
                      
 
            STATE OF IOWA, 
 
                      
 
                 Insurance Carrier,  
 
                 Defendants.    
 
            ___________________________________________________________
 
            1802
 
            Claimant's healing period found to end on date claimant's 
 
            treating physician released to return to return to work 
 
            without restrictions even though claimant subsequently was 
 
            unable to return to work.  Medical records indicated that 
 
            claimant did not progress in terms of healing beyond the 
 
            point of the original full release to return to work.
 
            
 
            1803; 4100
 
            Forty four year old female, high school graduate who could 
 
            not return to former work as a custodian awarded 40 percent 
 
            permanent partial disability benefits.  Claimant who had 
 
            numerous non-work related health problems not found to be an 
 
            odd-lot employee.  Record established that claimant 
 
            potentially had some transferable skills.  Claimant had not 
 
            meaningfully sought work since her inability to return to 
 
            employment with employer, however.
 
            
 
            4000.2
 
            Claimant not found entitled to additional benefits for 
 
            unreasonable delay in commencement or unreasonable 
 
            termination of benefits.  Physician released claimant to 
 
            return to work without restrictions.  Claimant underwent 
 
            hysterectomy subsequent to the work release and prior to 
 
            attempting a work return.  Claimant attempted a work return 
 
            and self assessed as unable to perform the work.  Held that 
 
            under the circumstances presented, claim was fairly 
 
            debatable.
 
            
 
 
            
 
            
 
            
 
            
 
            
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                                          :
 
            CHARLES E. JIMMERSON,         :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :         File No. 917653
 
                                          :
 
            ACRO MANUFACTURING CORP.,     :      A R B I T R A T I O N
 
                                          :
 
                 Employer,                :         D E C I S I O N
 
                                          :
 
            and                           :
 
                                          :
 
            UNITED FIRE & CASUALTY,       :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ____________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by the 
 
            claimant, Charles E. Jimmerson, against his employer, Acro 
 
            Manufacturing Corporation, and its insurance carrier, United 
 
            Fire & Casualty, to recover benefits under the Iowa Workers' 
 
            Compensation Act as the result of an injury sustained on 
 
            April 28, 1989.  This matter came on for hearing before the 
 
            undersigned deputy industrial commissioner at Cedar Rapids, 
 
            Iowa, on May 21, 1992.  A first report of injury has been 
 
            filed.
 
            
 
                 The record consists of the testimony of claimant and of 
 
            Shawn M. Tigert as well as of joint exhibits 1 through 5 and 
 
            claimant's exhibits A through D.
 
            
 
                                      ISSUES
 
            
 
                 Pursuant to the hearing assignment order, the 
 
            prehearing report and the oral stipulations of the parties, 
 
            the parties have stipulated to the following:
 
            
 
                 1.  That claimant did receive an injury which arose out 
 
            of and in the course of his employment on April 28, 1989;
 
            
 
                 2.  That a causal relationship exists between 
 
            claimant's injury and claimed healing period or temporary 
 
            total disability;
 
            
 
                 3.  That defendants have paid claimant five weeks and 
 
            six days of healing period or temporary total disability 
 
            benefits entitling defendants to a credit in the amount of 
 
            $890.73; and,
 
            
 
                 4.  That claimant's rate of weekly compensation is 
 
            $152.08 based on a gross weekly wage of $220.00 for a 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            married individual entitled to three exemptions.
 
            
 
                 Issues remaining to be decided are:
 
            
 
                 1.  Whether a causal relationship exists between 
 
            claimant's work injury and claimed permanent disability;
 
            
 
                 2.  The nature and extent of any benefit entitlement 
 
            for both permanent and healing period or temporary total 
 
            disability; and,
 
            
 
                 3.  Whether claimant is entitled to payment of certain 
 
            medical costs.
 
            
 
                 As to medical costs, it is disputed that the fees 
 
            charged for medical services or supplies were reasonable; 
 
            that the expenses incurred were reasonable and necessary 
 
            medical treatment; that the expenses were causally connected 
 
            to the work injury; and, that defendants authorized the 
 
            expenses.
 
            
 
                                 FINDINGS OF FACT
 
            
 
                 The deputy, having heard the testimony and considered 
 
            the evidence, finds:
 
            
 
                 Claimant is a 41-year-old gentleman who is 5 feet, 8 
 
            inches tall and weighs approximately 103 pounds.  Claimant 
 
            has completed eighth grade, obtained a GED in 1972, and has 
 
            attended various community college programs obtaining a 
 
            diploma in business development from Kirkwood Community 
 
            College in 1991.
 
            
 
                 Claimant has had work experience as a janitor, deck 
 
            hand, interior and exterior painter and machine operator.  
 
            He currently works as a security guard.  His current 
 
            position involves minimal lifting and help is available 
 
            should claimant need assistance in lifting.
 
            
 
                 Claimant began work at Acro Manufacturing as a band saw 
 
            operator in approximately February 1989.  He described that 
 
            job as involving a lot of manual work.  A band saw operator 
 
            placed raw stock consisting of 15'-20' steel or iron on a 
 
            metal band cutter using either an overhead hoist or a 
 
            forklift.
 
            
 
                 On his injury date, claimant was loading steel stock 
 
            approximately 20 feet long and 3 1/2 inches in diameter from 
 
            the forklift to the band saw conveyor belt.  As claimant was 
 
            manually pushing the stock onto the belt, an end fell off.  
 
            Claimant pulled the end of the stock in an attempt to get it 
 
            back on the rollers.  Claimant felt immediate pain in the 
 
            shoulder area.
 
            
 
                 Subsequent to the April 28, 1989, work incident, 
 
            claimant revisited Leland G. Hawkins, M.D., with whom he had 
 
            begun treating on April 13, 1989.  On May 15, 1989, Dr. 
 
            Hawkins released claimant to return to work with a cervical 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            collar.  After two and one-half days of work, claimant had 
 
            an aggravation of symptoms and was again off work.  Claimant 
 
            was again released to return to work on approximately May 
 
            30, 1989, with a 20-pound lifting restriction.
 
            
 
                 On his work return, claimant's employer advised 
 
            claimant that no light-duty work was available and that his 
 
            production was down.  The employer then terminated claimant.  
 
            It is expressly found that claimant's inability to 
 
            physically perform his job played a role in his employment 
 
            termination.
 
            
 
                 Subsequent to his work release, claimant attempted job 
 
            retraining in wastewater management.  While claimant 
 
            performed well in his classroom work, claimant had an 
 
            aggravation of his physical symptoms while attempting to 
 
            physically perform his practicum.  His vocational 
 
            rehabilitation counselors then advised him to pursue less 
 
            strenuous training.  Claimant then enrolled in and completed 
 
            his business development curriculum.  With assistance from 
 
            his vocational rehabilitation counselors, claimant was able 
 
            to obtain his current employment with Merrill Security in 
 
            June 1991.  Claimant there had a beginning salary of $4.75 
 
            per hour and now earns $4.85 per hour.  In summer of 1991, 
 
            claimant was able to obtain significant overtime hours at 
 
            Merrill.  Claimant's current employer considers him a good 
 
            employee, although not having as much overall experience as 
 
            some of its other guards.  It appears that claimant's job 
 
            with Merrill is as secure as that of any at-will employee 
 
            provided Cargill continues to renew Merrill's contract to 
 
            provide Cargill with security services.
 
            
 
                 In late July 1989, claimant was attempting to remove 
 
            and then install a starter in his car.  Claimant began to 
 
            experience neck pain while working under the car holding the 
 
            starter.  The started subsequently fell on claimant's face 
 
            causing an abrasion and additional symptom aggravation.
 
            
 
                 Claimant describes his post-injury symptoms as pain in 
 
            both shoulders, pain in the neck radiating into his right 
 
            arm and headaches differently located than were headaches 
 
            prior to his April 28, 1989, work incident.  Medical 
 
            evidence in the record does not support claimant's 
 
            testimony, however.  Specifically:
 
            
 
                 On March 9, 1988, R. Reider, M.D., noted that claimant 
 
            had a five-year history of posterior neck headaches which 
 
            often radiated to the right side of the head into the top of 
 
            the head over the right eye.  The headaches lasted 1-2 hours 
 
            and occurred 3-4 times per week.
 
            
 
                 On June 26, 1988, a Dr. Eilers indicated that claimant 
 
            had a long history of neck pain and headaches of 
 
            questionable etiology with the headaches being in any area 
 
            of the head and producing a throbbing pressure feeling and 
 
            nausea.
 
            
 
                 On July 1, 1988, neurologist O. Anchetta, M.D., opined 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            claimant had persistent muscle contraction headaches which 
 
            started in the back of his neck, came over the head in a 
 
            band-like formation and affected the temples bilaterally.  
 
            On July 18, 1988, these were noted to last all day 
 
            approximately five days per week.  On August 15, 1988, MRI 
 
            of the cervical spine revealed mild degenerative changes but 
 
            was otherwise unremarkable without evidence of disc 
 
            herniation.  On April 13, 1989, Dr. Hawkins noted that 
 
            claimant was complaining of increasing pain in the cervical 
 
            spine over two years' duration.  The pain was noted to 
 
            radiate into the occipital area with pain on extremes of 
 
            flexion and hyperextension.  Claimant was then tender on the 
 
            C7 interspinous ligament.  Conservative care with a cervical 
 
            pillow, ice, heat and physical therapy and exercise were 
 
            prescribed.
 
            
 
                 An April 14, 1989, note of D. Griffith, licensed 
 
            physical therapist, notes that claimant had a history of 
 
            complaints in the cervicothoracic area over 4-5 years.  The 
 
            assessment was of chronic neck sprain of the cervicothoracic 
 
            region with tightness through the back and neck.
 
            
 
                 On May 1, 1989, Dr. Hawkins noted a history of claimant 
 
            pulling on steel on April 28, 1989, and experiencing 
 
            increasing pain in the cervical spine in the posterior 
 
            aspect "where he had his pain before."  On June 19, 1989, 
 
            Dr. Hawkins indicated that claimant had an increase in 
 
            mobility in the cervical spine and was capable of increasing 
 
            his activity.  Dr. Hawkins then released claimant to return 
 
            to work without restrictions.  A note of July 26, 1989, 
 
            indicates that claimant's neck was better until he irritated 
 
            it a couple of weeks previously for about five days with 
 
            headaches when he helped make a picnic table.  The note 
 
            further states that claimant took a starter out of a car 
 
            which irritated his neck for a few days.  A history of 
 
            August 9, 1989, indicates that, on July 30, 1989, claimant 
 
            was putting a starter in a car when his left arm went numb 
 
            and he dropped the starter on his head and face.  A note of 
 
            January 17, 1990, indicates that claimant had put a bed 
 
            together on a previous Saturday and subsequently experienced 
 
            pain.  On February 27, 1991, it is noted that claimant had 
 
            had car problems on the previous day and, while working on 
 
            his car, had pain in the cervicothoracic and upper trapezius 
 
            area.
 
            
 
                 On November 15, 1989, Earl Bickel, M.D., noted that 
 
            claimant had complaints of neck swelling, headaches, 
 
            stinging sensation and mild muscle spasm.  On examination, 
 
            claimant had mild tenderness along the foraminal neck area 
 
            with good range of motion and was neurologically intact.  
 
            X-rays were interpreted as relatively normal with 
 
            well-maintained disc spaces, no degenerative changes, and no 
 
            anterior posterior spurring.  Foramina were open and facets 
 
            were not involved.  On December 14, 1989, Dr. Bickel 
 
            apparently for vocational rehabilitation restricted claimant 
 
            from lifting more than 20 pounds and from repetitive hand 
 
            motion, gripping, arm movement and pushing and pulling.
 
            
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
                 An MRI of the cervical spine of December 6, 1989, 
 
            revealed a very slight, probably insignificant bulging 
 
            intervertebral disc at C4-5 which disc did not result in 
 
            significant effacement of the anterior portion of the 
 
            subarachnoid space.  The disc had not resulted in 
 
            displacement of the spinal cord nor resulted in significant 
 
            nerve root compression.
 
            
 
                 On May 3, 1990, P. Murray, M.D., and R. L. Henderson, 
 
            M.D., of the Orthopaedic Surgery Department of the 
 
            University of Iowa Hospitals and Clinics, reported that 
 
            claimant had a five-year history of neck pain first coming 
 
            on in 1984 when he was doing a lot of desk work.  Pursuant 
 
            to the history, claimant initially had headache with a 
 
            subsequent decrease in his headaches and an increase in his 
 
            neck pain.  The history further recites that claimant stated 
 
            he reinjured his neck at work without a specific incident, 
 
            although his work required lifting of approximately 
 
            140-pound objects.  An x-ray of May 3, 1990, revealed 
 
            minimal degenerative disc disease with marginal osteophyte 
 
            formation at C5-6.
 
            
 
                 On May 31, 1990, Marty Schwendinger, R.N., of the Mercy 
 
            Medical Center Pain Management Center, reported on a nursing 
 
            evaluation that claimant had a history of headaches and neck 
 
            pain since 1984.  Nurse Schwendinger indicated that, at that 
 
            time, the headaches were almost daily and originated at the 
 
            base of the skull and radiated to various regions of the 
 
            head.  Schwendinger indicated that claimant's current 
 
            headaches originate at the base of the skull and radiate 
 
            generally to the occipital region but vary in location as to 
 
            the entire head or the left or right side of the head.  
 
            Frequency of headaches on May 31, 1990, was three or four 
 
            times per week.  Schwendinger reported claimant's giving a 
 
            history of a neck injury at work in April 1989 with neck 
 
            pain intensified and left shoulder and arm intermittently 
 
            involved since then.  In a Pain Management Center biogenic 
 
            evaluation of June 6, 1990, C. Sparks noted claimant had 
 
            complaints of neck pain over the previous five and one-half 
 
            years of uncertain origin with neck and shoulder tension 
 
            headaches.
 
            
 
                 On March 2, 1992, claimant was noted to have continued 
 
            neck discomfort with muscle spasm on both sides of the neck 
 
            and shoulder blades.  Claimant was also reported as having 
 
            occasional numbness in the thumb with radiation to both 
 
            index fingers, more on the left when driving.  Claimant had 
 
            bilateral pain in the foraminal area at apparently C4, 5 and 
 
            6 and had normal motor and sensory exams.  A small mass was 
 
            noted on the supraspinous fossa.  A repeat MRI of March 5, 
 
            1992, showed slight bulging of the C4-5 disc essentially 
 
            unchanged from previous study.  It was further interpreted 
 
            on March 17, 1992, as showing marginal osteophytes of the 
 
            vertebral bodies at C4-5, C5-6 and C7-T1.  Claimant was not 
 
            considered a surgical candidate and symptoms were described 
 
            as of myositis or inflammation of the muscular layers with 
 
            muscle spasms.
 
            
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
                 On May 7, 1991, Dr. Hawkins opined that claimant was 
 
            disabled from April 28, 1989, through June 15, 1989, as a 
 
            result of the April 28, 1989, incident.  Dr. Hawkins 
 
            indicated there were no x-ray changes as a result of the 
 
            April 28, 1989, work injury and that claimant had no 
 
            permanent injury as the result of that injury.  Dr. Hawkins 
 
            further opined that claimant's starter incident recorded in 
 
            his August 1, 1989, notes was the beginning of another 
 
            injury to claimant's cervical spine.
 
            
 
                 On September 5, 1991, R. F. Neiman, M.D., opined that, 
 
            although claimant had had preexisting cervical spine 
 
            problems, the "density of the discomfort has certainly been 
 
            aggravated by the action which occurred in April of 1989."  
 
            Dr. Neiman opined that claimant had a 14.4 percent body as a 
 
            whole disability of which 4 percent related to his 
 
            preexisting condition and 11.4 percent related to the April 
 
            28, 1989, work injury.  Dr. Neiman opined that claimant was 
 
            capable of light-duty work without prolonged sitting or 
 
            standing and without extensive neck mobility.  He opined 
 
            claimant should avoid long motor rides, should lift no more 
 
            than 15-20 pounds on a repetitive basis but could lift up to 
 
            35 pounds no more than 4 times per hour.  Claimant was also 
 
            advised to avoid sudden temperature changes.
 
            
 
                 Dr. Hawkins' opinion testimony that no permanent injury 
 
            resulted from claimant's April 28, 1989, work incident is 
 
            accepted over Dr. Neiman's opinion that the April work 
 
            incident aggravated claimant's preexisting condition.  Dr. 
 
            Hawkins was claimant's primary treating physician for his 
 
            cervical spine complaints both before and after the work 
 
            incident until Dr. Hawkins' demise.  Dr. Neiman was an 
 
            evaluating physician only.  Dr. Hawkins, therefore, was in a 
 
            better position to judge the actual impact of claimant's 
 
            April 28, 1989, work incident on claimant's overall 
 
            functional well being.  Additionally, Dr. Hawkins' testimony 
 
            is substantiated by other medical evidence in the record in 
 
            that the medical evidence both prior to and subsequent to 
 
            claimant's work injury shows that radiologic findings and 
 
            physical examination findings are substantially similar 
 
            during both those periods.  It is expressly found that 
 
            claimant has not established any permanent functional 
 
            impairment causally related to his April 28, 1989, work 
 
            incident.
 
            
 
                 In that Dr. Hawkins has opined that claimant was 
 
            temporarily totally disabled from the April 28, 1989, work 
 
            incident through June 15, 1989, claimant is found to be 
 
            entitled to temporary total disability benefits for that 
 
            period less those two days when claimant was actually 
 
            working for defendant employer.  Defendants have paid 
 
            claimant weekly compensation at the appropriate rate for 
 
            five weeks and six days.  Claimant is entitled to seven 
 
            weeks of benefits, less two days, or six weeks and five days 
 
            of benefits.  Since defendants receive credit for the five 
 
            weeks and six days of benefits previously paid, defendants 
 
            are found liable to claimant for .857 weeks of temporary 
 
            total disability benefits.
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
                 Claimant is not found to have sustained any permanent 
 
            disability entitling him to permanent partial disability 
 
            benefits on account of loss of earning capacity.  Claimant 
 
            has not been found to have a permanent partial functional 
 
            impairment on account of his April 28, 1989, work incident.  
 
            Claimant's employer dismissed claimant subsequent to his 
 
            work injury.  That dismissal pointedly related to claimant's 
 
            inability to physically perform his job.  The record 
 
            reflects that claimant was having difficulties similar to 
 
            those brought to the fore by his April 28, 1989, work 
 
            incident both immediately and substantially prior to that 
 
            work incident.  The record also reflects that claimant had 
 
            similar difficulties as well brought on by several other 
 
            incidents subsequent to his work incident.  Claimant does 
 
            have restrictions on account of his physical condition.  His 
 
            physical condition remains that condition which claimant 
 
            brought to his work, however.  The condition, and presumably 
 
            appropriate restrictions on account of that condition, have 
 
            not changed substantially on account of the April 28, 1989, 
 
            work incident.  Claimant's April 28, 1989, work incident was 
 
            not a substantial aggravation of his preexisting condition.  
 
            Indeed, claimant's April 28, 1989, work incident can best be 
 
            described as bringing to light claimant's preexisting 
 
            physical condition and his preexisting inability to perform 
 
            the work of band saw operator without physical difficulties 
 
            rather than having lit up an otherwise dormant physical 
 
            condition.  Hence, claimant's dismissal for inability to 
 
            physical perform the work of band saw operator subsequent to 
 
            the April 28, 1989, work incident is found related to 
 
            claimant's preexisting physical difficulties which 
 
            prohibited him from successfully performing the job of band 
 
            saw operator and not related to the April 28, 1989, incident 
 
            of itself.  Hence, claimant's dismissal without more and in 
 
            the absence of any functional permanent impairment related 
 
            to the April 28, 1989, work incident does not form the basis 
 
            for an industrial disability award.
 
            
 
                 While claimant seeks payment of medical costs, no 
 
            medical bills are in evidence.  Claimant reported that $180 
 
            remains outstanding for his evaluation at the Mercy Medical 
 
            Center Pain Management Center.  That bill was submitted to a 
 
            collection agency and claimant has made $20 in payments on 
 
            the bill.  No copy of the bill was available.  Without more, 
 
            claimant's testimony regarding the bill would not be 
 
            sufficient for payment.  Additionally, medical evidence 
 
            suggests that claimant's need for evaluation at the Mercy 
 
            Medical Center Pain Management Center related to claimant's 
 
            preexisting condition and not to his temporary work injury.  
 
            Therefore, it is expressly found that claimant's evaluation 
 
            at the Mercy Medical Center Pain Management Center did not 
 
            relate to his temporary work injury and medical costs 
 
            relative to that evaluation are not costs for which 
 
            defendants are liable.
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 As to the issue of whether a causal relationship exists 
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            between claimant's April 28, 1989, injury and claimed 
 
            permanent disability:
 
            
 
                 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 
 
            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).
 
            
 
                 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).
 
            
 
                 For reasons stated in the above Findings of Fact, 
 
            claimant has not established a causal relationship between 
 
            his April 28, 1989, injury and claimed permanent disability.  
 
            Claimant further has not established that his April 28, 
 
            1989, injury resulted in a material aggravation or lighting 
 
            up of his preexisting condition of cervical spine, neck, 
 
            shoulder and headache pain.
 
            
 
                 As to the issue of claimant's entitlement to temporary 
 
            total disability, section 85.33(1) provides that an employee 
 
            is entitled to temporary total disability weekly benefits 
 
            until the employee has returned to work or is medically 
 
            capable of returning to employment substantially similar to 
 
            the employment in which the employee was engaged at the time 
 
            of the injury, whichever occurs first.  In this instance, 
 
            claimant returned to work on or about May 26, 1989, at which 
 
            time he was dismissed.  Claimant was released for work 
 
            without restrictions on June 19, 1989.  Dr. Hawkins has 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            opined that claimant was no longer temporarily totally 
 
            disabled on account of his April 28, 1989, work incident as 
 
            of June 16, 1989.  It is determined that that is the date on 
 
            which claimant was medically capable of returning to 
 
            employment substantially similar to any employment in which 
 
            he could have engaged without aggravating his preexisting 
 
            condition at the time of his injury.  In that claimant never 
 
            returned to work, the "medically capable of returning" test 
 
            as set forth here is adopted and claimant has established 
 
            entitlement to temporary total disability benefits through 
 
            June 15, 1989.
 
            
 
                 As to the question of industrial disability 
 
            entitlement:
 
            
 
                 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 the 
 
            employee is fitted.  Olson v. Goodyear Serv. Stores, 255 
 
            Iowa 1112, 125 N.W.2d 251 (1963); Barton v. Nevada Poultry, 
 
            253 Iowa 285, 110 N.W.2d 660 (1961).
 
            
 
                 A finding of impairment to the body as a whole found by 
 
            a medical evaluator does not equate to industrial 
 
            disability.  Impairment and disability are not synonymous.  
 
            The degree of industrial disability can be much different 
 
            than the degree of impairment because industrial disability 
 
            references to loss of earning capacity and impairment 
 
            references to anatomical or 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 the 
 
            healing period; the work experience of the employee prior to 
 
            the injury and after the injury and the potential for 
 
            rehabilitation; the employee's qualifications 
 
            intellectually, emotionally and physically; 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.  Likewise, an employer's refusal to give any sort 
 
            of work to an impaired employee may justify an award of 
 
            disability.  McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 
 
            (Iowa 1980).  These are 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 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            each of the factors are to be considered.  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 as well as 
 
            general and specialized knowledge to make the finding with 
 
            regard to degree of industrial disability.  See Christensen 
 
            v. Hagen, Inc., Vol. 1 No. 3 State of Iowa Industrial 
 
            Commissioner Decisions 529 (App. March 26, 1985); Peterson 
 
            v. Truck Haven Cafe, Inc., Vol. 1 No. 3 State of Iowa 
 
            Industrial Commissioner Decisions 654 (App. February 28, 
 
            1985).
 
            
 
                 Compensation for permanent partial disability shall 
 
            begin at the termination of the healing period.  
 
            Compensation shall be paid in relation to 500 weeks as the 
 
            disability bears to the body as a whole.  Section 85.34.
 
            
 
                 As recited in the above Findings of Fact, claimant has 
 
            not established functional impairment on account of his work 
 
            injury.  Likewise, claimant has not established that the 
 
            employer terminated him from employment for which he would 
 
            otherwise have been fitted on account of his work injury.  
 
            Therefore, claimant has not established an entitlement to 
 
            industrial disability on account of a loss of earning 
 
            capacity on account of his work injury.
 
            
 
                 As regards the issue of payment of certain medical 
 
            costs pursuant to section 85.27:
 
            
 
                 The employer shall furnish reasonable surgical, 
 
            medical, dental, osteopathic, chiropractic, podiatric, 
 
            physical rehabilitation, nursing, ambulance and hospital 
 
            services and supplies for all conditions compensable under 
 
            the workers' compensation law.  The employer shall also 
 
            allow reasonable and necessary transportation expenses 
 
            incurred for those services.  The employer has the right to 
 
            choose the provider of care, except where the employer has 
 
            denied liability for the injury.  Section 85.27.  Holbert v. 
 
            Townsend Engineering Co., Thirty-second Biennial Report of 
 
            the Industrial Commissioner 78 (Review-reopen 1975).
 
            
 
                 In that it has been found that claimant's evaluation at 
 
            the Mercy Medical Center Pain Management Center related to 
 
            claimant's underlying preexisting condition and not to his 
 
            work injury, claimant has not established entitlement to 
 
            payment of that medical cost.
 
            
 
                           
 
            
 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
                                       ORDER
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Defendants pay claimant point eight five seven (.857) 
 
            weeks of temporary total disability benefits at the rate of 
 
            one hundred fifty-two and 08/100 dollars ($152.08) per week.
 
            
 
                 Defendants pay interest pursuant to Iowa Code section 
 
            85.30, as amended.
 
            
 
                 Claimant and defendants share equally in payment of the 
 
            costs of this action pursuant to rule 343 IAC 4.33.
 
            
 
                 Defendants file claim activity reports as requested by 
 
            the agency pursuant to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ______ day of ____________, 1992.
 
            
 
                 
 
            
 
                 
 
                 
 
                                          ______________________________
 
                                          HELENJEAN M. WALLESER
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Robert R. Rush
 
            Mr. Matthew J. Nagle
 
            Attorneys at Law
 
            526 Second Avenue SE
 
            P.O. Box 2457
 
            Cedar Rapids, Iowa  52406-2457
 
            
 
            Mr. John M. Bickel
 
            Attorney at Law
 
            500 Firstar Bank Building
 
            P.O. Box 2107
 
            Cedar Rapids, Iowa  52406-2107
 
            
 
 
            
 
 
 
 
 
 
 
 
 
                                                   1801; 1803; 1807
 
                                                   Filed July 15, 1992
 
                                                   HELENJEAN M. WALLESER
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                      
 
            CHARLES E. JIMMERSON,    
 
                      
 
                 Claimant, 
 
                      
 
            vs.                                     File No. 917653
 
                      
 
            ACRO MANUFACTURING CORP.,           A R B I T R A T I O N
 
                      
 
                 Employer,                         D E C I S I O N
 
                      
 
            and       
 
                      
 
            UNITED FIRE & CASUALTY,  
 
                      
 
                 Insurance Carrier,  
 
                 Defendants.    
 
            ____________________________________________________________
 
            
 
            1801; 1803; 1807
 
            Claimant claimed injury and subsequent disability as a 
 
            result of a work incident.  Medical evidence established 
 
            claimant had had similar complaints both prior to the injury 
 
            and following nonwork-related incidents occuring subsequent 
 
            to the claimed work injury.  Treating physician's opinion of 
 
            temporary aggravation of preexisting condition without 
 
            work-related permanent disability accepted.  Employer 
 
            terminated 5'8", 103-pound claimant for inability to perform 
 
            band saw operating job on release for work with restrictions 
 
            after work incident.  Termination did not result in 
 
            industrial disability in that termination related to 
 
            claimant's preexisting inability to perform job as 
 
            manifested in the work incident and did not relate to 
 
            disability the work incident produced.
 
            
 
 
         
 
         
 
         
 
         
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER 
 
         ____________________________________________________________
 
                                       :
 
         CHRIS CRABLE,                 :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :         File No. 917787
 
         MODERN WELDING CO., INC.,     :
 
                                       :      A R B I T R A T I O N
 
              Employer,                :
 
                                       :         D E C I S I O N
 
         and                           :
 
                                       :
 
         NATIONAL UNION (AGI),         :
 
                                       :
 
              Insurance Carrier,       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration upon the petition of 
 
         claimant, Chris Crable, against his employer, Modern Welding Co., 
 
         Inc., and its insurance carrier, National Union Fire Insurance, 
 
         defendants.  The case was heard on January 10, 1994 at the Des 
 
         Moines County courthouse in Burlington, Iowa.  The record 
 
         consists of the testimony of claimant.  The record also consists 
 
         of the testimony of Pamela Crable, spouse; Robert E. Taeger, 
 
         plant superintendent; and Keith A. Tager, plant manager.  
 
         Finally, the record is comprised of claimant's exhibits 1-46 and 
 
         defendants' exhibits A-D.
 
         
 
                                      ISSUE
 
         
 
              The sole issue to determine is the nature and extent of any 
 
         permanent partial disability benefits.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Claimant is the 36-year-old married father of two small 
 
         children.  He is a 1977 graduate of Burlington High School.  As a 
 
         student, claimant enrolled in courses which involved the building 
 
         trades and other shop courses.  He indicated he was a C student.
 
         
 
              Claimant commenced his employment with the present 
 
         defendant-employer while he was in high school.  He received 
 
         on-the-job training in the use of grinders; buffers; drills; 
 
         drill presses; band saws; sandblasters; and he learned how to 
 
         weld.  His duties included working in the test area; reading blue 
 
         prints; and patching tanks and air testing them.  He was not 
 
         required to draft written reports.
 
         
 
              On May 24, 1989 claimant was assisting in the installation 
 
         of a fuse box which was located under a work bench.  According to 
 
         claimant, he was having a difficult time installing the box; he 
 

 
         
 
         Page   2
 
         
 
         
 
         
 
         was pushing on it; and at some point there was a flash of 
 
         orange-yellow light and an intense heat.   There was a loud pop 
 
         like the sound of an explosion.   Then claimant was pushed six 
 
         feet across the floor and in the opposite direction from the work 
 
         bench.  
 
         
 
              Claimant had sustained burns on his face, neck and arms.  A 
 
         co-employee made a telephone call to the 911 telephone 
 
         dispatcher.   Claimant was rushed to the Burlington Medical 
 
         Center and then later the same day, he was transported to the 
 
         burn unit at the University of Iowa.
 
         
 
              In the burn unit, Gerald P. Kealey, M.D., treated claimant.  
 
         The hospital records indicate claimant was burned on 13 percent - 
 
         14 percent of his body.   The physician's clinical note of May 
 
         31, 1989 summarized some of the treatments which claimant had to 
 
         endure.  Dr. Kealey indicated:
 
         
 
                 Laboratory studies are now within normal limits 
 
              except for hemoglobin 8.0 gm/dl and hematocrit 24%.  
 
              This individual involved himself in an electrical 
 
              contact flash injury seven days ago.  He was 
 
              immediately brought to the Burn Treatment Center and 
 
              resuscitated.  He had an obvious full thickness burn 
 
              wound over the proximal hand and flexor retinaculum of 
 
              the left wrist.  Because of this he was seen in 
 
              consultation with the Plastic and Reconstructive 
 
              Surgery Service.  The partial thickness and full 
 
              thickness injuries on the right and left forearm were 
 
              also accounted for.  He was taken to the operating room 
 
              on 5-30-89 at which time under general anesthesia 
 
              tangential excision and grafting of the right forearm 
 
              and small areas of the right hand were performed.  
 
              Tangential excision and grafting of the left forearm 
 
              was performed.  Dr. Cram of the Plastic and 
 
              Reconstructive Surgery Division fashioned a radial 
 
              forearm flap to cover the flexor retinaculum and flexor 
 
              tendons of the left forearm.  This procedure went in a 
 
              satisfactory manner.  Today the flap is pink.  The skin 
 
              grafts are in good position and his donor sites are in 
 
              reasonable condition.
 
         
 
                 Situation:  stable.  Prognosis:  good.
 
         
 
         (Exhibit 4)
 
         
 
              In 1991, Dr. Kealey evaluated claimant for purposes of 
 
         rendering a permanent partial impairment.  He noted the following 
 
         in relevant portion:
 
         
 
                 Initially I will address the problems associated 
 
              with your skin graft and radial forearm free-flap which 
 
              were necessary for the coverage of your burn wounds on 
 
              your upper extremities.  At this time your symptoms 
 
              have been stable for the last year.  You state that you 
 
              have bothered by [sic] cold exposure, especially over 
 
              the left radial forearm free-flap, and you say you must 
 
              protect both your forearms and your donor site on your 
 
              left thigh from direct sunlight as they sunburn very 
 

 
         
 
         Page   3
 
         
 
         
 
         
 
              easily, and they will not pigment properly.  You state 
 
              that you have poor sensation of your wounds, and you 
 
              have suffered injury which you were unaware of until 
 
              you noticed the bleeding rather than having protective 
 
              sensation of the areas that were grafted on your 
 
              forearms.  This is important as you are on Coumadin for 
 
              the rest of your life, and this anti-coagulation has 
 
              decreased the ability of your blood to clot and it can 
 
              become quite troublesome when you have an accidental 
 
              injury which you are unaware of.  You also state that 
 
              exposure of the grafted areas to harsh soaps, chemicals 
 
              and petroleum product solvents result in irritation, 
 
              dryness and flaking necessitating the use of skin 
 
              emollients or lotions frequently and protection 
 
              clothing during the hot and cold weather months.
 
         
 
                 On physical examination you have decreased sensation 
 
              over the grafted areas on the right forearm, and over 
 
              the left forearm (especially the left radial forearm 
 
              free-flap)  You have full range of motion, with good 
 
              grasp, strength and function of the hands, wrists, 
 
              elbows, and shoulders of the upper extremities.  Your 
 
              dexterity using the Nine Hole Peg Test and the 
 
              Minnesota Rate of Manipulation Test is within normal 
 
              limits.  In short, you have a well-healed injury of 
 
              which the symptoms cannot be expected to improve over 
 
              change [sic] over time.  Your complaints of decreased 
 
              sensitivity and sensation, and casual injury due to 
 
              unnoticed trauma are quite consistent with your type of 
 
              injury and grafting that was necessary to repair them.
 
         
 
                 The following test was used to establish your whole 
 
              man disability.  It is:
 
         
 
                      Guides to the Evaluation of Permanent 
 
                   Impairment, 3rd Edition, revised.  The 
 
                   Committee on Medical Rating of Physical 
 
                   Impairment, The Board of Trustees of the 
 
                   American Medical Association, 1984.
 
         
 
                 I would place you in Class One impairment of your 
 
              skin.  A patient belongs in Class One when signs and 
 
              symptoms of a skin disorder are present, and with 
 
              treatment there is no limitation or minimal limitation 
 
              in the performance of the activities of daily living 
 
              although exposure to certain physical or chemical 
 
              agents may increase limitations temporarily.  I would 
 
              assign you a 5% wholeman [sic] disability on the basis 
 
              of your skin problems.  You have chronic ongoing needs 
 
              for protection from chemicals, trauma and sunlight.  
 
              You have decreased sensation and you are susceptible to 
 
              injury.  You need to have protective clothing, 
 
              protecting sun block and skin emollients for the rest 
 
              of your life.
 
         
 
         (Exs. 16 & 17)
 
         
 
              While claimant was in the burn unit, he began to experience 
 
         difficulties with blood clots in his lower extremities.  His legs 
 

 
         
 
         Page   4
 
         
 
         
 
         
 
         had been the donor sites for his skin grafts.  He developed right 
 
         calf deep venous thrombosis.  He had had a previous history of 
 
         deep venous thrombosis.  The patient was treated with 2.5 mgs. of 
 
         Coumadin and then he was discharged from the University of Iowa 
 
         Hospitals.
 
         
 
              Claimant returned to Burlington.  However, he developed a 
 
         swollen left calf and difficulties breathing.  He sought 
 
         treatment at the Burlington Medical Center.  He was diagnosed as 
 
         having:
 
         
 
                 DISCHARGE DIAGNOSIS:
 
            1.  Deep venous thrombosis, left leg.
 
            2.  Large pulmonary embolus to the right lung.
 
            3.  Status post burn wounds to the upper                        
 
         extremities.
 
            4.  Depression, secondary to physical disorder.
 
         (Ex. 11)
 
         
 
              Because of his serious condition, he was transferred to the 
 
         University of Iowa.  He was treated for deep venous thrombosis.  
 
         Coumadin was continued.  Then claimant developed adrenal 
 
         hemorrhages because of ongoing anticoagulation with Coumadin and 
 
         because of intercurrent stress.    
 
         
 
              Claimant developed Addison's disease.  John H. MacIndoe, 
 
         M.D., began to treat claimant.  The physician opined the 
 
         following relative to claimant's condition:
 
         
 
                 As you know, he suffers from permanent and total 
 
              adrenal insufficiency as a result of a bilateral 
 
              adrenal hemorrhage that occurred in conjunction with 
 
              his electrical accident and subsequent deep vein 
 
              thromboses.  The proper treatment of this disorder is 
 
              associated with a normal life span.  Furthermore, it 
 
              should not limit his ability to under [sic] physical or 
 
              emotional stress.  He does seem to have an acute 
 
              awareness of his body and minor changes that he is 
 
              concerned might be due to his glucocorticoid therapy.  
 
              I am happy to reassure him when these issues arise, but 
 
              I can't help wondering whether his concerns are some 
 
              type of reaction to his rather serious and prolonged 
 
              medical problems.
 
         
 
                 He should continue taking daily doses of 
 
              hydrocortisone and mineralocorticoid (Florinef).  He 
 
              knows to increase the doses of the glucocorticoid 
 
              preparation during periods of physical and emotional 
 
              stress.  I will continue to follow him as long as he 
 
              wishes for this disorder and I have been quite pleased 
 
              at his progress to date.
 
         
 
         (Ex. A, attachment page 8)
 
         
 
              In his deposition, Dr. MacIndoe described Addison's disease 
 
         as:
 
         
 
                 A.  Addison's disease refers to the complete loss of 
 
              adrenal gland tissue.  Resulting impairment is a loss 
 

 
         
 
         Page   5
 
         
 
         
 
         
 
         
 
         
 
              of the ability to make several hormones, the most 
 
              important of which is something called cortisol, 
 
              frequently referred to in the lay terms as cortisone.
 
         
 
                 Q.  When an individual has the complete loss of 
 
              their adrenal glands, what are the effects that one 
 
              could experience?
 
         
 
                 A.  In the absence of replacing those hormones, 
 
              death is almost inevitable.
 
         
 
                 Q.  Would it be fair to state there are different 
 
              levels of complications that can result from the loss 
 
              of the adrenal glands as a result of Addison's disease?
 
         
 
                 A.  With the complete loss and the complete lack of 
 
              replacement, there may be several intervening stages 
 
              between the incident and death, but death again is 
 
              inevitable.  I can't think of a protracted illness that 
 
              goes on indefinitely that doesn't result in death, 
 
              unless there is some adrenal tissue present.  Another 
 
              way of saying it, is cortisone is an essential for 
 
              life.
 
         
 
                 Q.  And in terms of intervention in order to 
 
              compensate for Addison's disease, what is the course of 
 
              treatment that is followed?
 
         
 
                 A.  Course of treatment is usually the replacement 
 
              of the cortisone by mouth or with an oral tablet and 
 
              usually the replacement is given in two different 
 
              doses; a dose twice as strong in the morning -- it is 
 
              given twice a day, the morning dose being twice as 
 
              strong as the evening dose.  A total amount of 
 
              cortisone given by mouth is approximately equal by that 
 
              made by the adrenal glands each day in a nonstress 
 
              condition.  
 
         
 
         (Ex. A, p. 4, line 12 - p. 5, line 17)
 
         
 
              Since the onset of his Addison's disease, claimant has 
 
         engaged in hormone therapy.  He is required to take 
 
         hydracortisone two times daily as well as florinef once per day.  
 
         Dr. MacIndoe has indicated the hormone therapy will be for the 
 
         duration of claimant's life or else claimant will die.  Claimant 
 
         is not restricted from engaging in welding activities so long as 
 
         he does not work under undue stress.  He is to avoid the 
 
         increased risk of falling, bruising, or breaking bones (Ex. A, 
 
         p. 16).  There are no physical limitations (Ex. A, p. 16).  
 
         However,  claimant, as of 1992, is restricted from welding in 
 
         confined spaces (Ex. A, attachment p. 21).  The rationale for 
 
         restricting claimant from working in confined spaces is that 
 
         exposure to high levels of toxins can upset the balance the 
 
         medication has established (Ex. A, p. 22).  Dr. MacIndoe has also 
 
         advised claimant to avoid situations which produce chronic 
 
         anxiety (Ex. A, attachment p. 22).
 
         
 
              Following his work injury, claimant also treated with 
 
         several other specialists.  He sought treatment from Mark L. 
 

 
         
 
         Page   6
 
         
 
         
 
         
 
         
 
         
 
         Woodard, D.O., a cardiologist.  Dr. Woodard made several 
 
         recommendations relative to claimant's employment.  He 
 
         recommended:
 
         
 
                 I note that you have received a letter from Dr. 
 
              McFarlane from Hematology/Oncology at University 
 
              Hospitals.  They recommended in March of 1991 that the 
 
              patient should seek employment that does not include 
 
              prolonged standing.  In talking to the patient, it 
 
              sounds like he could do his current job if he could 
 
              just sit down for the majority of the time, while he 
 
              does his job; he thinks he could probably work that out 
 
              with your cooperation.  I think at this point that it 
 
              would be a very worthwhile decision.  It might prevent 
 
              a lot of problems in the long run.  Regarding the 
 
              immediate concern, we will start him on a local 
 
              anti-infective agent and will give him a brief course 
 
              of antibiotics.
 
         
 
                 If you have any questions, please let me know.  I 
 
              think that things could be worked out with the patient 
 
              to the benefit of both you and him, in terms of his 
 
              long--term productivity.
 
         
 
         (Ex. 19)
 
         
 
              Claimant treated with John D. Corson, M.D., Chief of 
 
         Vascular Surgery at the University of Iowa Hospitals and Clinics.  
 
         Dr. Corson prescribed compression stockings for claimant.  
 
         Claimant is to wear these at all times (Ex. 20).  Claimant is to 
 
         elevate his legs whenever possible (Ex. 21).
 
         
 
              Dr. MacIndoe has testified there is no impairment based upon 
 
         physical criteria (Ex. A, p. 22).  However, the endocrinologist 
 
         has provided an impairment rating relative to claimant's 
 
         condition.  In his report of March 13, 1991, Dr. MacIndoe opined:
 
         
 
                 We have overwhelming evidence that Mr. Crable's 
 
              primary adrenal insufficiency is the result of 
 
              bilateral adrenal hemorrhage which, in turn, resulted 
 
              from a combined state of stress and anti-coagulation.  
 
              The anti-coagulation was begun subsequent to a deep 
 
              vein thrombosis which appeared to result from a rather 
 
              prolonged surgery to repair electrical burns sustained 
 
              during an accident at work.  The patient has absolutely 
 
              no adrenocortical function and his continued health 
 
              depends upon him receiving adequate daily doses of 
 
              glucocorticoid and mineralocorticoid.  Although the 
 
              dosage of both of these medications is fairly constant 
 
              under normal conditions of work, physical health, and 
 
              emotional stress, major changes in physical or 
 
              emotional stress can lead to substantial changes in his 
 
              medication requirements.  A failure to meet those 
 
              requirements is likely to produce symptoms of severe 
 
              adrenal crisis associated with potentially 
 
              life-threatening hyponatremia, hyperkalemia, and shock.  
 
              Excessive therapy will result in the signs and symptoms 
 
              of hyper-gluococorticoidism characterized by weight 
 
              gain, hypertension, poor wound healing, and severe 
 

 
         
 
         Page   7
 
         
 
         
 
         
 
              progressive osteoporosis.  The potential 
 
              life-threatening complications of this disorder and the 
 
              need to maintain a delicate balance between excessive 
 
              and deficient hormone replacement, I would estimate his 
 
              percent impairment at approximately 65% [in reaching 
 
              this assessment I have utilized the tabulated criteria 
 
              for hypoadrenacorticoidism found on page 217 of Guides 
 
              to the Evaluation of Permanent Impairment, 3rd Edition 
 
              (revised), 1971].
 
         
 
                 In order to maintain appropriate monitoring and 
 
              therapy of his adrenocorticoid insufficiency, Mr. 
 
              Crable should be followed by a board certified 
 
              endocrinologist with experience in adrenal diseases, 
 
              will require daily oral cortisone and mineralocorticoid 
 
              (Florin-f) therapy, and frequent laboratory testing of 
 
              serum electrolyte values.  It is likely that he will 
 
              suffer multiple episodes of adrenocorticoid 
 
              insufficiency due to unexpected trauma, illness, or 
 
              other types of stress.   These will require emergency 
 
              treatment facilities and medications.
 
         
 
                 Mr. Crable has also sustained at least two major 
 
              episodes of lower extremity deep vein thrombosis.  Each 
 
              episode was associated with the life-threatening 
 
              complication of pulmonary embolism.  Although a single 
 
              episode of this may be managed with temporary 
 
              anticoagulant (Coumadin) therapy.  A recurrence 
 
              dictates that he be maintained on anticoagulant therapy 
 
              for life.  Again, the dosage of Coumadin necessary to 
 
              achieve this is likely to vary over time and with 
 
              changing conditions of health.  Even with careful 
 
              monitoring there is a 8-10% annual incidence of 
 
              complication due strictly to the use of this 
 
              medication.  Thus, given his normal life expectancy, 
 
              there is a significant risk of unwanted bleeding from 
 
              this medication.  Given these circumstances I would 
 
              estimate the life-long impairment due to this problem 
 
              is approximately 10%.
 
         
 
                 In order to maintain adequate levels of 
 
              anticoagulation the patient will require oral Coumadin 
 
              on a daily or every-other-day basis for the rest of his 
 
              life, frequent (at least monthly) laboratory tests of 
 
              blood coagulation, and liver function.  The patient 
 
              will also require the use of thigh high antiembolism 
 
              stockings to minimize furthering his chances of 
 
              recurrent deep vein thrombosis.  In the event of an 
 
              unexpected episode of bleeding, the patient will need 
 
              access to emergency treatment facilities, a variety of 
 
              medical testing procedures, and possibly parenteral 
 
              fluids including blood products.  Unexpected 
 
              hemorrhages into vital organs and/or joints can result 
 
              in further permanent medical disabilities depending on 
 
              the site and severity of the problem.
 
         
 
         (Ex. A, attachments 10 & 11)
 
         
 
              At the time of the hearing claimant was working for this 
 

 
         
 
         Page   8
 
         
 
         
 
         
 
         defendant.  Since his return to work he has been working in the 
 
         special shop area where he is often asked to perform precision 
 
         welding.  He wears personal protective equipment including 
 
         glasses; a hard hat; ear plugs; and safety shoes.  In addition to 
 
         precision welding, claimant is also asked to perform some 
 
         janitorial functions and to assist in the supply room.
 
         
 
              Claimant testified that after prolonged standing, his legs 
 
         swell and then they ache.  Claimant indicated he develops ulcers 
 
         on his feet as a result of his circulatory problems.  Every day 
 
         he wears his compression stockings to work.  He remarked to this 
 
         deputy that he is able to stand for one hour and then he must sit 
 
         and rest.  Claimant testified there are jobs within the shop 
 
         where he is required to stand in order to complete the assigned 
 
         tasks.  He indicated there are jobs which cannot be performed in 
 
         the sitting position.  He reported he does the best job he can 
 
         do, but he is fearful he will re-injure himself.  He is fearful 
 
         he will lose this job, although there is no factual basis in the 
 
         record to support his fear.
 
         
 
              Claimant works 40 hours per week but if over time is 
 
         offered, he generally takes it.  He earns slightly more now than 
 
         he did on the date of the work injury.  At the time of the 
 
         hearing, claimant was earning approximately $11.15 per hour.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              The burden of proof is on the party asserting the 
 
         affirmative of an issue on an administrative proceeding; "on the 
 
         party who would suffer a loss if the issues were not 
 
         established."  Wonder Life Co. v. Liddy, 207 N.W.2d 27 (Iowa 
 
         1973); Norlan v. Ides, 412 N.W.2d 904 (Iowa 1987).
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which the employee is 
 
         fitted.  Olson v. Goodyear Serv. Stores, 255 Iowa 1112, 125 
 
         N.W.2d 251 (1963); Barton v. Nevada Poultry, 253 Iowa 285, 110 
 
         N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  
 
         Impairment and disability are not synonymous.  The degree of 
 
         industrial disability can be much different than the degree of 
 
         impairment because industrial disability references to loss of 
 
         earning capacity and impairment references to anatomical or 
 
         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 the healing period; 
 
         the work experience of the employee prior to the injury and after 
 

 
         
 
         Page   9
 
         
 
         
 
         
 
         the injury and the 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.  
 
         Likewise, an employer's refusal to give any sort of work to an 
 
         impaired employee may justify an award of disability.  McSpadden 
 
         v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980).  These are 
 
         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.  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 as well as general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Christensen v. Hagen, Inc., Vol. 1 No. 3 State of Iowa 
 
         Industrial Commissioner Decisions 529 (App. March 26, 1985); 
 
         Peterson v. Truck Haven Cafe, Inc., Vol. 1 No. 3 State of Iowa 
 
         Industrial Commissioner Decisions 654 (App. February 28, 1985).
 
         
 
              Compensation for permanent partial disability shall begin at 
 
         the termination of the healing period.  Compensation shall be 
 
         paid in relation to 500 weeks as the disability bears to the body 
 
         as a whole.  Section 85.34.
 
         
 
              Even though claimant's actual earnings have not been 
 
         diminished, he has sustained a loss of earning capacity.  A 
 
         showing that there has been no loss of actual earnings does not 
 
         preclude a finding of industrial disability.  Michael v. Harrison 
 
         County, 34th Biennial Report of the Iowa Industrial Commissioner 
 
         218 (1979).  However, industrial disability does not equal or 
 
         exceed the physical impairment ratings which are offered as 
 
         evidence.  Impairment ratings are only one factor in determining 
 
         industrial disability.  Collier v. Sioux City Community School 
 
         District, File No. 953453, (App. Dec., February 25, 1994).
 
         
 
              There are several factors in the present case which show 
 
         claimant has an industrial disability.  There are restrictions 
 
         which have been imposed upon claimant.  He is no longer allowed 
 
         to weld within confined spaces.  Such an environment places undue 
 
         stress on him.  Claimant must alternate standing and sitting.  
 
         Prolonged standing negatively impacts upon claimant's physical 
 
         condition.  He is required to wear compression stockings at all 
 
         times.   He has been besieged by ulcers on his feet.  Despite the 
 
         presence of the ulcers, claimant has been able to work his 
 
         regular schedule.   
 
         
 
              Claimant is currently a welder.  Many welding jobs require 
 
         the worker to stand in order to complete the task.  Since 
 
         claimant is to refrain from prolonged standing, he is precluded 
 
         from performing many welding tasks.  This, in turn, makes 
 

 
         
 
         Page  10
 
         
 
         
 
         
 
         
 
         
 
         claimant less marketable.  He is not now as attractive an 
 
         employee as he once was.  His capacity for earnings has been 
 
         reduced.
 
         
 
              Claimant is fortunate his employer has accommodated him in 
 
         the workplace.  It is doubtful whether another employer would 
 
         make as many accommodations as this employer has done.  
 
         Defendant-employer is to be commended for the excellent job the 
 
         company officials have done in placing claimant back into the 
 
         workplace.  The defendants are to be commended.  This deputy was 
 
         impressed with their efforts.
 
         
 
              Claimant is also to avoid chemicals and solvents in the 
 
         workplace.  These too may place undue stress on him and result in 
 
         adrenal crisis.   He must be selective in choosing an environment 
 
         which will not aggravate his breathing, upset his hormonal 
 
         balance or place him in adrenal crisis.  Certain work 
 
         environments are now unavailable to him.  Claimant is to use the 
 
         utmost care when monitoring his hydrocortisone.  He will remain 
 
         on this external medication for the duration of his life.  The 
 
         necessity of continued use of hormones exposes claimant to 
 
         potential problems such as diabetes or loss of bone.  It is 
 
         important for him to strike a balance in his hormonal levels.  
 
         
 
              Likewise, the necessity of continued use of Coumadin also 
 
         exposes claimant to increased likelihood of ancillary problems.  
 
         Claimant must avoid situations where he will cut or bruise 
 
         himself.  He is precluded from taking another type of welding 
 
         job.
 
         
 
              Therefore, after reviewing all of the evidence; after having 
 
         heard the testimony; and after having observed the witnesses, it 
 
         is the determination of the undersigned deputy industrial 
 
         commissioner that claimant is entitled to a 50 percent permanent 
 
         partial disability.  Claimant is entitled to 250 weeks of 
 
         permanent partial disability benefits at the stipulated rate of 
 
         $284.00 per week commencing on January 2, 1990.
 
         
 
                              
 
         
 
         
 
         Page  11
 
         
 
         
 
         
 
                                    ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Defendants shall pay unto claimant two hundred fifty (250) 
 
         weeks of permanent partial disability benefits at the stipulated 
 
         rate of two hundred eighty-four and no/l00 dollars ($284.00) per 
 
         week commencing on January 2, 1990.
 
         
 
              Defendants shall take credit for all permanent partial 
 
         disability benefits previously paid to claimant.
 
         
 
              Accrued benefits are to be paid in a lump sum together with 
 
         statutory interest at the rate of ten percent (10%) per year.
 
         
 
              Costs are taxed to defendants pursuant to rule 343 IAC 4.33.
 
         
 
              Defendants shall file a claim activity report as requested 
 
         by this division and pursuant to rule 343 IAC 3.1.
 
         
 
         
 
         
 
              Signed and filed this ____ day of July, 1994.
 
         
 
         
 
         
 
                                       ______________________________               
 
                                       MICHELLE A. McGOVERN
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Steven J. Crowley
 
         Attorney at Law
 
         PO Box 945
 
         6th Flr  Burlington Bldg
 
         Burlington  IA  52601
 
         
 
         Mr. John E. Swanson
 
         Attorney at Law
 
         8th Flr  Fleming Bldg
 
         218 6th Ave
 
         Des Moines  IA  50309
 
         
 
 
            
 
 
 
 
 
 
 
                                                1800
 
                                                Filed July 29, 1994
 
                                                MICHELLE A. McGOVERN
 
            
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER 
 
            ____________________________________________________________
 
                      
 
            CHRIS CRABLE,  
 
                      
 
                 Claimant, 
 
                      
 
            vs.       
 
                                                  File No. 917787
 
            MODERN WELDING CO., INC.,     
 
                                                A R B I T R A T I O N
 
                 Employer, 
 
                                                   D E C I S I O N
 
            and       
 
                      
 
            NATIONAL UNION (AGI),    
 
                      
 
                 Insurance Carrier,  
 
                 Defendants.    
 
            ___________________________________________________________
 
            1800
 
            
 
            Claimant was awarded a 50 percent permanent partial 
 
            disability as a result of an electrical burn which he 
 
            sustained while he was working.  Claimant received burns on 
 
            his forearms, neck, and face.  Claimant received treatment 
 
            from the burn unit at the University of Iowa Hospitals and 
 
            Clinics.  The surgeons performed skin grafts from claimant's 
 
            thighs to his forearms.  While claimant was in the hospital, 
 
            he developed certain blood clots in his legs.  He was placed 
 
            on Coumadin.  Also while he remained in the hospital, 
 
            claimant developed adrenal crisis.  His adrenal gland was 
 
            destroyed as a result of the shock of the injury and as a 
 
            result of the continued use of Coumadin.  Certain external 
 
            medications were prescribed for claimant for the duration of 
 
            his life.  The endocrinologist testified that if claimant 
 
            failed to take the requisite hormonal medication, death was 
 
            imminent.
 
            
 
            Claimant eventually returned to work at defendant's welding 
 
            shop where he had been employed as a welder.  
 
            Defendant-employer was engaged in the manufacture of 
 
            underground storage tanks.  Claimant was precluded from 
 
            welding in confined spaces.  He was also advised to 
 
            alternate sitting with standing, as standing aggravated 
 
            claimant's vascular condition.  Claimant was required to 
 
            wear compression stockings at all times.  Claimant had been 
 
            working with ulcers on his feet.   He was precluded from 
 
            working near chemicals and solvents.  His physician opined 
 
            that solvents and chemicals could place undue stress on 
 
            claimant and he could develop adrenal crisis.
 

 
            
 
 
 
 
 
 
 
 
 
 
 
            Claimant sustained no actual loss of earnings.  However, he 
 
            had sustained a loss of his earning capacity since many 
 
            welding jobs were no longer available to him.
 
            Held:  Claimant was awarded a 50 percent permanent partial 
 
            disability.