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                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            DARLENE HUNT,  :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 921048
 
            EVEREADY BATTERY CO.,    :
 
                      :    A R B I T R A T I O N
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            AETNA CASUALTY & SURETY CO.,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
                 
 
            
 
                 This is a proceeding in arbitration brought by Darlene 
 
            Hunt, (claimant) commenced with the filing of a petition on 
 
            October 9, 1989 against Eveready Battery Co., (employer) and 
 
            Aetna Casualty & Surety Co.,(Aetna), (collectively 
 
            defendants) Eveready's insurer for worker's compensation 
 
            benefits as a result of an alleged injury to claimant's back 
 
            occurring on January 19, 1989.  On January 3, 1991, the 
 
            matter came on for hearing in Council Bluffs, Iowa.  The 
 
            parties appeared as follows:  the claimant in person and by 
 
            her counsel Sheldon Gallner of Council Bluffs, Iowa and 
 
            Eveready and Aetna by their counsel Thomas M. Plaza of Sioux 
 
            City, Iowa.  
 
            
 
                 The record in this proceeding consisted of the 
 
            following: 
 
            
 
                 1.  The testimony of the claimant, and the testimony of 
 
            Tracy Kuhn on behalf of the claimant.  Diane Bailey Weaver 
 
            testified on behalf of Eveready.
 
            
 
                 2.  Joint exhibits 1-80, 82-87 and claimant's exhibit 
 
            88. 
 
            
 
                 At the close of all evidence, the case was deemed fully 
 
            submitted.
 
            
 
                                  stipulations 
 
            
 
                 The parties stipulated to the following matters at the 
 
            time of the hearing: 
 
            
 
                 That an employer-employee relationship existed between 
 
            claimant and the employer at the time of the injury.
 
            
 
                 That the claimant sustained an injury on January 19, 
 
            1989 which arose out of an in the course of employment.
 

 
            
 
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                 The injury caused a temporary disability during the 
 
            period of recovery.
 
            
 
                 The claimant's time off work for which claimant now 
 
            seeks either temporary total disability or healing period 
 
            benefits is as follows: January 20, 1989, February 2, 1989, 
 
            February 3, 1989 and February 6, 1989 to September 6, 1990.
 
            
 
                 That the type of permanent disability, if the injury is 
 
            found to be a cause of permanent disability, is industrial 
 
            disability to the body as a whole.
 
            
 
                 Claimant's rate of weekly compensation is stipulated to 
 
            be $221.30.  The claimant's gross weekly earnings are 
 
            $365.20.
 
            
 
                 Claimant is single.  She is entitled to one exemption. 
 
            
 
                 The fees charged for medical services are fair and 
 
            reasonable and the expenses were incurred for reasonable and 
 
            necessary medical treatment. 
 
            
 
                 The amount of a credit for the payment of medical 
 
            benefits under a non-occupational group plan is $858.60. 
 
            
 
                 That amount of credit for the benefits paid to claimant 
 
            totals 100 1/7 weeks through December 28, 1990 plus benefits 
 
            paid to the date of this decision.
 
            
 
                 There are no bifurcated claims. 
 
            
 
                                     issues 
 
            
 
                 1.  Whether a causal relationship exists between 
 
            claimant's claimed injuries and the claimed industrial 
 
            disability and the nature and extent of any entitlement to 
 
            benefits.
 
            
 
                 2.  Whether claimant is entitled to medical benefits 
 
            including a determination of causal connection to the work 
 
            injury and the causal connection of this condition to a work 
 
            injury.
 
            
 
                 3.  The extent and assessment of costs for the action.
 
            
 
                               Preliminary Matters
 
            
 
                 After the record was closed in this matter, claimant 
 
            filed an application for a nunc pro tunc order to include 
 
            another exhibit regarding a medical bill from Dr. Bowman in 
 
            the amount of $1,027.60.  No resistance to the application 
 
            was filed by defendants.  Rule 343 IAC 4.31 is unequivocal 
 
            in its language.  It provides that no evidence shall be 
 
            taken after the hearing.  Consequently, the evidence will 
 
            not be received into evidence pursuant to rule 343 IAC 4.31 
 
            and the application is denied.
 
            
 
                 Secondly, scattered throughout the medical evidence 
 
            submitted in this matter, there are references to pain that 
 

 
            
 
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            claimant was experiencing in her right wrist.  The eventual 
 
            diagnosis of claimant's discomfort was carpal tunnel 
 
            syndrome.  This injury is not part of the dispute in this 
 
            case and any references made to the carpal tunnel condition 
 
            in this decision have no bearing on any later claims the 
 
            claimant may make in regard to this injury.  
 
            
 
                                FINDINGS OF FACT 
 
            
 
                 After considering all of the evidence and the arguments 
 
            of counsel, the undersigned makes the following findings of 
 
            fact and conclusions of law. 
 
            
 
                 1.  At the time of the hearing, claimant was 46 years 
 
            old, divorced mother of three grown children.  Claimant left 
 
            school after she completed the 9th grade.  However, she 
 
            obtained her GED in 1986 as part of a personal program to 
 
            obtain further education.  Claimant lives in Red Oak, Iowa.
 
            
 
                 2.  After claimant left school, claimant got married 
 
            and worked at the Gold Crown Inn for several years.  While 
 
            she raised her family, claimant and her former husband 
 
            farmed.  She assisted with the farm operation, tended a 
 
            large vegetable garden, a rose garden and she raised 
 
            chickens.  After claimant was divorced, she accepted 
 
            employment as a waitress at the local Holiday Inn.  
 
            Eventually, claimant was promoted to Dining Room Manager and 
 
            Sales Representative arranging parties and banquets.  
 
            Claimant worked for Holiday Inn for 14 years.  She left when 
 
            the hotel came under new management.  At the time she left 
 
            in 1984, claimant was making approximately $200.00 per week.
 
            
 
                 3.  Claimant's next employment was for the Sheraton Inn 
 
            in Springfield, Missouri as the Banquet Director.  Claimant 
 
            was responsible for managing the food service and she was a 
 
            bar tender.  Claimant earned approximately $250.00 per week 
 
            plus tips.  In 1986, claimant decided to return to the Omaha 
 
            area and she took a job with the Holiday Inn in Omaha.  She 
 
            was hired as the Dining Room Manager and Food Service 
 
            Director.  Her job duties were not substantially different 
 
            from the duties she had while working in Springfield.  She 
 
            was responsible for planning, setting up and serving at 
 
            banquets.  Claimant's wage at the Holiday Inn was $225.00.  
 
            She worked in this capacity for one year until she returned 
 
            to Red Oak for personal reasons.
 
            
 
                 4.  Upon her return to Red Oak, claimant was employed 
 
            by Quality Furniture Store.  Claimant's duties included 
 
            appraising, buying, refinishing and selling both new and 
 
            used furniture.  Claimant was also responsible for payroll, 
 
            doing basic bookkeeping and banking.  Claimant was paid 
 
            approximately $200.00 per week plus an occasional sales 
 
            commission.
 
            
 
                 5.  Claimant left her employment with Quality Furniture 
 
            Store to accept employment with Eveready Battery Co. in July 
 
            of 1988.  Claimant was hired as a visual inspector.  
 
            Claimant's job duties required her to inspect finished 
 
            battery cases for imperfections and remove those cases which 
 
            did not meet the production standards.  This job, like the 
 

 
            
 
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            jobs that claimant had held all her life was not physically 
 
            strenuous.  Additionally, claimant volunteered for overtime 
 
            work which included painting and substituting for other 
 
            workers on the production line.
 
            
 
                 6.  Before claimant started with Eveready she had no 
 
            relevant medical history to speak of.  Claimant had no prior 
 
            problems with her back and had never been treated for any 
 
            back condition.
 
            
 
                 7.  In December of 1988, Eveready eliminated claimant's 
 
            position.  Claimant was given the opportunity to bid onto a 
 
            production line.  Claimant bid onto the body maker line and 
 
            became a body maker tender.  Claimant was primarily 
 
            responsible for lubricating, starting and operating the 
 
            assigned machines during the shift, cleaning the machines 
 
            and sweeping the area as required, clearing minor jams, 
 
            feeding blanks into the assigned machines from trays or 
 
            boxes, performing quality checks and recording data, 
 
            supplying empty boxes, removing full boxes, buffing out 
 
            burrs on tracks and rails that could cause scratches and 
 
            emptying chip trays.  Claimant's job required her to twist, 
 
            bend, stoop, and pull either metal blanks, finished battery 
 
            bodies or jammed blanks as these items went in and out of 
 
            the bodymaker machines.  Additionally, claimant was required 
 
            to lift boxes of metal blanks weighing approximately 35 
 
            pounds.  She lifted 5 of these boxes an hour to keep the 
 
            machine supplied.  Claimant's job required repetitive 
 
            movements of her back.
 
            
 
                 8.  On January 19, 1989, while at work, claimant bent 
 
            down at her work station and felt a sharp pain in her back.  
 
            Claimant finished her shift but then went to see her family 
 
            doctor, Dr. Artherholt.  Dr. Artherholt felt claimant had 
 
            sprained her back.  He referred claimant for physical 
 
            therapy.  He recommended that she return to her job for 
 
            three days on light duty.  Claimant returned to work in a 
 
            light duty position on January 23, 1989.  Dr. Artherholt 
 
            continued to treat claimant for her back pain while she was 
 
            assigned light duty work.  After claimant had been on light 
 
            duty, for about a week, a supervisor came to her and asked 
 
            her to fill in on a production line.  Claimant obliged and 
 
            while on duty on February 1, 1989, she bent over to pick up 
 
            a chunk of wax that weighed approximately 12 pounds and had 
 
            a sudden onset of increased low back pain.  Claimant left 
 
            work on February 1, 1989 due to pain.  Claimant saw the 
 
            plant physician, Dr. Reagan, on February 3, 1989 and then 
 
            saw Dr. Artherholt on February 6, 1989.  Claimant had pain 
 
            in the right lumbosacral area on the left, radiating to the 
 
            right, posterior, upper thigh and a little bit to the right 
 
            lower quadrant of the abdomen.  Claimant was also continuing 
 
            her physical therapy.  She reported the reinjury to the 
 
            therapist during the time period between February 3, 1989 
 
            and February 6, 1989.  On February 6, 1989 claimant's 
 
            physical therapy was discontinued.
 
            
 
                 9.  On February 6, 1989, Eveready announced a reduction 
 
            in force due to business conditions of approximately 18 
 
            employees.  Claimant was among the group of employees 
 
            subject to this layoff.   In order to select the employees 
 

 
            
 
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            that would be laid off, the employees with the same service 
 
            dates drew cards.  Claimant apparently drew the right card 
 
            and remained employed but off work due to an injury.
 
            
 
                 10. On February 7, 1989, claimant had a lumbar CT scan 
 
            that showed a mild accentuation of the lordotic lumbar 
 
            curve, a mild bulging of the L5-S1 disc and an L5 pars 
 
            defect.  The CT scan was ordered by Dr. Reagan and Dr. 
 
            Artherholt.  
 
            
 
                 11. On February 13, 1989, Aetna advised claimant's 
 
            counsel that it would authorize claimant to see Doctors 
 
            Reagan, Artherholt, Estes, a neurosurgeon, Fruin, a 
 
            neurosurgeon or Taylon for the treatment of her back.  Aetna 
 
            also advised that should claimant want to change medical 
 
            providers, she needed to make the request in writing and 
 
            Aetna would consider the request. Claimant was advised not 
 
            to obtain medical care without Aetna's approval.
 
            
 
                 12. Dr. Estes examined claimant on February 21, 1989.  
 
            He also found that she had a demonstrated pars defect.  This 
 
            structural anomaly accounts for the production and 
 
            exacerbation of back pain subsequent to repetitive maneuvers 
 
            which involve lifting.  His diagnosis of her condition was 
 
            musculoskeletal back pain with a coexistent 
 
            spondylolisthesis of the pars innerartiuclar of the L5-S1 
 
            complex.  The radiographic studies reviewed by Dr. Estes 
 
            revealed that claimant had an old fracture that was most 
 
            likely caused by degeneration of the joints connecting the 
 
            fifth lumbar vertebra.  Dr. Estes also concluded that 
 
            claimant's condition predisposed claimant to mechanical back 
 
            pain subsequent to strenuous physical activity such as 
 
            repetitive lifting and bending.  Claimant's current episode 
 
            of pain was caused by claimant's work but did not cause the 
 
            fracture to the nearby joints.  Dr. Estes also determined 
 
            that claimant's future employment should be tailored to her 
 
            predisposition and the she should not lift anything heavier 
 
            than 20 pounds in a repetitive fashion.  She also needed to 
 
            avoid stairs and prolonged sitting and standing for the near 
 
            term.  Thereafter, Dr. Estes recommended strict bed rest for 
 
            three weeks and a course of medication.  
 
            
 
                 13. Claimant's pain did not abate even though claimant 
 
            apparently followed Dr. Estes's recommendations regarding 
 
            bed rest and the medication he had prescribed.  On March 16, 
 
            1989, claimant returned to see Dr. Estes and her pain had 
 
            not improved.  Dr. Estes next ordered an EMG study from Dr. 
 
            Len Weber.  The EMG study was normal for her back.  Claimant 
 
            was seen again by Dr. Estes and he prescribed physical 
 
            therapy and a change in medication to Valium and Feldene.  
 
            Claimant was also asked to obtain flexion and extension 
 
            lumbar spine films.
 
            
 
                 14. At this juncture in her treatment, claimant was 
 
            unhappy with her course of treatment from Dr. Estes.  She 
 
            believed that the bed rest he had prescribed was unnecessary 
 
            and she refused to take the Valium.  In a terse reply to 
 
            claimant's counsel, Dr. Estes described the course of 
 
            treatment that had been recommended to claimant.  The 
 
            response indicates that claimant was seeking more aggressive 
 

 
            
 
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            and invasive testing than Dr. Estes felt was necessary to 
 
            reduce claimant's symptoms.  The debate appeared to center 
 
            around whether claimant had a defined disc problem with 
 
            resulting pressure on the nerves going into her legs or a 
 
            problem with the bones in her back.  Dr. Estes felt that the 
 
            complaints of pain were not attributable to the bulging disc 
 
            but rather stemmed from the pars defect aggravated by her 
 
            work activities.  Dr. Estes determined that claimant was 
 
            suffering from spondylolisthesis and he suggested that he 
 
            refer claimant on to an orthopedic surgeon for a second 
 
            opinion since a bone abnormality falls within the specialty 
 
            of an orthopedic surgeon rather than a neurological surgeon.
 
            
 
                 15. On May 2, 1989, Dr. Estes saw claimant for the last 
 
            time.  He examined her and noted that there had been no 
 
            improvement.  He concluded by indicating that he felt 
 
            conservative treatment was the appropriate course of action 
 
            to treat claimant's back.  Dr. Estes then referred claimant 
 
            to Dr. Bowman, an orthopedist, for further treatment.  
 
            Eveready received a copy of these progress notes and had 
 
            notice of the referral to Dr. Bowman.  Additionally, Dr. 
 
            Estes progress notes indicate that Dr. Bowman and Dr. Reagan 
 
            received copies of this report.
 
            
 
                 16. On May 5, 1989, Aetna again advised claimant 
 
            through her attorney that it would not pay for unauthorized 
 
            care.  Aetna further indicated that it felt that since there 
 
            were other doctors available to claimant within the 
 
            authorized group, she could continue to be treated by any of 
 
            those doctors.
 
            
 
                 17. Claimant was seen by Dr. Bowman on May 15, 1989.  
 
            At the conclusion of the examination, Dr. Bowman concluded 
 
            that claimant was suffering from spondylolysis at L5 and 
 
            chronic lumbar strain with radiculopathy.  Dr. Bowman also 
 
            recommended conservative treatment.  He recommended an 
 
            epidural steroid injection, an aerobic spine fitness 
 
            program, medication and a fabricated lumbar support.  He 
 
            also recommended that claimant return to school.  Dr. Bowman 
 
            also provided claimant with a continuing restriction from 
 
            work dependant upon claimant's response to the conservative 
 
            treatment.
 
            
 
                 18. On June 16, 1989, Eveready announced another 
 
            reduction in force.  This time claimant was among the group 
 
            of employees laid off.  In the event of a recall, claimant 
 
            would be the second person called back with her service 
 
            date.
 
            
 
                 19. Throughout the summer, claimant followed the 
 
            conservative course of treatment suggested by Dr. Bowman.  
 
            On July 25, 1989, Dr. Bowman indicated that claimant's old 
 
            job would not fit within her safe limitations.  However, Dr. 
 
            Bowman did indicate that factory work per se would not be 
 
            excluded from claimant's safe zone.  On August 8, 1989, 
 
            claimant requested surgery.  Dr. Bowman indicated that this 
 
            was an elective procedure involving quality of life issues.  
 
            The surgery was not necessary to correct a problem with 
 
            claimant's spinal chord.  There was no emergency associated 
 
            with this surgery.  Claimant felt that she had not benefited 
 

 
            
 
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            from the conservative course of treatment.  Dr. Bowman 
 
            proposed a bone mass fusion with the attendant procedures to 
 
            complete the fusion.
 
            
 
                 20. Dr. Bowman wrote to Aetna on August 8, 1989 to 
 
            advise that claimant had requested surgery.  Dr. Bowman 
 
            reported that claimant had severe exacerbation of her 
 
            symptoms when she tried to increase her level of activity.  
 
            Dr. Bowman indicated that he would cooperate if Aetna wanted 
 
            to get a second opinion.  Additionally, he predicted that a 
 
            vocational disposition could not be made until claimant was 
 
            6 months from the surgery date.
 
            
 
                 21. On August 21, 1989, Aetna wrote to claimant's 
 
            counsel and indicated that it wanted claimant to be 
 
            evaluated at Mayo Clinic in accordance with Dr. Bowman's 
 
            suggestion that a second opinion be obtained.  The 
 
            evaluation at Mayo Clinic was scheduled for mid October.  
 
            With this letter, Aetna advised claimant that since the 
 
            surgery was elective it would not pay for the surgery that 
 
            claimant had scheduled on September 5, 1989.
 
            
 
                 22. On August 26, 1989, Dr. Bowman indicated to Aetna 
 
            that surgical intervention is warranted when a patient has a 
 
            progressive slip or where the condition has not responded to 
 
            a course of conservative treatment.  Dr. Bowman indicated 
 
            that the surgery was not mandatory but a legitimate option 
 
            given claimant's current symptoms and treatment history.  
 
            Finally, Dr. Bowman indicated that the cause of claimant's 
 
            problem was linked to her job.  Generally, a 
 
            spondylolisthesis is totally asymtomatic and becomes 
 
            disabling as a result of an injury which then results in 
 
            chronic, intractable symptoms.  While the defect was 
 
            pre-existing, the disability that the claimant suffers from 
 
            day to day was a result of the work injury.
 
            
 
                 23. On September 6, 1989, Dr. Bowman performed a Gill 
 
            procedure, L-5, Edwards instrumentation,(spondylolisthesis), 
 
            lateral mass fusion, bilateral, L5-S1 and insertion of bone 
 
            stimulator on claimant.
 
            
 
                 24. In January of 1990, claimant began a course of 
 
            daily physical reconditioning with Midwest Rehabilitation 
 
            Services in Omaha.  Additionally, Aetna retained 
 
            Rehabilitation Professionals, Inc., to provided vocational 
 
            services for the claimant and to coordinate medical services 
 
            with Dr. Bowman's office and with Midwest Rehabilitation 
 
            Clinic.  The vocational rehabilitation specialist found 
 
            claimant to be highly motivated and proud of her 
 
            achievements.  During the first part of January 1990, 
 
            claimant began attending classes through the Iowa Southwest 
 
            Community College Extension Campus at Red Oak.  She intends 
 
            to get an associate degree and would like to get a four year 
 
            degree.  After claimant finishes her schooling, she wants to 
 
            get a job in sales or in public relations where she can use 
 
            her skill in working with the public.  As claimant began her 
 
            rehabilitation, she was still in a lay off status with 
 
            Eveready subject to recall.
 
            
 
                 25. Claimant attended the physical conditioning program 
 

 
            
 
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            with Midwest Rehabilitation regularly until February 23, 
 
            1990.  On that date she was given a functional capacity 
 
            assessment.  This assessment demonstrated that claimant was 
 
            capable of light to sedentary work with a lifting 
 
            restriction of around 22 pounds.  The rehabilitation 
 
            specialist felt that with further reconditioning, claimant's 
 
            overall functioning would improve.  At this juncture in her 
 
            recovery, the vocational specialist recommended that 
 
            claimant continue with the work hardening program at Midwest 
 
            Rehabilitation and attend sessions twice a week.
 
            
 
                 26. After February 23, 1990, claimant did not return to 
 
            Midwest Rehabilitation.  She went to school and participated 
 
            in a home exercise program that included a spa membership.  
 
            In May of 1990, claimant expressed an interest in returning 
 
            to Midwest Rehabilitation but she could not go unless she 
 
            was reimbursed for mileage by Aetna.  Even after the mileage 
 
            reimbursements had been arranged, claimant did not return to 
 
            Midwest Rehabilitation.  
 
            
 
                 27. On May 25, 1990, claimant was seen by Dr. Len 
 
            Weber, one of her initial treating physicians, for an 
 
            independent medical evaluation.  The examination and the 
 
            report were very thorough.  Dr. Weber found that claimant 
 
            had bilateral spondylolysis of L5, with grade I 
 
            spondylolisthesis at L5 on S1 becoming symptomatic with job 
 
            activities around December of 1988.  Additionally he found 
 
            that the treatment of claimant's condition had been a 
 
            surgical fusion at L5-S1.  Lastly, in connection with 
 
            claimant's back, Dr. Weber found that claimant still had 
 
            persistent low back discomfort, a residual of the injury and 
 
            the surgery.  Dr. Weber recommended that claimant lift no 
 
            more than 20 pounds frequently or 40 pounds occasionally, 
 
            with all lifting done out of a squat rather than a bent 
 
            forward position.  Claimant must also avoid repetitive 
 
            flexion or extension movements of the back as much as 
 
            possible.  Based upon Dr. Weber's findings and using the AMA 
 
            Guides, third edition, he assigned a 12 percent whole person 
 
            impairment to claimant.  This rating was specifically for a 
 
            fusion for spondylolysis and spondylolisthesis at a single 
 
            level with residual symptoms of back discomfort.  Dr. Weber 
 
            also concluded that the surgical procedure used by Dr. 
 
            Bowman was appropriate given claimant's failure to respond 
 
            to conservative treatment over a nine month period and her 
 
            subsequent(but partial) improvement after surgery.
 
            
 
                 28. On July 9, 1990, Dr. Bowman indicated that claimant 
 
            had a 20 percent impairment of the body as a whole based on 
 
            the AMA guides second edition.  Dr. Bowman indicated that 
 
            the Guide rates a Pars defect with a grade one slip as 
 
            having a 20 percent impairment.  In August, 1990, Dr. Bowman 
 
            again felt that claimant had a 20 percent impairment and 
 
            that her limitations and restrictions as outlined in the 
 
            functional capacity evaluation performed in February was an 
 
            accurate assessment of claimant's capacities and 
 
            limitations. 
 
            
 
                 29. Dr. Weber examined claimant again on November 2, 
 
            1990 for a follow up evaluation.  Dr. Weber found that there 
 
            had been no change in claimant's condition between the first 
 

 
            
 
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            examination he performed on May 25, 1990 and the November 
 
            examination.  He also believed that claimant had reached 
 
            maximum medical improvement at the time of the first 
 
            examination, on May 25, 1990.  Dr. Weber also reconfirmed 
 
            his impairment rating of 12 percent based upon the AMA 
 
            Guide, third edition and claimant's restrictions and 
 
            residual symptoms.  In connection with the rating he 
 
            provided the following explanation:
 
            
 
                 Please note that I used the current third edition, not 
 
            the second edition of the AMA Guides.  The impairment rating 
 
            was revised downward from 20 percent whole person impairment 
 
            in the second edition (see page 57, Table 53) for grade I or 
 
            grade II traumatic spondylolysis and spondylolisthesis, to 
 
            8% whole person impairment in the third edition (see page 
 
            73, table 49) for grade I or grade II unoperated 
 
            spondylolysis and spondylolisthesis or 12 percent whole 
 
            person impairment for operated single level 
 
            spondylolisthesis with residual symptoms.  I believe that 
 
            the third edition rating is more in line with what 
 
            impairment ratings are given for other back conditions 
 
            causing similar symptoms.
 
            
 
                 Since Dr. Weber used the more current AMA Guides, his 
 
            impairment rating will be adopted as the correct rating.  
 
            Additionally, since the AMA Guides third edition adopt only 
 
            an 8 percent impairment for an unoperated spondylolysis and 
 
            spondylolisthesis this impairment rating will be adopted as 
 
            the correct rating for this condition.
 
            
 
                 29. The date that claimant reached maximum medical 
 
            improvement has been a moving target throughout claimant's 
 
            recuperation period.  Dr. Weber believed that claimant had 
 
            reached maximum improvement in May of 1990.  Dr. Bowman gave 
 
            an impairment rating in July of 1990 and then agreed that 
 
            claimant had reached maximum medical improvement by August 
 
            of 1990.  More significantly, Dr. Bowman's impairment rating 
 
            did not change between July and August.  A review ofóDr. 
 
            Bowman's records indicates that while Dr. Bowman thought 
 
            that maximum healing would be reached in August, there was 
 
            no change or improvement noted in the claimant's condition 
 
            between May 18, 1990 and July 31, 1990.  Based on the date 
 
            that Dr. Bowman gave claimant her impairment rating, 
 
            claimant's healing period ended on July 9, 1990.
 
            
 
                 30. Eveready attempted to recall claimant from her lay 
 
            off status beginning on September 14, 1990.  Eveready had an 
 
            increase in sales and needed to temporarily call back 13 
 
            people.  Claimant could not be reached.  However, on 
 
            September 17, 1990, Eveready contacted claimant and advised 
 
            her that it would need an additional 20 people next week for 
 
            temporary assignments at the plant.  Claimant was advised 
 
            that if she wanted to return, Eveready would need a list of 
 
            her restrictions.  The list of restrictions was not provided 
 
            by claimant.  On September 28, 1990, claimant was again 
 
            contacted about returning to Eveready.  Diane Weaver 
 
            described the jobs that she had open and described the 
 
            lifting associated with each job.  Claimant had asked Dr. 
 
            Bowman for the restriction list and she had not received it 
 
            yet.  Claimant attempted contact with Dr. Bowman but to no 
 

 
            
 
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            avail.  Claimant was able to reach her attorney.  Claimant 
 
            told Diane Weaver that her attorney had a report from Dr. 
 
            Bowman that said she could not lift and could do no factory 
 
            work.  No such report was admitted into evidence and the 
 
            only reference to factory work restrictions is contained in 
 
            a letter dated July 25, 1989 and the possibility of factory 
 
            work is not ruled out.  Additionally, the functional 
 
            capacity evaluation adopted by Dr. Bowman contains no such 
 
            restrictions.  Claimant indicated that she would not take 
 
            any of the offered jobs but that if there was an opening in 
 
            the office to please let her know.
 
            
 
                 31. Claimant has made minimal effort to find other 
 
            employment since the offer of employment was made by 
 
            Eveready.  Job leads were provided to claimant at the end of 
 
            November 1990 and claimant did not follow up on these leads 
 
            until the days before the hearing on this matter.  Claimant 
 
            does however, maintain her status as a student at 
 
            Southwestern Community College.  The job leads provided to 
 
            claimant were for positions in Council Bluffs and Omaha.  
 
            The job market in Red Oak is limited.  The jobs available 
 
            provided a wage base of approximately $5.00 to $7.00 per 
 
            hour.  If claimant's average wage at these jobs is $6.00 per 
 
            hour she would earn approximately $240 per week.  While at 
 
            Eveready, claimant earned $9.13 per hour or about $365 per 
 
            week.
 
            
 
                 32. Claimant is seeking payment of the following 
 
            medical expenses:
 
            
 
                 9-5-89 to 9-23-89    Bergan Mercy          $800.00
 
            
 
                 Claimant is seeking payment of the following costs:
 
            
 
                 VENDOR             ITEM                COST
 
            
 
                 Creighton U.       Medical Information $50.00
 
                 Dr. Bowman         Report              $50.00
 
                 Dr. Weber          Report              $15.00
 
                 Dr. Bowman         Report              $50.00
 
                 Dr. Bowman         Med. Information    $50.00
 
                 Ind. Commr.        Filing Fee          $65.00
 
                 Dr. Bowman         Report              $50.00
 
                 PMS                Med. Records        $30.45
 
                 Dr. Bowman         Report              $50.00
 
                                    TOTAL:             $410.45
 
            
 
                               Conclusions of law 
 
            
 
                 1.  Whether a causal relationship exists between 
 
            claimant's claimed injuries and the claimed industrial 
 
            disability and the nature and extent of any entitlement to 
 
            benefits.
 
            
 
                 The parties have agreed that the claimant's injury 
 
            arose out of and in the course of her employment.  Claimant 
 
            must next demonstrate by a preponderance of the evidence 
 
            that the work related aggravation of her pre-existing back 
 
            condition on January 19, 1989 is causally related to the 
 
            disability on which she now bases her claim.  Bodish v. 
 

 
            
 
            Page  11
 
            
 
            
 
            
 
            
 
            Fischer, Inc., 133 N.W.2d 867, 868 (Iowa 1965);  Lindahl v. 
 
            L. O. Boggs, 18 N.W.2d 607,613-14 (Iowa 1945).  A 
 
            possibility is insufficient; a probability is necessary.  
 
            Burt v. John Deere Waterloo Tractor Works, 73 N.W.2d 732, 
 
            738 (Iowa 1955).  The question of causal connection is 
 
            essentially within the domain of expert testimony.  Bradshaw 
 
            v. Iowa Methodist Hospital, 101 N.W.2d 167,171 (Iowa 1960).  
 
            Expert medical evidence must be considered with all other 
 
            evidence introduced bearing on the causal connection.  Burt, 
 
            73 N.W.2d at 738.  The opinion of the experts need not be 
 
            couched in definite, positive or unequivocal language.  
 
            Sondag v. Ferris Hardware, 220 N.W.2d 903, 907 (Iowa 1974).  
 
            Moreover, the expert opinion may be accepted or rejected, in 
 
            whole or in part, by the trier of fact.  Sondag, 220 N.W.2d 
 
            at 907.  The weight to be given to such an opinion is for 
 
            the finder of fact, and that may be affected by the 
 
            completeness of the premise given the expert and other 
 
            material circumstances.  Bodish, 133 N.W.2d at 870; 
 
            Musselman, 154 N.W.2d at 133.  The Supreme Court has also 
 
            observed that greater deference is ordinarily accorded 
 
            expert testimony where the opinion necessarily rests on 
 
            medical expertise.  Sondag, 220 N.W.2d at 907.
 
            
 
                 Finally, the Supreme Court has consistently held that a 
 
            claimant may recover for a work connected aggravation of a 
 
            preexisting condition.  Almquist v. Shenandoah Nurseries, 
 
            254 N.W. 35,38 (Iowa 1934); Gosek v. Garmer and Stiles Co., 
 
            158 N.W.2d 731, 737 (Iowa 1968); Barz v. Oler, 133 N.W.2d 
 
            704, 707 (Iowa 1965); Olson v. Goodyear Service Stores, 125 
 
            N.W.2d 251, 256 (Iowa 1963); Yeager v. Firestone Tire & 
 
            Rubber Co., 112 N.W.2d 299, 302 (Iowa 1961); Ziegler v. 
 
            United States Gypsum Co., 106 N.W.2d 591, 595 (Iowa 1960).
 
            
 
                 In this instance the causal connection to claimant's 
 
            current disability was established by claimant's doctor, Dr. 
 
            Bowman and the defendants' doctor, Dr. Weber.  There is no 
 
            evidence in the record that suggests that claimant's 
 
            aggravation of a previously asymptomatic condition was 
 
            caused by anything but her activities at work.  The work 
 
            injury resulted in a permanent functional impairment for the 
 
            claimant that is compensable.  Consequently, claimant has 
 
            carried her burden on this point.
 
            
 
                 The more difficult question in this dispute is the 
 
            question of the extent of benefits claimant is entitled to 
 
            as a result of her injury.  Claimant urges that she entitled 
 
            to an odd-lot designation which results in a finding of 
 
            permanent total disability.  Defendants urge that claimant 
 
            is not an odd-lot employee and that she is capable of 
 
            returning to the competitive labor market.  Claimant has 
 
            failed to sustain her burden of going forward to show that 
 
            she is an odd-lot employee.  However, claimant has 
 
            demonstrated that she has suffered a loss in earning 
 
            capacity and will be compensated accordingly.
 
            
 
                 In examining the odd-lot question, there are two cases 
 
            that offer guidance.  In Guyton v. Irving Jensen Co., 373 
 
            N.W.2d 101, 105 (Iowa 1985) the Supreme Court adopted the 
 
            odd-lot doctrine.  Under this doctrine, the Court found that 
 
            a worker becomes an odd-lot employee when an injury makes 
 

 
            
 
            Page  12
 
            
 
            
 
            
 
            
 
            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.  In Hainey v. Protein Blender, 445 N.W.2d 398, 400 
 
            (Iowa App. 1989), the Court of Appeals provided some 
 
            explanation of the Guyton decision.  Among other things, the 
 
            court concluded that if a person has no reasonable prospect 
 
            of steady employment, that individual has no prospect of 
 
            material earning capacity.  Additionally, this standard 
 
            contemplates that the injured worker will take some 
 
            affirmative action to either find employment or take other 
 
            steps to improve the prospects for reemployment.  If the 
 
            injured worker remains unemployable even after this effort, 
 
            then an odd-lot designation can be made.  Guyton, 373 N.W.2d 
 
            at 105, Hainey, 445 N.W.2d at 400.  Such steps can include 
 
            vocational rehabilitation or making a reasonable effort to 
 
            obtain further training.  Pyle v. Carstensen Freight Lines, 
 
            Inc., File No. 753661, (Iowa Ind. Comm'r Appeal July 24, 
 
            1987).(claimant attempted to go to school but his heart pain 
 
            prevented him from pursuing this option.  Otherwise, he was 
 
            unemployable).
 
            
 
                 Ultimately, the application of the odd-lot doctrine 
 
            involves an allocation of the burden of production of 
 
            evidence.  The Supreme Court found that the burden of 
 
            persuasion on the issue of industrial disability always 
 
            remains with the worker.  If the evidence of the degree of 
 
            obvious physical impairment coupled with other factors such 
 
            as claimant's mental capacity, education, training or age 
 
            place claimant prima facie in the odd-lot category, the 
 
            burden then shifts to the employer to show that some kind of 
 
            suitable work is regularly and continuously available to the 
 
            claimant.  Guyton, 373 N.W.2d at 105; Hainey, 445 N.W.2d at 
 
            400.
 
            
 
                 In this case, claimant has failed to meet the prima 
 
            facie threshold that triggers application of the odd-lot 
 
            designation.  An examination of claimant's abilities after 
 
            her back fusion demonstrates that claimant is not an odd lot 
 
            employee.  Claimant is 46, literate, with a GED and some 
 
            advanced education.  Claimant has sufficient skills in 
 
            reading, math and interpersonal relationships and dynamics 
 
            to work with the public in a variety of jobs.  Moreover, 
 
            claimant's training and experience demonstrates that she is 
 
            capable of organizing an event, giving attention to detail 
 
            and supervising other workers.  Claimant has experience in 
 
            handling money and performing payroll duties and rudimentary 
 
            bookkeeping functions.  Claimant's physical impairment 
 
            certainly limits claimant's choices of employment in a 
 
            factory setting and otherwise.  However, even claimant's 
 
            doctor indicated that all factory work per se would not be 
 
            excluded from her limitations. 
 
            
 
                 The undisputed evidence in the record indicates that 
 
            claimant is capable of returning to a light sedentary 
 
            position right now in the food service industry or in a 
 
            sales position in Omaha, Council Bluffs or Red Oak at a wage 
 
            level comparable to what she was earning prior to her 
 

 
            
 
            Page  13
 
            
 
            
 
            
 
            
 
            employment with Eveready.  This prospect suggests that 
 
            claimant has a loss in earning capacity, but her combination 
 
            of physical impairment, education, age, and training do not 
 
            make her unemployable in the competitive labor market.  
 
            Claimant has not made a reasonable effort to look for work 
 
            within her restrictions to determine whether she is 
 
            incapable of obtaining employment in any well known branch 
 
            of the labor market.  Making a first contact with potential 
 
            employers a week before the hearing when claimant had been 
 
            provided with job leads at least a month earlier does not 
 
            demonstrate that claimant is incapable of being employed in 
 
            a well known branch of the labor market.  Moreover, even 
 
            though Eveready made overtures to discuss with claimant a 
 
            return to work within her restrictions, in September of 
 
            1990, claimant declined to pursue this alternative.
 
            
 
                 Claimant has chosen to pursue an educational option at 
 
            this juncture.  This choice is laudable and will presumably 
 
            enhance the eventual employability of the claimant.  But the 
 
            choice of this option alone will not support a finding of 
 
            odd-lot employee.  However, this conclusion does not 
 
            foreclose the possibility that sometime in the future, even 
 
            with additional education, claimant may discover that her 
 
            employment options are substantially limited or nonexistent 
 
            as a result of her back injury.  At that point, she may ask 
 
            to have her industrial disability reconsidered.
 
            
 
                 Claimant has suffered a functional impairment to the 
 
            body as a whole.  With an impairment to the body as a whole, 
 
            an industrial disability has been sustained.  Industrial 
 
            disability was defined in Diederich v. Tri-City Railway Co., 
 
            258 N.W.2d 899, 902 (Iowa 1935) as 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 person.  The essence of an earning 
 
            capacity inquiry then, is not how much has the claimant been 
 
            functionally impaired, but whether that impairment, in 
 
            combination with the claimant's age, education, work 
 
            experience, pre and post injury wages, motivation and 
 
            ability to get a job within her restrictions, if any 
 
            restrictions have been imposed, have caused a loss of 
 
            earning capacity.  Olson v. Goodyear Service Stores, 125 
 
            N.W.2d 251, 257 (Iowa 1963); Diederich v. Tri-City Railway 
 
            Co., 258 N.W. 899, 902 (Iowa 1935);  Peterson v. Truck Haven 
 
            Cafe, Inc., 1 Iowa Industrial Comm'r Dec. No. 3, 654, 658 
 
            (1985); Christening v. Hague, Inc., 1 Iowa Industrial Comm'r 
 
            Dec. No. 3, 529, 534-535 (1985).
 
            
 
                 There are no weighting guidelines that indicate how 
 
            each of the factors are to be considered.  There are no 
 
            guidelines which give, for example, age a weighted value of 
 
            ten percent of the total value, education a value of fifteen 
 
            percent of the total, motivation five percent of the total, 
 
            work experience thirty percent of the total etc.  Neither 
 
            does a rating of functional impairment directly correlate to 
 
            the 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 to the body as a whole.  It therefore becomes 
 
            necessary for the deputy or commissioner to draw upon prior 
 

 
            
 
            Page  14
 
            
 
            
 
            
 
            
 
            experience and general and specialized knowledge to make a 
 
            finding with regard to the degree of industrial disability.  
 
            See, Peterson, 1 Iowa Industrial Commissioner Decisions No. 
 
            3, at 658; Christening, 1 Iowa Industrial Commissioner 
 
            Decisions No. 3, at 535.
 
            
 
                 Several factors are pertinent in claimant's 
 
            circumstances.  Claimant is no longer able to perform the 
 
            type of work she was doing at Eveready at the time of her 
 
            injury.  Moreover, claimant is foreclosed from doing jobs 
 
            that require frequent stooping, bending, and lifting.  
 
            Claimant cannot lift amounts repetitively in excess of 20 
 
            pounds.  Claimant was earning $9.13 per hour at the time of 
 
            her injury.  The jobs identified for claimant by the 
 
            vocational rehabilitation specialist pay between $5.00 and 
 
            $7.00 per hour.  Claimant's pay differential is 
 
            approximately $3.13 per hour.  At claimant's age, in the 
 
            mid-forties, claimant is at the peak of her earning 
 
            capacity.  This makes claimant's loss more severe than it 
 
            would be for a younger or older worker.  Becke v. 
 
            Turner-Busch Inc., 34 Biennial Report 34, 36(Iowa Ind. 
 
            Comm'r Appeal 1979); Walton v. B & H Tank Corp., II Iowa 
 
            Industrial Commissioner Report 426, 429 (1981); McCoy v. 
 
            Donaldson Company, Inc., File Nos. 752670, 805300, Slip op. 
 
            at 6 (Iowa Ind. Comm'r Appeal April 28, 1989). 
 
            
 
                 There is however, an excellent chance that claimant 
 
            will be retrained as she is vigorously pursuing an advanced 
 
            degree with the help of the Iowa State Vocational 
 
            Rehabilitation program.  Claimant has declined to return to 
 
            Eveready even though Eveready offered to work with claimant 
 
            to determine if there were jobs available with Eveready 
 
            within claimant's restrictions.  Claimant has not seriously 
 
            looked for other work.  Finally, claimant did not complete 
 
            her course of work hardening in Omaha to maximize her 
 
            functional capacity.  
 
            
 
                 Based upon the foregoing factors, all of the factors 
 
            used to determine industrial disability, and employing 
 
            agency expertise, it is determined that claimant sustained a 
 
            30 percent industrial disability.
 
            
 
                 Claimant is also entitled to healing period benefits.  
 
            Healing period benefits may be characterized as that period 
 
            during which there is a reasonable expectation of 
 
            improvement of a disabling condition and ends when maximum 
 
            medical improvement is reached.  Armstrong Tire and Rubber 
 
            Co. v. Kubli, 312 N.W.2d 60, (Iowa Ct. App., 1981).  In 
 
            discussing the concept of healing period as contemplated by 
 
            Iowa Code Section 85.34(1) (1991) the Kubli Court observed 
 
            that recuperation refers to that condition in which healing 
 
            is complete and the extent of the disability can be 
 
            determined. Kubli, 312 N.W.2d at 65.  The healing period 
 
            generally terminates at the time the attending physician 
 
            determines that the employee has recovered as far as 
 
            possible from the effects of the injury. Kubli, 312 N.W.2d 
 
            at 65.  When a permanent rating is given, it indicates that 
 
            the physician does not expect the claimant to improve and 
 
            this conclusion meets the criteria of Iowa Code Section 
 

 
            
 
            Page  15
 
            
 
            
 
            
 
            
 
            85.34(1) and Thomas v. William Knudson & Sons, Inc., 349 
 
            N.W.2d 124, 126 (Iowa App. 1984).  The fact that a person 
 
            continues to receive medical care does not indicate that the 
 
            healing period continues.  Medical treatment which is 
 
            maintenance in nature often continues beyond that point when 
 
            maximum medical recuperation has been accomplished.  Medical 
 
            treatment that anticipates improvement does not necessarily 
 
            extend healing period particularly when the treatment does 
 
            not in fact improve the condition.  Tallman v. American Can 
 
            Co., 1 Iowa Industrial Commissioner Decisions No.4 1115, 
 
            1120 (Appeal 1985); Derochie v. City of Sioux City, II Iowa 
 
            Industrial Commissioner Report 112, 114 (1982).
 
            
 
                  Claimant's healing period ended on July 9, 1990.  On 
 
            this date, Dr. Bowman advised both Eveready and claimant 
 
            that she had a 20 percent functional impairment.  Even 
 
            though Dr. Bowman used the second edition of the AMA Guides, 
 
            he believed that claimant had a measurable impairment on 
 
            that date.  More significantly, claimant's rating did not 
 
            change between the July date and the August date urged by 
 
            claimant.  Consequently, claimant is entitled to healing 
 
            period benefits for the dates of January 20, 1989, February 
 
            2, 1989, February 3, 1989 and from February 6, 1989 to July 
 
            9, 1990.
 
            
 
                 The defendants have already paid claimant 100 1/7 weeks 
 
            of benefits through December 28, 1990.  Additionally, 
 
            defendants have paid claimant benefits from the date of the 
 
            hearing to the date of this decision.  Defendants shall have 
 
            a credit against all amounts awarded herein.  
 
            
 
                 2.  Whether claimant is entitled to medical benefits 
 
            including a determination of causal connection to the work 
 
            injury and the causal connection of this condition to a work 
 
            injury.
 
            
 
                 The next issue for resolution involves claimant's 
 
            entitlement to medical expenses.  Under Iowa Code section 
 
            85.27 (1991) an employer has the responsibility to provide 
 
            an injured worker with reasonable medical care and has the 
 
            right to select the care the worker will receive.  In order 
 
            for the employer to be held responsible for claimant's 
 
            medical expenses, claimant must show that the treatment 
 
            sought was either of an emergency nature or was authorized.  
 
            Templeton v. Little Giant Crane & Shovel, 1 State of Iowa 
 
            Industrial Commissioner Decisions No. 3, 702, 704 (Iowa Ind. 
 
            Comm'r Appeal 1985).  An employee may engage medical 
 
            services if the employer has expressly or impliedly conveyed 
 
            to the employee the impression that the employee has 
 
            authorization to proceed in this fashion.  2 Larson's 
 
            Workmen's Compensation Law Section 61.12(g) (1990).  
 
            However, even if the treatment is unauthorized a claimant 
 
            may still recover if the treatment improves the claimant's 
 
            condition and the treatment ultimately mitigates defendants' 
 
            liability.  Thomas v. Broadlawns Medical Center, File No. 
 
            81240, Slip op. at pp. 6-8 (Iowa Ind. Comm'r October 31, 
 
            1990);  Butcher v. Valley Sheet Metal, IV Iowa Industrial 
 
            Commissioner Report 49 (1983); Rittgers v. United Parcel 
 

 
            
 
            Page  16
 
            
 
            
 
            
 
            
 
            Service, III Iowa Industrial Commissioner Report 210 (1982).  
 
            The claimant has the burden of demonstrating that the 
 
            medical services obtained were related to the injury in 
 
            order to have the expenses reimbursed or paid.  Auxier v. 
 
            Woodward State Hospital, 266 N.W.2d 139, 144 (Iowa 1978).  
 
            
 
                 Based upon the analysis above, it is clear that 
 
            claimant has established that her injury is the cause of a 
 
            permanent disability.  As a consequence, the necessary nexus 
 
            has been established and Eveready must provide medical 
 
            benefits to claimant pursuant to Iowa Code section 85.27 
 
            (1991).
 
            
 
                 The question that remains is whether the medical care 
 
            received by the claimant was authorized by Eveready.  
 
            Immediately after claimant suffered her injury and before 
 
            claimant's petition was filed, Aetna was very aggressive in 
 
            taking control of claimant's care from the beginning of the 
 
            case.  Aetna gave claimant a choice of doctors and advised 
 
            claimant through correspondence with her attorney who the 
 
            authorized doctors were.  Claimant was not satisfied with 
 
            the care she was receiving from doctors designated by Aetna.  
 
            Claimant asked for a referral to Dr. Bowman.  Dr. Estes, one 
 
            of the authorized physicians obliged thus establishing the 
 
            necessary link from one authorized physician to the next.  
 
            Carnes v. Sheaffer Eaton, No. 836644, Slip op. at 6 (Iowa 
 
            Ind. Comm'r Arb. February 7, 1991); Munden v. Iowa Steel & 
 
            Wire, 33 Iowa Industrial Commissioner Biennial Report 99, 
 
            100 (Arb. 1979).  Consequently, Dr. Bowman was an authorized 
 
            physician after the referral by Dr. Estes.
 
            
 
                 The fighting issue is the authorization for the surgery 
 
            that claimant had on September 5, 1989.  Section 85.27 
 
            provides that the employer is entitled to direct the medical 
 
            care of the claimant.  As part of this privilege, the Code 
 
            requires the employer to supply prompt, reasonable care.  In 
 
            exercising the right to direct a worker's medical care, the 
 
            agency has found that the employer's desire to obtain a 
 
            second opinion is not an unreasonable request as long as the 
 
            request is made in a timely fashion.  See, Martin v. Armour 
 
            Dial, 2 Iowa Industrial commissioner Decisions No. 1 253, 
 
            258 (1985); Hensley v. Swift Independent Packing Co. 1 Iowa 
 
            Industrial Commissioner Decision No. 4, 881, 885 (Iowa 
 
            1981).  It should be noted that in both of these cases, the 
 
            request for a second opinion was found to be unreasonable 
 
            because the request came either within one or two days prior 
 
            to scheduled surgery.  While this authority is not binding, 
 
            it is persuasive authority.  This writer is persuaded by 
 
            this view that the request for a second opinion is 
 
            reasonable as long as the claimant's course of treatment is 
 
            not disrupted unnecessarily and the employer has offered an 
 
            appropriate alternative.
 
            
 
                 In this instance, the request for a second opinion was 
 
            reasonable and timely made.  There was no emergency.  Dr. 
 
            Bowman indicated that the proposed surgery, scheduled for 
 
            September 6, 1989 was elective.  Moreover, Dr. Bowman 
 
            invited a second opinion regarding the proposed surgery.  
 

 
            
 
            Page  17
 
            
 
            
 
            
 
            
 
            There was no suggestion that there would be any disruption 
 
            in claimant's treatment.  After Aetna had correspondence 
 
            with Dr. Bowman, it advised claimant by letter dated August 
 
            21, 1989 through her attorney, that prior to her surgery, it 
 
            wanted claimant to obtain a second opinion from Mayo Clinic.  
 
            Aetna had set up a tentative appointment for claimant for 
 
            some time in mid October.  Aetna also advised in the letter 
 
            dated August 21, 1989 that it would not authorize surgery at 
 
            this time and that if claimant proceeded she did so at her 
 
            peril.  Claimant went ahead with the surgery anyway.  As a 
 
            result, claimant's back surgery was unauthorized, and the 
 
            defendants are not liable for those costs including the 
 
            hosptial chagres owed to Bergan Mercy and any amounts owed 
 
            to Dr. Bowman.
 
            
 
                 Nor is claimant saved by the argument that the surgery 
 
            improved her condition, thus mitigating the liability of the 
 
            defendants.  In an unoperated state, claimant's back injury 
 
            resulted in a functional impairment of 8 percent to the body 
 
            as a whole.  After the operation, claimant's back fusion 
 
            resulted in a functional impairment of 12 percent to the 
 
            body as a whole.  Claimant continues to have low back pain.  
 
            This evidence indicates that the surgery did not improve 
 
            claimant's condition.
 
            
 
                 3.  The extent and assessment of costs for the action.
 
            
 
                 The final issue for resolution involves the extent and 
 
            assessment of costs in this matter.  Claimant urges that all 
 
            of the following items should be assessed as costs in this 
 
            dispute:
 
            
 
                 VENDOR             ITEM                COST
 
            
 
                 Creighton U.       Medical Information $50.00
 
                 Dr. Bowman         Report              $50.00
 
                 Dr. Weber          Report              $15.00
 
                 Dr. Bowman         Report              $50.00
 
                 Dr. Bowman         Med. Information    $50.00
 
                 Ind. Commr.        Filing Fee          $65.00
 
                 Dr. Bowman         Report              $50.00
 
                 PMS                Med. Records        $30.45
 
                 Dr. Bowman         Report              $50.00
 
                                    TOTAL:             $410.45
 
            In connection with the report limit included in this rule, 
 
            hospital records are treated as practioners reports.  Diede 
 
            v. Contemporary Industries Corp., 2 Iowa Industrial 
 
            Commissioner Decisions 492, 495 (Arb. 1985).
 
            
 
                 Clearly, rule 343 IAC 4.33 does not allow all of these 
 
            items to be assessed as costs. Claimant may seek payment.  
 
            Consequently the costs of this action will be as follows:
 
            
 
                 Filing Fee                   $65.00
 
            Creighton U.       Medical Information $50.00
 
            Dr. Bowman        Report               $50.00
 
                 TOTAL:       $165.00
 
            
 
                 These costs shall be assessed against the defendant.
 
            
 

 
            
 
            Page  18
 
            
 
            
 
            
 
            
 
                                      Order
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 1.  Eveready and Aetna shall pay to claimant healing 
 
            period benefits for the dates of January 20, 1989, February 
 
            2, 1989, February 3, 1989 and from February 6, 1989 to July 
 
            9, 1990 at the rate of two hundred and twenty-six and 30/100 
 
            dollars ($221.30).  As these benefits have accrued, they 
 
            shall be paid in a lump sum together with statutory interest 
 
            thereon pursuant to Iowa Code section 85.30 (1991).
 
            
 
                 2.  Eveready and Aetna shall pay to claimant permanent 
 
            partial disability benefits in the amount of thirty percent 
 
            (30%) with payment commencing on July 10, 1990.  As these 
 
            benefits have accrued, they shall be paid in a lump sum 
 
            together with statutory interest thereon pursuant to Iowa 
 
            Code section 85.30 (1991).
 
            
 
                 3.  Eveready and Aetna shall have a credit in the 
 
            amount of one hundred and one-sevenths weeks (100 1/7) to 
 
            December 28, 1990 against any amounts owed.  Eveready and 
 
            Aetna shall have a credit for weekly benefits paid from 
 
            December 29, 1990 to the date of this decision.  
 
            Additionally, Eveready and Aetna shall have a credit for 
 
            eight hundred fifty-eight and 60/100 dollars ($858.60) for a 
 
            medical bill paid by them.
 
            
 
                 4.  Eveready and Aetna shall not be liable for any 
 
            expenses associated with claimant's surgery to her back.
 
            
 
                 5.  The costs of this action totaling one hundred 
 
            sixty-five dollars ($165.00) shall be assessed Eveready and 
 
            Aetna pursuant to rule 343 IAC 4.33.
 
            
 
                 6.  Eveready and Aetna shall file claim activity 
 
            reports as required by rule 343 IAC 3.1.
 
            
 
     
 
            
 
            
 
            Page  19
 
            
 
            
 
            
 
            
 
            Signed and filed this ____ day of April, 1991.
 
            
 
            
 
            
 
            
 
                      
 
            ________________________________
 
                 ELIZABETH A. NELSON
 
                 DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr Sheldon M Gallner
 
            Attorney at Law
 
            803 Third Avenue
 
            PO Box 1588
 
            Council Bluffs Iowa 51502
 
            
 
            Mr Thomas M Plaza
 
            Attorney at Law
 
            200 Home Federal Building
 
            PO Box 3086
 
            Sioux City Iowa 51102
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                      5-1402.60; 5-1802; 5-1803
 
                      5-4100; 5-2907
 
                      Filed April 18, 1991
 
                      ELIZABETH A. NELSON
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            DARLENE HUNT,  :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File No. 921048
 
            EVEREADY BATTERY CO.,    :
 
                      :    A R B I T R A T I O N
 
                 Employer, :
 
                      :      D E C I S I O N
 
            and       :
 
                      :
 
            AETNA CASUALTY & SURETY CO.,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            5-1402.60
 
            Claimant was not authorized to have surgery for her back, 
 
            when the insurance carrier asked her to obtain a second 
 
            opinion at Mayo Clinic before she had surgery.  The request 
 
            for the second opinion was made well in advance of the 
 
            surgery.  Claimant went ahead with the surgery anyway.  The 
 
            treating physician had invited a second opinion prior to the 
 
            surgery.  Surgery did not improve claimant's condition in 
 
            that claimant's condition in the unoperated state caused an 
 
            8 percent functional impairment and in the operated state 
 
            caused a 12 percent functional impairment.  After the 
 
            surgery, claimant still suffered from persistent low back 
 
            pain.
 
            
 
            5-1802
 
            Claimant's healing period ended when the treating physician 
 
            gave a rating, even though he used the AMA Guides second 
 
            edition instead of the AMA Guides third edition.
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            5-1803, 5-4100
 
            Claimant, is 46 year old, literate, with readily 
 
            transferrable skills to another job in the competitive labor 
 
            market.  Claimant failed to make a prima facie case for odd 
 
            lot designation.  Claimant did demonstrate a loss of earning 
 
            capacity.  Claimant is no longer able to perform the type of 
 
            work she was doing at the time of her injury. Claimant is 
 
            foreclosed from doing jobs that require frequent stooping, 
 
            bending, and lifting.  Claimant cannot lift amounts 
 
            repetitively in excess of 20 pounds.  Claimant was earning 
 
            $9.13 per hour at the time of her injury.  The jobs 
 
            identified for claimant by the vocational rehabilitation 
 
            specialist pay between $5.00 and $7.00 per hour.  Claimant's 
 
            pay differential is approximately $3.13 per hour.  There is 
 
            however, an excellent chance that claimant will be retrained 
 
            as she is vigorously pursuing an advanced degree.  An 
 
            industrial disability of 30 percent was awarded.
 
            
 
            5-2907
 
            Claimant sought payment of costs for several doctors' 
 
            reports and hospital records.  In accordance with rule 343 
 
            IAC 4.33, the cost of two reports and the filing fee were 
 
            allowed.
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                      
 
            THOMAS PLATT,  
 
                      
 
                 Claimant, 
 
                                             File No. 921051
 
            vs.       
 
                                               A P P E A L
 
            IBP, INC.,     
 
                                              D E C I S I O N
 
                 Employer, 
 
                 Self-Insured,  
 
                 Defendant.     
 
            ___________________________________________________________
 
                             STATEMENT OF THE CASE
 
            
 
                 Defendant's appeal from an arbitration decision 
 
            awarding claimant 18 percent permanent partial disability 
 
            benefits.  
 
            
 
                 The record on appeal consists of the transcript of the 
 
            arbitration hearing and of joint exhibits A through XX.  
 
            Both parties filed briefs on appeal.
 
            
 
                                    ISSUES
 
                 
 
                 Defendant states the issues on appeal as:
 
            
 
                 1.  Whether the deputy industrial commissioner's 
 
            finding that claimant sustained a permanent injury is 
 
            contrary to the record and the law; 
 
            
 
                 2.  Whether the deputy industrial commissioner's 
 
            finding that the claimant is entitled to temporary partial 
 
            benefits was contrary to the record and the facts presented; 
 
            and
 
            
 
                 3.  Whether the deputy industrial commissioner's order 
 
            of healing period benefits for the time between November 11, 
 
            1988 and June 15, 1990 is contrary to the record and the 
 
            law.
 
            FINDINGS OF FACT
 
            
 
                 The arbitration decision adequately and accurately 
 
            reflects the pertinent findings and will not be totally 
 
            reiterated herein.  The following exception and additions 
 
            are made, however.
 
            
 
                 Claimant graduated from high school in 1978.  
 
            
 
                 William Hamsa, Jr., M.D., an orthopedic specialist 
 
            performed an independent medical examination of claimant at 
 
            claimant's request.  In a May 12, 1989 medical report, Dr. 
 
            Hamsa stated his impression that claimant suffered from 
 
            probable nonspecific tendinitis in both wrists and hands.  
 
            Dr. Hamsa further opined: 
 
            
 
                 I think this gentlemen's problem is job-related 
 
                 and unfortunately this is one of those difficult 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 situations, that if he cannot put up with his 
 
                 symptoms and work by his pain tolerance, he 
 
                 probably is going to have to find something else 
 
                 to do.  I think his doctor is on the right track 
 
                 in the way he is treating him and I often will use 
 
                 a cast for a short period of time to mobilize the 
 
                 wrist as this type of distress.  It would appear 
 
                 that the patient's main disability are persistence 
 
                 of symptoms rather than a percentage of 
 
                 disability.
 
            
 
                 John Walker, M.D., examined claimant on or about June 
 
            15, 1990.  Dr. Walker found claimant had grip strength of 
 
            110 kiloponts on the right and 82 kiloponts on the left.  
 
            Dr. Walker stated that claimant's grip was obviously "down 
 
            bilaterally for a man of [the claimant's] muscle 
 
            development."  Dr. Walker made the following diagnoses:  
 
            (1)  Over use stress syndrome of the right upper extremity 
 
            with stenosing tenosynovitis of the long flexor tendon of 
 
            the ring finger.
 
            (2)  Early low grade post-traumatic arthritis of the right 
 
            wrist.
 
            (3)  Over use stress syndrome involving the forearms, hands 
 
            and fingers of the left, upper extremity.
 
            (4)  Low grade, early, post-traumatic arthritis of the 
 
            radial carpal joint on the left.  
 
            (5)  A stenosing tenosynovitis of the flexor tendons of the 
 
            long finger, right hand.
 
            
 
                 Claimant underwent a preemployment physical in 1982.  
 
            Grip strength on testing then was 98 kilograms on the right 
 
            and 75 kilograms on the left.  
 
            
 
                 J. Michael Donohue, M.D., performed an independent 
 
            medical examination on January 29, 1991.  Claimant's grip 
 
            strength then measured, on three sequences, 95, 85, and 85, 
 
            on the right and 80, 75, and 80, on the left.  
 
            
 
                                CONCLUSIONS OF LAW
 
            
 
                 The citations of law in the arbitration decision are 
 
            appropriate to the issues and the evidence with the 
 
            following additions:
 
            
 
                 A treating physician's testimony is not entitled to 
 
            greater weight as a matter of law than that of a physician 
 
            who later examines claimant in anticipation of litigation.  
 
            Weight to be given testimony of physician is a fact issue to 
 
            be decided by the industrial commissioner in light of the 
 
            record the parties develop.  In this regard, both parties 
 
            may develop facts as to the physician's employment in 
 
            connection with litigation, if so; the physician's 
 
            examination at a later date and not when the injuries were 
 
            fresh; his arrangement as to compensation; the extent and 
 
            nature of the physician's examination; the physician's 
 
            education, experience, training, and practice; and all other 
 
            factors which bear upon the weight and value of the 
 
            physician's testimony.  Both parties may bring all this 
 
            information to the attention of the factfinder as either 
 
            supporting or weakening the physician's testimony and 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            opinion.  All factors go to the value of the physician's 
 
            testimony as a matter of fact not as a matter of law.  
 
            Rockwell Graphic Systems, Inc. v. Prince, 366 N.W.2d 176, 
 
            192 (Iowa 1985).
 
            
 
                 An expert's opinion based on an incomplete history is 
 
            not necessarily binding on the commissioner but must be 
 
            weighed with other facts and circumstances.  Musselman v. 
 
            Central Telephone Co., 261 Iowa 352, 360, 154 N.W.2d 128, 
 
            133 (1967).  
 
            
 
                 Under Iowa Code section 17A.14(5) this agency's 
 
            experience, technical competence, and specialized knowledge 
 
            may be utilized in the evaluation of the evidence.  
 
            
 
                 The analyses of the evidence and the conclusions of law 
 
            the deputy reached as regards the issues of whether claimant 
 
            received an injury which arose out of and in course of 
 
            claimant's employment; whether a causal relationship exists 
 
            between claimant's injury and claimed disability; whether 
 
            claimant is entitled to temporary partial disability 
 
            benefits; and whether claimant is entitled to payment of 
 
            certain medical costs under section 85.27 and section 85.39 
 
            are adopted and will not be reiterated herein.  
 
            
 
                 The deputy's decisions as to claimant's entitlement to 
 
            healing period benefits and claimant's entitlement to 
 
            permanent partial disability benefits are modified as 
 
            follows:
 
            
 
                 Under section 85.34(1) claimant is entitled to healing 
 
            period benefits until the first to occur of three events, 
 
            namely: 1) claimant has returned to work; 2) significant 
 
            improvement from the injury is not anticipated; or 3) until 
 
            the employee is medically capable of returning to employment 
 
            substantially similar to the employment in which the 
 
            employee was engaged at the time of the injury.  
 
            
 
                 Claimant had returned to work prior to his July 1989 
 
            termination with employer.  From the record as a whole it 
 
            appears that his work return was intermittently part-time or 
 
            light duty.  Indeed, claimant's position when terminated was 
 
            a light duty position.  Given that the part-time and light 
 
            duty positions may well have resulted in a lessor income 
 
            than claimant would have received had he returned to his 
 
            position at the time of the injury, those returns to work 
 
            are, as the deputy concluded, best characterized as periods 
 
            of temporary partial disability and not as a return to work 
 
            for the purposes of section 85.34(1).  Dr. Donohue, 
 
            claimant's treating physician, on September 8, 1989 clearly 
 
            opined that claimant had reached maximum medical 
 
            improvement, however.  Dr. Donohue also saw claimant on 
 
            December 15, 1989 at which time the doctor essentially 
 
            released claimant from the doctor's care stating that should 
 
            claimant's symptoms change he would reevaluate claimant in 
 
            the future.  The evidence does not show that claimant 
 
            received medical care from other physicians subsequent to 
 
            either September 8, 1989 or December 15, 1989.  Indeed, the 
 
            evaluation of December 15, 1989 appears to have been a 
 
            follow-up examination only and not an examination for 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            rendering of additional care.  Given such, Dr. Donohue's 
 
            opinion that claimant had reached maximum medical 
 
            improvement as of September 8, 1989 is the best and most 
 
            objective evidence relative to the appropriate termination 
 
            point for claimant's healing period.  Claimant is entitled 
 
            to healing period benefits for those times actually off work 
 
            from his date of injury through September 8, 1989.  
 
            
 
                 We consider the question of claimant's entitlement to 
 
            permanent partial disability.  
 
            
 
                 As the deputy noted, Dr. Walker, who examined claimant 
 
            at claimant's request, has given claimant impairment ratings 
 
            of 24 percent of the right upper extremity and 21 percent of 
 
            the left upper extremity.  Twenty-four percent of the right 
 
            upper extremity converts to 14 percent of the body as a 
 
            whole.  Twenty-one percent of the left upper extremity 
 
            converts to 13 percent of the body as a whole.  Under the 
 
            combined values chart of the AMA Guides 14 and 13 percent 
 
            body as a whole ratings convert to a 25 percent combined 
 
            value body as a whole rating.  Dr. Walker also restricted 
 
            claimant from repetitive use of his hands, fingers, wrists, 
 
            forearms and upper extremities bilaterally.  
 
            
 
                 Dr. Donohue, claimant's treating physician, stated that 
 
            the objective findings did not support a rating of permanent 
 
            partial impairment.  Dr. Donohue did indicate that claimant 
 
            should avoid repetitive use of his upper extremities with 
 
            respect to wrist flexion and extension or gripping 
 
            activities bilaterally.  
 
            
 
                 Dr. Hamsa, an orthopedic specialist who also examined 
 
            claimant at claimant's request, opined that claimant's 
 
            condition was more a matter of persistent symptoms than a 
 
            matter of objectively rateable permanent partial impairment.
 
            
 
                 Dr. Walker's permanency rating is suspect on a number 
 
            of grounds.  Initially, Dr. Walker's impairment rating with 
 
            the impairment attributable to the work injury is based on 
 
            an incomplete history.  While it may be true that claimant's 
 
            grip strength was less than the norm for an individual of 
 
            claimant's muscle development, it appears that claimant's 
 
            grip strength was at least as good or better on examination 
 
            with Dr. Walker than claimant's grip strength had been on 
 
            examination at the time of his pre-employment physical and 
 
            at the time of Dr. Donohue's January 29, 1991 evaluation of 
 
            claimant's grip strength where values obtained were 
 
            consistent with values obtained in 1982.  Hence, it cannot 
 
            be said that claimant's work-related injury has contributed 
 
            significantly, if at all, to any reduction to claimant's 
 
            grip strength.  To the extent that Dr. Walker's ratings of 
 
            permanent partial impairment reflect Doctor's erroneous 
 
            conclusions relative to claimant's grip strength, Dr. 
 
            Walker's opinions must be discounted.  
 
            
 
                 Additionally, Dr. Walker had evaluated claimant's 
 
            impairment as an impairment to the upper extremities and as 
 
            fairly significant impairment to the upper extremities.  The 
 
            diagnoses which Dr. Walker provides, with the exceptions of 
 
            his statement of overuse syndrome of the right and left 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            upper extremities and the left forearm is (sic) all involve 
 
            claimant's fingers, wrists or hands.  Given that claimant's 
 
            diagnoses and symptoms are predominantly located in the 
 
            wrist, hands and fingers the doctor's opinions as to 
 
            impairment in the upper extremities overall appear 
 
            significantly higher than impairments generally found with 
 
            such conditions.  Furthermore, both the treating physician, 
 
            also a reputable orthopedic specialist who had much more 
 
            sustained long-term contact with claimant, and claimant's 
 
            own other evaluating physician, that is Dr. Hamsa, have 
 
            opined that claimant's condition is not one where objective 
 
            findings warrant assignation of percentage of permanent 
 
            partial impairment.  Given such, it is most curious that Dr. 
 
            Walker's opinions as to percentage of permanent partial 
 
            impairment in the upper extremities is so great.  Indeed, 
 
            Dr. Donhoue and Dr. Hamsa's statements and findings are such 
 
            that this case appears analogous to that of a lower back 
 
            injury where the evidence establishes some incident of 
 
            injury and where pain has persisted for six months or longer 
 
            without significant objective findings or need for surgical 
 
            intervention.  Under the AMA Guides, Third Edition, those 
 
            conditions are considered to result in a five percent 
 
            permanent partial impairment to the body as a whole.  A like 
 
            finding is appropriate in claimant's circumstance and is 
 
            consistent with the intent of section 85.34(2)(s) that 
 
            simultaneous injuries to two members be evaluated on a 500 
 
            week basis but without consideration of industrial 
 
            disability.  Claimant is found to have sustained a permanent 
 
            partial disability of five percent of the body as a whole.  
 
            
 
                 WHEREFORE, the decision of the deputy is affirmed and 
 
            modified.
 
            
 
                           
 
            
 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
                                      ORDER
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 Defendant pay claimant permanent partial disability 
 
            benefits for twenty-five (25) weeks at the rate of two 
 
            hundred forty-eight and 47/100 dollars ($248.47) per week 
 
            commencing September 9, 1989.
 
            
 
                 Defendant pay claimant healing period benefits for the 
 
            time claimant was actually off work from November 15, 1988 
 
            through September 8, 1989.
 
            
 
                 Defendant pay claimant temporary partial disability 
 
            benefits for the time he was required to work on a part-time 
 
            or light duty basis from November 15, 1988 through July 11, 
 
            1989.
 
            
 
                 Defendant pay medical benefits and transportation 
 
            expenses pursuant to Iowa Code sections 85.27 and 85.39.
 
            
 
                 Defendant pay accrued amounts in a lump sum.  
 
            
 
                 Defendant receive credit for weekly benefits previously 
 
            paid.  
 
            
 
                 Defendant pay interest pursuant to Iowa Code section 
 
            85.30.  
 
            
 
                 Defendant pay costs of this appeal, including the costs 
 
            of transcription of the arbitration hearing.
 
            
 
                 Defendant file claim activity reports pursuant to rule 
 
            343 IAC 3.1(2).
 
            
 
                 Signed and filed this ____ day of April, 1993.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          BYRON K. ORTON
 
                                          INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. Steve Hamilton
 
            Attorney at Law
 
            606 Ontario Street
 
            PO Box 188
 
            Storm Lake, IA  50588
 
            
 
            Mr. John Comer
 
            Attorney at Law
 
            PO Box 515
 
            Dakota City, NE  68731
 
            
 
 
            
 
            Page   1     
 
            
 
            
 
            
 
            
 
                                         1801.1, 1802, 1803, 1808
 
                                         Filed April 29, 1993
 
                                         Byron K. Orton
 
                      
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
            ____________________________________________________________
 
                      
 
            THOMAS PLATT,  
 
                      
 
                 Claimant, 
 
                                             File No. 921051
 
            vs.       
 
                                              A P P E A L
 
            IBP, INC.,     
 
                                             D E C I S I O N
 
                 Employer, 
 
                 Self-Insured,  
 
                 Defendant.     
 
            ___________________________________________________________
 
            Decision of the deputy affirmed and modified.
 
            
 
            1801.1
 
            
 
                 Held that, where claimant returned to light duty and 
 
            part-time work or both with employer who subsequently 
 
            terminated claimant, deputy properly concluded claimant was 
 
            entitled to temporary partial disability during periods 
 
            prior to claimant's termination in which claimant's wages 
 
            were less than when injured because claimant was employed in 
 
            a part-time or light duty status.
 
            
 
            1802
 
            
 
                 Held that, claimant was entitled to healing period 
 
            benefits for those times when claimant was actually off work 
 
            on account of his injury from claimant's injury date to the 
 
            date on which claimant's treating physician opined claimant 
 
            had reached maximum medical improvement, a time 
 
            approximately two months subsequent to the employer's 
 
            termination of claimant.
 
            
 
            1803; 1808
 
            
 
                 Treating orthopedic specialist and one of claimant's 
 
            two examining orthopedic specialists opined claimant had no 
 
            permanency rating.  Claimant's second examining orthopedic 
 
            specialist gave a significant rating to the upper 
 
            extremities.  That rating was based on an incomplete 
 
            history.  Claimant's restrictions were largely related to 
 
            his forearms, wrists, hands and fingers.  Claimant had a 
 
            documented cumulative trauma involving overuse syndrome of 
 
            the left forearm and of both wrists, hands and fingers.  
 
            Claimant had persistent symptoms more than six months after 
 
            the injury and a lack of objective findings.  Claimant's 
 
            circumstances were found similar to those of an individual 
 
            with a documented back injury without objective findings and 
 

 
            
 
            Page   2     
 
            
 
            
 
            
 
            
 
            with pain persisting for at least six months after the 
 
            injury.  Five percent permanent partial disability awarded 
 
            under section 85.34(2)(s).
 
            
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            THOMAS PLATT,                 :
 
                                          :
 
                 Claimant,                :      File No. 921051
 
                                          :
 
            vs.                           :    A R B I T R A T I O N
 
                                          :
 
            IBP, INC.,                    :      D E C I S I O N
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ___________________________________________________________
 
            
 
                 
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Thomas 
 
            Platt against IBP, Inc., as employer and self-insured.  Mr. 
 
            Platt bases his claim upon an alleged injury occurring on 
 
            November 15, 1988.  In accordance with the prehearing report 
 
            and hearing assignment order, the parties submit the 
 
            following issues for resolution:
 
            
 
                 1.  Whether claimant received an injury which arose out 
 
            of and in the course of his employment;
 
            
 
                 2.  Whether there is a causal relationship between the 
 
            alleged injury and the disability;
 
            
 
                 3.  Whether claimant is entitled to temporary 
 
            disability, healing period benefits or permanent partial or 
 
            permanent total disability benefits;
 
            
 
                 4.  Whether claimant is entitled to temporary partial 
 
            disability benefits; and,
 
            
 
                 5.  Whether claimant is entitled to reimbursement for 
 
            an independent medical examination, pursuant to Iowa Code 
 
            section 85.39.
 
            
 
                 The case was heard and fully submitted at Storm Lake, 
 
            Iowa on March 26, 1991.  The record consists of testimony 
 
            from Thomas Platt and Carol Sebben; and, joint exhibits 
 
            A-XX.
 
            
 
                     
 
            
 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            findings of fact
 
            
 
                 The undersigned deputy, having heard all of the 
 
            testimony and having reviewed all of the evidence received, 
 
            finds the following facts:
 
            
 
                 Thomas Platt, claimant, was born on December 25, 1959.  
 
            He graduated from Crestland High School in Early, Iowa in 
 
            1959.  After graduation, he attended Black Hawk College, 
 
            taking courses in heavy machinery and millwright work.  
 
            After three months, claimant quit school and began 
 
            employment as an electrician's helper for Platt Electric 
 
            Company, his father's business.
 
            
 
                 From July through August of 1978, claimant worked in 
 
            the construction field.  He then moved to Davenport and 
 
            worked at Service Rubber in Rock Island, Illinois until May 
 
            of 1982.
 
            
 
                 Claimant returned to Early, Iowa and in August of 1982 
 
            began working for TASCO, a construction company from Texas 
 
            hired to refurbish various packing plants for IBP.  
 
            Claimant's position required him to help build walls and 
 
            various other general construction duties. 
 
            
 
                 In September of 1982, claimant was hired to work for 
 
            defendant IBP.  In his more than seven years with the 
 
            company, claimant has held a variety of positions for the 
 
            IBP plant in Storm Lake, Iowa.
 
            
 
                 In his first two years at IBP, claimant worked as a 
 
            picnic skinner.  This position required him to take the hide 
 
            off of meat which was moved by a conveyor belt.  Claimant 
 
            stated he worked 10 hours per day for six days a week, and 
 
            skinned between 400 and 500 pieces per hour.  During this 
 
            time, claimant had no absences or reported injuries.
 
            
 
                 Claimant then tried to bid to another position called 
 
            boning picnics.  He performed this job for approximately six 
 
            weeks, and did not qualify for the position.  He was then 
 
            sent back to the picnic skinner position, where he was 
 
            frozen on the job for one year.
 
            
 
                 In approximately 1985, claimant bid to a boxing job 
 
            which required him to take meat from the line, place it in a 
 
            box, weigh the box, and then put the box on a pallet.  
 
            Claimant stated he made the boxes at the same time, which 
 
            required him to place a plastic liner in the box prior to 
 
            putting the meat into the box.  Claimant stated that the 
 
            boxes ordered were too big, and he was required to stretch 
 
            the plastic over the box.  At this point, claimant voiced 
 
            initial complaints about thumb, wrist and hand pain.  He 
 
            continued on this job for approximately one year.
 
            
 
                 Eventually, claimant was placed back on the picnic 
 
            skinner job.  He began to encounter more problems with his 
 
            upper extremities, and sought treatment from R. A. 
 
            Dierwechter. M.D.  Although there are no records from Dr. 
 
            Dierwechter which clearly identify that claimant was being 
 
            treated for physical problems with his hands or upper 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            extremities, and claimant returned to his regular job 
 
            duties.  (Joint Exhibit TT, pp. 41-42; Joint Ex. P; Jt. Ex. 
 
            Q)
 
            
 
                 Claimant next bid on a box shop position as a loin tray 
 
            former.  This night shift position required claimant to load 
 
            a hopper with cardboard boxes, wait until the machine had 
 
            folded the boxes, and then claimant manually flipped the lid 
 
            of the box to its specified position.  He performed this job 
 
            for two years, and then bid into a position as a floor 
 
            janitor.  This position required claimant to shovel and run 
 
            a squeegee to pull fat across the floor.  He was also 
 
            required to unload tubs of fat.
 
            
 
                 The evidence in the case indicates that claimant had 
 
            complained of hand and finger pain as far back as June of 
 
            1984, and continuing through November of 1988, and he has 
 
            alleged an injury of November 15, 1988.  The medical records 
 
            from the defendant employer reflect that claimant finally 
 
            received medical care from the company doctor on November 
 
            10, 1988.  (Jt. Ex. U, p. 8)  Claimant was initially treated 
 
            by S. Wulfekuher, M.D., on November 10, 1988.  Dr. 
 
            Wulfekuher's notes indicate that claimant complained of 
 
            numbness in the hands.  There was a loss of sensation over 
 
            the palmar and dorsal surfaces of both hands.  Nerve 
 
            conduction studies were ordered.  (Jt. Ex. II; Jt. Ex. GG)  
 
            These tests were normal, with no evidence of carpal tunnel 
 
            syndrome.  (Jt. Ex. S)  
 
            
 
                 Claimant returned to Dr. Wulfekuher on December 8, 
 
            1988.  On this visit, claimant was diagnosed as having mild 
 
            lateral epicondylitis (tennis elbow), bilaterally.  (Jt. Ex. 
 
            II)  Claimant was to return to work with avoidance of 
 
            shoveling duties for 4-8 weeks.  (Jt. Ex. JJ)  The employer 
 
            was aware of this restriction, however, claimant was 
 
            returned to a job which required shoveling duties.  (Jt. Ex. 
 
            U, p. 9)
 
            
 
                 Claimant continued to have problems, continued to work 
 
            with the medical staff secured by IBP, and continued to have 
 
            restrictions of no repetitive grasping or use of a shovel.  
 
            (Jt. Ex. U, p. 10)  Yet, claimant was continually placed 
 
            upon his regular job which involved grasping the handle of a 
 
            shovel or squeegee.
 
            
 
                 Claimant was eventually referred to J. Michael Donohue, 
 
            M.D.  Dr. Donohue's notes indicate that claimant was 
 
            evaluated for bilateral forearm discomfort and intermittent 
 
            numbness in both hands on March 29, 1988. 
 
            
 
                 Dr. Donohue's assessment was probably posterior inner 
 
            osseous nerve entrapment, more pronounced on the right than 
 
            left.  No objective or clinical findings were consistent 
 
            with carpal tunnel syndrome.  Dr. Donohue related the nerve 
 
            entrapment to the forearm discomfort of claimant, and 
 
            recommended rigid immobilization of the wrist with a cast on 
 
            the right forearm.  Claimant was to be re-evaluated in four 
 
            weeks.
 
            
 
                 Claimant was released to return to work on a job which 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            involved picking up pieces of fat from a belt and dropping 
 
            them into a bucket.  
 
            
 
                 Claimant returned to Dr. Donohue on a April 26, 1989.  
 
            Although the right forearm discomfort had resolved, 
 
            claimant's left arm displayed moderate tenderness over the 
 
            extensor muscular.  Claimant was fitted with a short arm 
 
            cast on the left upper extremity, and a bi-valved cast on 
 
            the right arm to be used at work.  He was to be re-evaluated 
 
            in four weeks.
 
            
 
                 Claimant returned to Dr. Donohue on May 24, 1989.  At 
 
            that time, his condition had improved, and Dr. Donohue 
 
            released him to return to work on the line for two hours a 
 
            day, with the remainder of his shift fulfilled with 
 
            activities that avoided repetitive pushing, pulling or 
 
            gripping activities with his upper extremities.  Dr. Donohue 
 
            progressively increased claimant's activities on the line, 
 
            and beginning July 26, 1989, claimant was to work 8 hours 
 
            per day on the line.  (Jt. Ex. F, p. 5)
 
            
 
                 Claimant was subsequently terminated on July 11, 1989.
 
            
 
                 Claimant returned to Dr. Donohue in July and August of 
 
            1989, with complaints of upper extremity pain.  He was 
 
            diagnosed as having overuse syndrome to both upper 
 
            extremities, however no objective findings pointed to 
 
            permanent impairment.  An EMG was ordered, although Dr. 
 
            Donohue opined that if the results were negative, claimant 
 
            could return to regular activities with no further medical 
 
            intervention.  His final diagnosis was that of bilateral 
 
            upper extremity dysfunction, with subjective complaints 
 
            out-weighing objective findings.  (Jt. Ex. F, pp. 6-7)
 
            
 
                 Claimant returned to Dr. Donohue in September and 
 
            December of 1989, with negative results from the EMG and 
 
            serological tests.  Again, Dr. Donohue was of the opinion 
 
            that claimant had bilateral upper extremity dysfunction.
 
            
 
                 Dr. Donohue's final opinion came on January 29, 1991.  
 
            His assessment remained the same, as he diagnosed claimant's 
 
            problem as bilateral upper extremity dysfunction with 
 
            objective findings including a nodularity in the flexion 
 
            tendon of the right long finger, ring and small fingers.  
 
            Additionally, there was a nodule on the ring and small 
 
            finger on the left hand.  Potential treatment included a 
 
            release of the A1 pulley of the right long finger.  Dr. 
 
            Donohue was of the opinion that claimant had sustained no 
 
            permanent injury.  However, he imposed restrictions of 
 
            avoiding repetitive use of the upper extremities with 
 
            respect to wrist flexion and extension and gripping 
 
            activities.  (Jt. Ex. C)
 
            
 
                 Prior to Dr. Donohue's final evaluation, claimant 
 
            underwent an independent medical examination with John 
 
            Walker, M.D, an orthopedic specialist.  Dr. Walker also 
 
            found overuse and stress syndrome of the forearms, hands and 
 
            wrists, bilaterally.  Based upon his evaluation and review 
 
            of tests results, Dr. Walker made the following assessment 
 
            with regards to claimant's impairment:
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            
 
                    As far as the right, upper extremity is 
 
                 concerned, it is my opinion that he has a 
 
                 permanent, partial impairment amounting to 24% of 
 
                 the right, upper extremity.
 
            
 
                    As far as the left upper extremity is 
 
                 concerned, it is my opinion that he has a 
 
                 permanent, partial impairment amounting to 21% of 
 
                 the left, upper extremity.
 
            
 
            (Jt. Ex. A, p. 6)
 
            
 
                         analysis and conclusions of law
 
            
 
                 The first issue to be addressed is whether claimant 
 
            received an injury which arose out of and in the course of 
 
            his employment with IBP, Inc.
 
            
 
                 An employee is entitled to compensation for any and all 
 
            personal injuries which arise out of and in the course of 
 
            the employment.  Section 85.3(1).
 
            
 
                 Claimant has the burden of proving by a preponderance 
 
            of the evidence that he received an injury on November 15, 
 
            1988 which arose out of and in the course of his employment. 
 
            McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 
 
            1976); Musselman v. Central Telephone Co., 261 Iowa 352, 154 
 
            N.W.2d 128 (1967). 
 
            
 
                 The injury must both arise out of and be in the course 
 
            of the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 
 
            Iowa 402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 
 
            of the Iowa Report.  See also Sister Mary Benedict v. St. 
 
            Mary's Corp., 255 Iowa 847, 124 N.W.2d 548 (l963) and Hansen 
 
            v. State of Iowa, 249 Iowa 1147, 91 N.W.2d 555 (1958).
 
            
 
                 The words "out of" refer to the cause or source of the 
 
            injury.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 402, 
 
            68 N.W.2d 63 (1955). 
 
            
 
                 The words "in the course of" refer to the time and 
 
            place and circumstances of the injury.  McClure v. Union 
 
            et al. Counties, 188 N.W.2d 283 (Iowa 1971); Crowe, 246 Iowa 
 
            402, 68 N.W.2d 63.
 
            
 
                 The evidence suggests that claimant began complaining 
 
            of pain in the finger, hands, wrists and forearms in 1984.  
 
            The positions he has held while working for IBP have 
 
            required him to use extensively and repetitively his arms 
 
            and wrists.  Each time claimant sought treatment from a 
 
            company doctor, he related the pain to the duties he was 
 
            performing.  There is no evidence to indicate that claimant 
 
            received an injury while off of the job.  As a result, it is 
 
            found that claimant received an injury which arose out of 
 
            and in the course of his employment.
 
            
 
                 The next issue to be addressed is whether there is a 
 
            causal relationship between claimant's injury and his 
 
            disability.
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            
 
                 The claimant has the burden of proving by a 
 
            preponderance of the evidence that the injury of November 
 
            15, 1988 is causally related to the disability on which he 
 
            now bases his claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 
 
            133 N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 
 
            296, 18 N.W.2d 607 (1945).  A possibility is insufficient; a 
 
            probability is necessary.  Burt v. John Deere Waterloo 
 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
            question of causal connection is essentially within the 
 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
 
            Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). 
 
            
 
                 However, expert medical evidence must be considered 
 
            with all other evidence introduced bearing on the causal 
 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
 
            of experts need not be couched in definite, positive or 
 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
 
            903 (Iowa 1974).  However, the expert opinion may be 
 
            accepted or rejected, in whole or in part, by the trier of 
 
            fact.  Id. at 907.  Further, the weight to be given to such 
 
            an opinion is for the finder of fact, and that may be 
 
            affected by the completeness of the premise given the expert 
 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
 
            133 N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 
 
            N.W.2d 128.
 
            
 
                 Furthermore, if the available expert testimony is 
 
            insufficient alone to support a finding of causal 
 
            connection, such testimony may be coupled with nonexpert 
 
            testimony to show causation and be sufficient to sustain an 
 
            award.  Giere v. Aase Haugen Homes, Inc., 259 Iowa 1065, 146 
 
            N.W.2d 911, 915 (1966).  Such evidence does not, however, 
 
            compel an award as a matter of law.  Anderson v. Oscar Mayer 
 
            & Co., 217 N.W.2d 531, 536 (Iowa 1974).  To establish 
 
            compensability, the injury need only be a significant 
 
            factor, not be the only factor causing the claimed 
 
            disability.  Blacksmith v. All-American, Inc., 290 N.W.2d 
 
            348, 354 (Iowa 1980).
 
            
 
                 From the evidence submitted, there appears to be no 
 
            question that claimant's disability is related to his 
 
            injury.  Prior to his employment with IBP, claimant was 
 
            required to undergo a company physical, and passed.  There 
 
            is no indication that he had suffered from any type of 
 
            finger, hand, wrist or upper extremity medical conditions or 
 
            problems prior to his employment with IBP.  Dr. Wulfekuher 
 
            related claimant's condition to his work, thereby 
 
            restricting his capacity to perform required job functions 
 
            at various times throughout his course of treatment.  Dr. 
 
            Donohue is silent on the causal connection, but Dr. Walker, 
 
            the doctor who performed the independent medical 
 
            examination, directly links claimant's disability with his 
 
            work.  As a result, it is found that claimant's disability 
 
            is causally related to his injury.
 
            
 
                 The next issue to be addressed is whether claimant is 
 
            entitled to permanent partial disability. 
 
            
 
                 Claimant has been given impairment ratings from Dr. 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            Walker, as previously set out in this decision.  The 24 
 
            percent permanent impairment assigned to the right upper 
 
            extremity converts to a 13 percent body as a whole under the 
 
            AMA Guide, 3rd Edition.  The 21 percent permanent impairment 
 
            assigned to the left upper extremity converts to a 13 
 
            percent body as a whole impairment pursuant to the Guide.  
 
            Additionally, claimant was given permanent restrictions of 
 
            no repetitive types of jobs involving the hands, fingers, 
 
            wrists, forearms and upper extremities on either the right 
 
            or the left side.
 
            
 
                 Dr. Donohue, who treated claimant on approximately 
 
            eight different occasions found no permanency, but proposed 
 
            a permanent restriction of avoiding repetitive use of both 
 
            upper extremities with respect to wrist flexion and 
 
            extension or gripping activities.  (Jt. Exs. F, E, D, & C)
 
            
 
                 William Hamsa, Jr., M.D., is an orthopedic specialist 
 
            who also performed an independent medical examination.  He 
 
            provided the following opinion:
 
            
 
                 I think this gentleman's problem is job-related 
 
                 and unfortunately this is one of those difficult 
 
                 situations, that if he cannot put up with his 
 
                 symptoms and work by his pain tolerance, he 
 
                 probably is going to have to find something else 
 
                 to do.  I think his doctor is on the right track 
 
                 in the way he is treating him and I often will use 
 
                 a cast for a short period of time to mobilize the 
 
                 wrist as this type of distress.  It would appear 
 
                 that the patient's main disability are persistence 
 
                 of symptoms rather than a percentage of 
 
                 disability.
 
            
 
            (Jt. Ex. VV)
 
            
 
                 It would be difficult for the undersigned to come to 
 
            the conclusion that claimant has sustained no permanent 
 
            disability, given the type of work he has done for more than 
 
            seven years, and in light of the medical restrictions placed 
 
            upon him.  However, both impairments seem to be extreme, and 
 
            it has been necessary to carefully review the functional 
 
            limitations claimant exudes.  Claimant's disability will 
 
            fall under the guidelines of Iowa Code section 85.34(s), and 
 
            will be based upon a body as a whole injury; however, an 
 
            analysis of the litany of factors that comprise an 
 
            industrial disability is not warranted.  See, Simbro v. 
 
            DeLong Sportswear, 332 N.W.2d 886 (1983) 
 
            
 
                 Claimant still suffers from bouts of swelling of his 
 
            forearms; nodules on at least two of his fingers; some 
 
            limitations on range of motion of his wrists; numbness and 
 
            tingling in the right hand and all fingers; loss of grip in 
 
            the left and right hands; and, pain.  After considering all 
 
            of these factors, as well as claimant's testimony detailing 
 
            difficulties incurred in using the injured members, and all 
 
            of the medical evidence regarding general loss of use, it is 
 
            found that claimant has sustained a permanent partial 
 
            disability of 18 percent of the body as a whole.
 
            
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
                 As claimant has sustained a permanent injury, he is 
 
            entitled to healing period benefits for the amount of time 
 
            he was totally off of work and receiving medical treatment.  
 
            See, Iowa Code section 85.34(1).
 
            
 
                 The next issue to be addressed is whether claimant is 
 
            entitled to temporary partial disability benefits.
 
            
 
                 Iowa Code section 85.33(2) provides, in pertinent part:
 
            "[T]emporarily, partially disabled" means the condition of 
 
            an employee for whom it is medically indicated that the 
 
            employee is not capable of returning to employment 
 
            substantially similar to the employment in which the 
 
            employee was engaged at the time of injury, but is able to 
 
            perform other work consistent with the employee's 
 
            disability.  "Temporary partial benefits" means benefits 
 
            payable, in lieu of temporary total disability and healing 
 
            period benefits, to an employee because of the employee's 
 
            temporary partial reduction in earning ability as a result 
 
            of the employee's temporary partial disability . . . 
 
            Between the date of injury and claimant's termination, he 
 
            was placed on part-time and on light duty positions 
 
            periodically.  Claimant is entitled to tempoary partial 
 
            disability payments on those days he worked in a light duty 
 
            or part-time status.  His rate for tempoary partial 
 
            disability benefits is calculated under Iowa Code section 
 
            85.33(4):
 
               If an employee is entitled to temporary partial benefits 
 
            . . . the employer for whom the employee was working at the 
 
            time of injury shall pay to the employee weekly compensation 
 
            benefits, . . . for and during the period of temporary 
 
            partial disability.  The temporary partial benefit shall be 
 
            sixty-six and two-thirds percent of the difference between 
 
            the employee's weekly earnings at the time of injury . . . 
 
            and the employee's actual gross weekly income from 
 
            employment during the period of temporary partial 
 
            disability.
 
            
 
                 The next issue to be addressed is whether claimant is 
 
            entitled to medical benefits pursuant to Iowa Code section 
 
            85.27.
 
            
 
                 Defendant are disputing that the medical services 
 
            rendered were fair and reasonable, and causally connected to 
 
            the work injury.  As previously laid out in the opinion, 
 
            claimant did sustain an injury which arose out of and in the 
 
            course of his employment.  He is entitled to have all 
 
            medical benefits provided for under the statute, and is to 
 
            be reimbursed any and all transportation expenses incurred 
 
            in receiving medical treatment.
 
            
 
                 Dr. Walker's fee of $706.00 is also disputed as to 
 
            being fair and reasonable.  Claimant is entitled to an 
 
            independent medical examination as provided for under Iowa 
 
            Code section 85.39.  Dr. Walker's fee is not unreasonable 
 
            given the detailed examination given to claimant, and 
 
            defendant is ordered to pay for the same.
 
            
 
                                      order
 
            
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
                 THEREFORE, it is ordered:
 
            
 
                 That defendant shall pay claimant permanent partial 
 
            disability benefits for ninety (90) weeks at the rate of two 
 
            hundred forty-eight and 47/100 dollars ($248.47) per week 
 
            commencing on June 15, 1990.
 
            
 
                 That defendant shall pay claimant healing period 
 
            benefits for the time he was off of work from November 15, 
 
            1988 through June 15, 1990.
 
            
 
                 That defendant shall pay temporary partial disability 
 
            benefits for the time he was required to work on part-time 
 
            or light duty status.
 
            
 
                 That defendant shall pay medical benefits, and 
 
            transportation expenses pursuant to Iowa Code section 85.27 
 
            and Iowa Code section 85.39.
 
            
 
                 That defendant shall pay accrued amounts in a lump sum 
 
            and shall receive credit against the award for weekly 
 
            previously paid.
 
            
 
                 That defendant shall pay interest on benefits awarded 
 
            herein as forth in Iowa Code section 85.30.
 
            
 
                 That defendant shall pay the costs of this proceeding, 
 
            pursuant to rule 343 IAC 4.33.
 
            
 
                 That defendant shall file claim activity reports as 
 
            requested by the agency pursuant to rule 343 IAC 3.1(2).
 
            
 
                 Signed and filed this ____ day of June, 1991.
 
            
 
            
 
            
 
            
 
                                          
 
            ________________________________
 
                                          PATRICIA J. LANTZ
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr Steve Hamilton
 
            Attorney at Law
 
            606 Ontario Street
 
            PO Box 188
 
            Storm Lake Iowa 50588
 
            
 
            Ms Marie L Welsh
 
            Attorney at Law
 
            PO Box 515 Dept #41
 
            Dakota City Nebraska 68731
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      5-1803.1
 
                      Filed June 21, 1991
 
                      PATRICIA J. LANTZ
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            THOMAS PLATT,  :
 
                      :
 
                 Claimant, :       File No. 921051
 
                      :
 
            vs.       :    A R B I T R A T I O N
 
                      :
 
            IBP, INC.,     :        D E C I S I O N
 
                      :
 
                 Employer, :
 
                 Self-Insured,  :
 
                 Defendant.     :
 
            ___________________________________________________________
 
            
 
            5-1803.1
 
            Claimant worked for defendant for seven years.  He developed 
 
            bilateral upper extremity overuse syndrome.  Company 
 
            physician rendered a zero percent permanent impairment 
 
            rating, but imposed medical restrictions limiting claimant's 
 
            use of both upper extremities.
 
            An IME was performed by John Walker, M.D., who rendered a 
 
            left upper extremity impairment of 21 percent, and a right 
 
            upper extremity impairment of 24 percent.
 
            Claimant was awarded 18 percent body as a whole disability, 
 
            as guided by Iowa Code section 85.34(s).