BEFORE THE IOWA INDUSTRIAL COMMISSIONER _________________________________________________________________ DEANDRA SINK n/k/a DEANDRA PATTERSON, File Nos. 991761 Claimant, 930170 vs. A R B I T R A T I O N ALDI, INC., D E C I S I O N Employer, and KEMPER INSURANCE and TRAVELERS INSURANCE, Insurance Carrier, Defendants. ________________________________________________________________ STATEMENT OF THE CASE This is a consolidated proceeding in arbitration brought by Deandra Sink, claimant, against Aldi, Inc., employer, and Kemper Insurance and Travelers Insurance, defendants, for workers' compensation benefits as a result of alleged injuries on August 18, 1989 and July 12, 1991. Kemper insured the first injury and Travelers the second. On April 18, 1995, a hearing was held on claimant's petition and the matter was considered fully submitted at the close of this hearing. Since the filing of the petition, claimant has married and the caption shall be changed to reflect her new last name, Patterson. The parties have submitted a hearing report of contested issues and stipulations which was approved and accepted as a part of the record of this case at the time of hearing. The oral testimony and written exhibits received during the hearing are set forth in the hearing transcript. According to the hearing report, the parties have stipulated to the following matters: 1. At the times alleged in the petitions, claimant received injuries arising out of and in the course of employment with Aldi. 2. Claimant is not seeking additional temporary total or healing period benefits at this time. 3. If permanent partial disability benefits are awarded for the August 18, 1989 and July 12, 1991 injuries, they shall begin as June 1, 1990 and August 13, 1992 respectively. 4. At the time of the August 18, 1989 injury, claimant was married and entitled to four exemptions. The parties dispute the gross weekly earnings. 5. At the time of the July 12, 1991 injury, claimant's gross weekly earnings were $300.08; she was married; and, she was entitled to four exemptions. Therefore, claimant's weekly rate of compensation is $206.15 according to the industrial commissioner's published rate booklet for this injury. 6. It was stipulated that the medical bills submitted by claimant at the hearing are fair and reasonable and causally connected to the medical condition upon which the claim herein is based but that the issue of their causal connection to any work injury remains an issue to be decided herein. ISSUES The parties submitted the following issues for determination in this proceeding: I. The extent of claimant's entitlement to disability benefits; and, II. The extent of claimant's entitlement to medical benefits. FINDINGS OF FACT Having heard the testimony and considered all of the evidence, the deputy industrial commissioner finds as follows: A credibility finding is necessary to this decision as defendants placed claimant's credibility at issue during cross- examination as to the nature and extent of the injury and disability. From her demeanor while testifying, claimant is found credible. Claimant, Deandra Patterson, worked for Aldi from 1986 until November 1991 at which time she was fired because suitable work was not available within her physician imposed work restrictions. Deandra worked as a "selector" in an Aldi warehouse filing orders from Aldi stores for grocery items warehoused at the facility. Deandra would travel around the warehouse on an electric cart placing the ordered items onto a pallet. When the order was filled, the pallet would be loaded onto trucks for shipment to the store. This work required repetitive lifting and carrying cases of grocery items weighing from 5-65 pounds each. Claimant was required to load approximately 325 cases an hour prior to her injury. The injury on August 18, 1989 involved the left shoulder. Deandra stated that while lifting a case of six gallon jugs she felt something pop and pain ensued. As Deandra thought the problem only temporary, she continued to work and did not seek immediate medical attention. However, after two months Deandra steadily grew worse and eventually she lost feeling in her hands and arms. Upon a diagnosis of infrascapular cervical chronic strain, Deandra received treatment from John Baldwin, D.O., a family practice physician, in the form of medication and physical therapy. Claimant suffered flareups of pain after activity at home and work during this treatment but Dr. Baldwin felt all of Deandra's shoulder problems were due to the August 1989 work injury. Claimant remained off work extensively until the spring of 1990 when her care was changed to Robert Prentice, M.D., an orthopedic surgeon. Soon thereafter Dr. Prentice returned claimant to work in a reduced capacity. Deandra started initially at 60 percent of the standard rate but her rate was gradually increased to 80 percent. At hearing Deandra estimated that she achieved 90 percent of her rate by the time of her second injury in 1991. Dr. Prentice never formally increased the restricted rate over 80 percent. Dr. Prentice opines that claimant suffered a 20 percent permanent loss of use of her left upper extremity from the 1989 injury. Despite viewing a video surveillance tape of certain types of work activity at home in June 1990, Dr. Prentice did not change his views as to the extent of disability or his belief that claimant was an honest, credible person. It is clear that the injury, consisting of chronic musculolegamentous strain of the soft tissue surrounding the scapula, extends beyond the arm into the shoulder and the body as a whole. Therefore, it is found that the work injury of August 18, 1989 is a cause of a significant loss of use to the body as a whole. During treatment for the left shoulder condition, claimant complained of and was treated for low back pain by Dr. Baldwin. Dr. Baldwin felt that this was related as well to the injury due to overcompensation for the upper body injury. Dr. Prentice disagrees or at least states that he cannot causally relate the low back condition to the shoulder injury within a reasonable degree of medical certainty. As Dr. Prentice is a specialist in the field of orthopedics, his views must be given greater weight than those of Dr. Baldwin. Therefore, a causal connection of the low back condition to a work injury could not be found. The injury on July 12, 1991 occurred to the right shoulder when claimant reached overhead to prevent a case of groceries from falling on her. Deandra first was treated by Dr. Prentice for this condition but soon thereafter the doctor felt that he could offer her nothing further in treatment and suggested a doctor closer to her residence. Deandra then began treating with M. H. Paul, D.O., who imposed light duty restrictions against lifting and repetitive movements of the right shoulder. Claimant was terminated by Aldi in November 1991 for the reason that no work was available at the warehouse within such restrictions. Dr. Paul treated claimant over the next several months. This treatment remained initially conservative but eventually Dr. Paul performed arthroscopic surgery in the right shoulder. Despite this surgery and extensive treatment by Dr. Paul, Deandra's right shoulder symptoms have persisted. In August 1991, using the AMA Guides for rating impairments, Dr. Paul opined that claimant suffered a three percent body as a whole permanent impairment due to the right shoulder condition and concurs with a functional capacity evaluation as descriptive of her limitations. This evaluation demonstrated various limitations such as a maximum level lift of 35 pounds; standing lift of 35 pounds; overhead lift of only 20 pounds; unilateral carrying of 20 pounds on the left; pushing 51 pounds; and, pulling 69 pounds. Based upon the uncontroverted views of Dr. Paul, it is found that the work injury of July 12, 1991 is a cause of a significant loss of use to the body as a whole as demonstrated by the functional capacity evaluation. Deandra testified that she had no prior or subsequent injuries to the shoulders other than those at work herein. There is no evidence in the record to suggest otherwise. Deandra is 32 years of age. She is a high school graduate and has taken some post high school classes in accounting at a local community college. She has worked in light duty jobs such as cashier at a food store; accounting work in a small produce business she operated with her husband; and, an office job making corrections to technical drawings. She is capable of performing this work today, although such work paid considerably less than her wages at Aldi. With reference to loss of earning capacity just prior to the 1991 right shoulder injury, Deandra's medical condition was far from excellent. She had a clear functional impairment which did not exist before the 1989 left shoulder injury. However, despite a restricted level of activity, claimant was able to continue working in her selector job at Aldi without loss of pay or benefits. After the 1991 right shoulder injury, Deandra's earning capacity significantly changed. She was no longer able to return to her selector job at Aldi and she has not worked since. Claimant's current restrictions due to the right shoulder problems prevent a return to heavy manual labor jobs. However, as pointed out by Dr. Prentice, claimant is naturally restricted from many such jobs due to her small physic. These restrictions do not prevent working in light duty jobs such as cashier or bookkeeper which she has performed in the past. Despite referrals to various jobs by a vocational consultant retained by defendants, claimant has remained unemployed. However, much of this is due to lack of motivation. At hearing she stated that she gave up looking for work because the only available work was at minimum wage which would not pay for her baby sitting. This may be true but clearly her current unemployment is largely due to her life situation and not her disability. However, even if she had minimum wage employment, she would have suffered a major loss of earning capacity from the loss of her job at Aldi. That job paid in excess of $12 per hour at the time of the termination and claimant had fringe benefits not available to those in minimum wage employment. Despite a wide range of jobs available at Aldi, whether it be at the warehouse or at their other locations, Aldi made no effort to accommodate for Deandra's disability after the 1991 injury. This is clear evidence of a significant disability which must be compensated. Therefore, the work injury of August 18, 1989 is a cause of a mild 10 percent loss of earning capacity. The work injury of July 12, 1991 is a cause of an additional 50 percent loss of earning capacity. Medical benefits are disputed with reference to the 1989 injury. As established by the hearing report and the record, defendant Kemper has denied the causal connection of the requested medical expenses to the work injury. Frankly, the undersigned cannot determine from the record what the requested expenses involve and no testimony was offered with reference to the requested bills. Defendant, Kemper, also claims that claimant was part-time at the time of the first injury. Claimant admitted at hearing that her hours varied and that she worked 25-30 hours a week. However, defendant Kemper did not offer any evidence that claimant's earnings were less than the usual weekly earnings of a regular full-time adult laborer in the line of industry in which claimant was injured. It is possible that such an arrangement was full time for Aldi employment at least. CONCLUSIONS OF LAW I. The question of causal connection is essentially within the domain of expert medical opinion. Bradshaw v. Iowa Methodist Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). The opinion of experts need not be couched in definite, positive or unequivocal language and the expert opinion may be accepted or rejected, in whole or in part, by the trier of fact. Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974). The weight to be given to such an opinion is for the finder of fact to determine from the completeness of the premise given the expert or other surrounding circumstances. Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965). Furthermore, if the available expert testimony is insufficient alone to support a finding of causal connection, such testimony may be coupled with non-expert 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 (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 (1980). In the case of a preexisting condition, an employee is not entitled to recover for the results of a preexisting injury or disease but can recover for an aggravation thereof which resulted in the disability found to exist. Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963). As the claimant has shown that the work injury was a cause of permanent physical impairment or limitation upon activity involving the body as a whole, the degree of permanent disability must be measured pursuant to Iowa Code section 85.34(2)(u). However, unlike scheduled member disabilities, the degree of disability under this provision is not measured solely by the extent of a functional impairment or loss of use of a body member. A disability to the body as a whole or an "industrial disability" is a loss of earning capacity resulting from the work injury. Diederich v. Tri-City R. Co., 219 Iowa 587, 593, 258 N.W. 899 (1935). A physical impairment or restriction on work activity may or may not result in such a loss of earning capacity. Examination of several factors determines the extent to which a work injury and a resulting medical condition caused an industrial disability. These factors include the employee's medical condition prior to the injury, immediately after the injury and presently; the situs of the injury, its severity and the length of healing period; the work experience of the employee prior to the injury, after the injury and potential for rehabilitation; the employee's qualifications intellectually, emotionally and physically; earnings prior and subsequent to the injury; age; education; motivation; functional impairment as a result of the injury; and inability because of the injury to engage in employment for which the employee is fitted. Loss of earnings caused by a job transfer for reasons related to the injury is also relevant. See Peterson v. Truck Haven Cafe, Inc., Vol. I, No. 3 Iowa Industrial Comm'r Decisions 654, 658 (App. February 28, 1985). A showing that claimant had no loss of his job or actual earnings does not preclude a finding of industrial disability. See Michael v. Harrison County, Thirty-fourth Biennial Rep., Iowa Industrial Comm'r 218, 220 (App. 1979); Bearce v. FMC Corp., 465 N.W.2d 531 (Iowa 1991) only held that continued employment with no loss of earnings is significant evidence that should not be overlooked in measuring loss of earning capacity. Loss of potential employment is also a factor to consider in assessing industrial disability. Collier v. Sioux City Comm. Sch. Dist., File No. 953453 (App. February 25, 1994). Furthermore, a refusal by an employer to reemploy the injured worker is evidence of lack of employability. Pierson v. O'Bryan Brothers, File No. 951206 (App. January 22, 1995). Meeks v. Firestone Tire & Rubber Co., File No. 876894 (App. January 22, 1993). See also Larson, Workmen's Compensation Law, 57.61, pp. 10-164.90-.95; Sunbeam Corp. v. Bates, 271 Ark 609 S.W.2d 102 (1980); Army & Air Force Exchange Service v. Neuman, 278 F. Supp 865 (W.D. La 1967); Leonardo v. Uncas Manufacturing Co., 77 R.I. 245, 75 A 2d 188 (1950). In the case sub judice, it was found that claimant suffered a 10 percent loss of her earning capacity as a result of the 1989 work injury. Such a finding entitles claimant to 50 weeks of permanent partial disability benefits as a matter of law under Iowa Code section 85.34(2)(u) which is 10 percent of 500 weeks, the maximum allowable number of weeks for an injury to the body as a whole in that subsection. It was also found that claimant suffered an additional 50 percent loss of her earning capacity as a result of the 1991 work injury. Such a finding entitles claimant to 250 additonal weeks of permanent partial disability benefits as a matter of law under Iowa Code section 85.34(2)(u) which is 50 percent of 500 weeks, the maximum allowable number of weeks for an injury to the body as a whole in that subsection. With reference to computing rate of weekly compensation for the 1989 injury, the introductory paragraph of Iowa Code section 85.36 states as follows: Weekly earnings means gross salary, wages, or earnings of an employee to which such employee would have been entitled had the employee worked the customary hours for the full pay period in which the employee was injured, as regularly required by the employee's employer for the work or employment for which the employee was employed, . . . Thereafter, various subsections are contained in Iowa Code section 85.36 which describe numerous alternative methods to arrive at gross weekly earnings. In the case at bar, many subsections could apply. As claimant customarily worked less than 40 hours each week, the rate could be computed under Iowa Code section 85.36(10) which annualizes income from all sources for "so-called" part-time employees. As claimant received her check every two weeks, subparagraph two may apply which divides by two the bi-weekly pay. As claimant was paid on an hourly basis, Iowa Code section 85.36(6) can be utilized which would average the earnings over the last 13 representative weeks. The primary purpose of workers' compensation statute is to benefit workers and worker's dependents and is to be interpreted liberally with view toward that objective. Caterpillar Tractor Co. v. Shook, 313 N.W.2d 503 (Iowa 1981). Consequently, given the intent set forth in the introductory paragraph of Iowa Code section 85.36, use of any method of computation which would not result in a reasonable approximation of the worker's customary earnings from employment would be contrary to the express intent and the purposes of the statute. The various subsections are not a heirarcy of choices (the first one to apply is to be applied first). Likewise, use of a particular subsection is not dictated by how or when a person is paid or how much he or she works in a given week. The subsections are only various alternatives which may be utilized by this agency to arrive at customary earnings. Thilges v. Snap-On Tools Corp., 528 N.W.2d 614 (Iowa 1995); Hanigan v. Hedstrom Concrete Products, Inc., 524 N.W.2d 158 (Iowa 1994); Foster v. Plaza Restaurant and Lounge, (Arb. Filed February 27, 1989); Greer v. Sartori Memorial Hospital, (Arb. Filed May 19, 1989). Defendant Kemper argues for application of section 85.36(10) to annualize claimant's income thereby greatly lowering the rate for the 1989 injury. As claimant had no other income that year, the method would not arrive at a gross rate that would not be customary for her or representative of her real wage earnings at the time of injury. As defendant Kemper stands to greatly benefit from application of such a method, it bears the burden of proof. However, Kemper did not offer any evidence to show that claimant's earnings were less than those having the same or similar jobs at Aldi or elsewhere. Consequently, the undersigned rejects use of such a method to arrive at claimant's rate. The best method to arrive at a rate that would represent weekly earnings had Deandra worked the customary hours during the week of the injury as mandated by the first sentence of section 85.34 and applicable case law, is to use the 13 week average earnings for the 1989 injury. According to the hearing report, the parties agreed that this amount is $286.47 resulting in a rate of compensation in the amount of $196.54 per week. II. According to the hearing report, defendant Kemper asserts that claimant is not entitled to reimbursement for certain medical expenses under Iowa Code section 85.27 which provides employers with the right to chose the care. They also deny the causal connection of these expenses to the work injury. This agency has held that it is inconsistent to deny liability and the obligation to furnish care on one hand and at the same time claim a right to choose the care. Kindhart v. Fort Des Moines Hotel, I Iowa Industrial Comm'r Decisions No. 3, 611 (App. 1985); Barnhart v. MAQ Incorporated, I Iowa Industrial Comm'r Report 16 (App. 1981). Therefore, defendant had no right to choose the care. However, from the evidence presented, little could be found as to the causal connection of these expenses to the injury. Consequently, no specific findings will be made as to these expenses. However, reimbursement will be ordered for those expenses that are related to those medical conditions found work related in this decision. ORDER 1. Defendant, Kemper, shall pay to claimant fifty (50) weeks of permanent partial disability benefits at a rate of one hundred ninety-six and 54/l00 dollars ($196.54) per week from June 1, 1990. 2. Defendant, Travelers, shall pay to claimant two hundred fifty (250) weeks of permanent partial disability benefits at a rate of two hundred six and 15/l00 dollars ($206.15) per week from August 13, 1992. 3. Defendant, Kemper, shall pay those portions of medical expenses listed in the prehearing report that are related to medical conditions found work related herein. 4. Both defendants shall pay accrued weekly benefits in a lump sum and shall receive credit against this award for all benefits previously paid. 5. Both defendants shall pay interest on weekly benefits awarded herein as set forth in Iowa Code section 85.30. 6. Defendant, Kemper and Travelers, shall equally pay the costs of this action pursuant to rule 343 IAC 4.33, including reimbursement to claimant for any filing fees paid in this matter. 7. Both defendants shall file activity reports on the payment of this award as requested by this agency pursuant to rule 343 IAC 3.1. Signed and filed this ____ day of June, 1995. ______________________________ LARRY P. WALSHIRE DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr. William Bauer Attorney at Law 100 Valley St Box 517 Burlington IA 52601 Mr. Harry W. Dahl Attorney at Law 974 73rd St STE 16 Des Moines IA 50312 5-1803 Filed June 2, 1995 LARRY P. WALSHIRE BEFORE THE IOWA INDUSTRIAL COMMISSIONER _________________________________________________________________ DEANDRA SINK n/k/a DEANDRA PATTERSON, File Nos. 991761 Claimant, 930170 vs. A R B I T R A T I O N ALDI, INC., D E C I S I O N Employer, and KEMPER INSURANCE, Insurance Carrier, Defendants. ________________________________________________________________ 5-1803 Nonprecedential, extent of disability case. Page 1 before the iowa industrial commissioner ____________________________________________________________ : JANET SHATSWELL, : : Claimant, : : vs. : : File No. 930291 CITY OF ONAWA, IOWA, : : A R B I T R A T I O N Employer, : : D E C I S I O N and : : EMPLOYERS MUTUAL COMPANIES, : : Insurance Carrier, : Defendants. : ___________________________________________________________ STATEMENT OF THE CASE This is a proceeding in arbitration upon the April 11, 1990 petition of claimant, Janet Shatswell, surviving spouse of dece dent Cole B. Shatswell, Jr., who died on October 22, 1989, as a result of severe occlusive two vessel coronary atherosclerosis with an organized thrombus in the right coronary artery with fatal ventricular arrhythmias allegedly caused or aggravated by his employment as a police officer with the City of Onawa, Iowa. This case came on for hearing before the undersigned deputy industrial commissioner on June 26, 1991, in Council Bluffs, Iowa. The record was considered fully submitted at the close of the hearing. The record in this case consists of joint exhibits 1-27; and testimony of Jane Shatswell and Larry Taylor. Numerous other witnesses, including many highly qualified physicians, tes tified by deposition. issues The parties have stipulated that an employer/employee rela tionship existed between Cole B. Shatswell, Jr. (hereinafter referred to as "decedent") and defendant employer at the time of his death, and that the appropriate rate of weekly benefits is $298.89. The issues presented for resolution include: 1. Whether decedent's death resulted from an injury arising out of and in the course of his employment with the City of Onawa, Iowa; and, 2. Whether claimant is entitled to burial benefits. findings of fact Page 2 The undersigned has carefully considered all the testimony given at the hearing, arguments made, evidence contained in the exhibits herein, and makes the following findings: On and before October 22, 1989, decedent was the Chief of Police for the City of Onawa, Iowa. October 22, 1989 was a Sunday and Officer Shatswell was working that day. About 11:15 a.m. he went home to have lunch with his wife, Janet. About 11:30 a.m. he received a telephone call stating that the store security officer at the Medicine Chest had detained one shoplifter and was in the process of detaining a second shoplifter and the assistance of the city police was needed. Officer Shatswell left home and drove directly to the Medicine Chest Pharmacy. When Officer Shatswell arrived, Kim Coonrod, the store secu rity officer, was near the front of the Medicine Chest store in the process of detaining a shoplifter, Joan Darling. Earlier, Coonrod had observed Darling removing items of merchandise from the store and putting them in her purse. She left the store without paying for the items. Upon arriving at the scene, Mrs. Darling was bent over the passenger front seat of her car and, according to Coonrod, was taking the items out of her purse and stuffing them under the front seat of her car (Exhibit 16, pages 11 and 12). Officer Shatswell then asked Mrs. Darling to quit removing the stolen items from her purse and get out of the vehicle. She refused. Officer Shatswell was then required to grab Mrs. Darling by the shoulders and physically pull her out of the vehicle (Ex. 16, p. 12, lines 6-16). Kim Coonrod then went into the vehicle to retrieve the stolen merchandise and did not see Officer Shatswell and Mrs. Darling for the next few moments (Ex. 16, p. 20, ll. 19-23). There was another eyewitness at the scene. Mr. Johnny Stevens was sitting in his pickup truck observing the arrest. In his deposition Johnny Stevens stated that after Officer Shatswell removed Mrs. Darling from her vehicle: So, he -- he helped her toward the curb again and she was kind of throwin' her arms back toward him, you know, kind of pushin' away and struck him across the -- chest and then she got up on the curb. Well, he -- I noticed then that he didn't look right. He kind of slowed down and he turned around and went toward the car again to get back inside the car, he stuck his head in a little ways and then he came back out and he turned around and leaned back toward the backside of their car and I noticed his hands were shakin' real bad and I couldn't really see his face expressions, cause he had sunglasses on, but I knew somethin' was wrong then, so I watched him and the shaking got a little worse and then he crossed his arms acrossed his chest and he kind of turned and went down on his chest. (Ex. 15, p. 9, ll. 6-21) All attempts to revive Officer Shatswell were unsuccessful Page 3 and he was pronounced dead at 12:31 p.m. The autopsy report of G. N. Herbeck, M.D., is contained in the record as joint exhibit 3. In the summary portion of the report Dr. Herbeck states: The death in this 37-year-old Caucasian male is attributed to severe occlusive two vessel coronary arteriosclerosis with an organized thrombus in the right coronary artery. This most likely resulted in a fatal arrhythmia in an already compromised heart showing evidence of a recent (2-3 weeks) myocardial infarction, biventricular hypertrophy, and congestive heart failure. The claimant's expert cardiologist, Ward Chambers, M.D., in his deposition stated: "My opinion is that Mr. Shatswell suf fered sudden death from a malignant ventricular arrhythmia pre cipitated by his altercation with the lady involved in the case." (Ex. 17, p. 5, ll. 14-17). When asked for the basis for his opinion, Dr. Chambers stated: Q. All right. What about those facts, can you be more specific, as to the specific facts which led you to conclude that must have been the precipitating event? A. The deceased was involved in altercation, both verbal and physical, with the alleged shoplifter that involved pushing, shoving, hitting, over a few minute period of time. Q. Are you aware of the relative size differences between the two parties? A. Yes, sir. Q. Did you see this as being like a fight that was going on between the two of them? A. The physical differences are irrelevant. The physi cal abuse the patient suffered, I think, had nothing to do with the arrhythmia. Q. All right. What did, if the physical abuse didn't have anything to do with it, what caused it, if you will? A. It would be the emotional component of the argument. Q. All right. And can you be more specific as to what you mean by the emotional component? A. Certainly. If one is a police officer and involved in any sort of physical exchange that involved pulling a patient out of a car, having the patient go back in abusive type language, physical actions Page 4 against yourself, that will evoke a rather strong physiologic response, whether the patient is touched or not. It's well-known in the cardiology litera ture that emotional stress produces physiologically two important changes. One would be the production or release of epinephrine from the adrenal glands and the other would be sympathetic nervous system discharges that affect the heart. Both of these are known to precipitate ventricular arrhythmias and cause adverse physiologic changes in the heart. This is commonly noted by physicians that, in fact, cardiovascular symptoms many times are precipitated more easily by stress than physical exertion. (Ex. 17, p. 6, l. 1 - p. 7, l. 15) Dr. Herbeck, who did the autopsy, agreed with Dr. Chambers (Ex. 13). Mr. Shatswell's primary treating physician, Curtis A. Mock, M.D., also agreed with Dr. Chambers that the fight was the cause of Mr. Shatswell's fatal arrhythmia (Ex. 18, pp. 32 & 33). The defendants' expert cardiologist, Ronald A. Draur, M. D., in his deposition states that decedent died of a malignant ven tricular arrhythmia caused by coronary artery disease and a recent subendocardial myocardial infarction (Ex. 19, p. 8, ll. 9- 18). Based on the deposition of Johnny Stevens, Dr. Draur concluded that the confrontation between decedent and shoplifter was not so stressful as to precipitate the fatal ventricular arrhythmia (Ex. 19, p. 11, ll. 2-15). Decedent was survived by his wife Janet and three minor children, Troy R. Shatswell born June 2, 1974; Bryan C. Shatswell born November 8, 1976; and Cole B. Shatswell, III, born May 2, 1983. Mrs. Shatswell described decedent as a gentle, caring, fun loving individual who was devoted to his family. Trooper Larry M. Taylor described decedent in the same way. Mr. Taylor, a 17 year veteran with the Iowa State Patrol, testified that the job-related stress of a police officer is greater than the normal, non-employment stress encountered in daily life. conclusions of law Decedent's coronary artery disease and subendocardial myocardial infarction preexisted his fatal malignant ventricular arrhythmia. Individuals with preexisting heart conditions have been permitted recovery in cases where the work either required heavy exertion which, superimposed on an already defective heart, aggravates or accelerates the condition, or where unusually strenuous employment exertion results in a heart injury. Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974). There must be a direct causal connection between the employment exertion and the resulting injury before compensation is appropriate. Littell v. Lagomarcino Grupe Co., 235 Iowa 523, 17 N.W.2d 120 (1945). It is claimant's burden to establish by a preponderance of the evidence that decedent's injury arose out of and in the course of his employment, Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 Page 5 (1965), and that a mere possibility of such is insufficient; rather, a probability is necessary. Burt v. John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955). The record clearly indicates that decedent had a preexisting heart condition. The autopsy report of Dr. Herbeck indicated that decedent had severe occlusive two vessel coronary atherosclerosis with an organized thrombus in the right coronary artery. There was evidence of a myocardial infarction (2-3 weeks), biventricular hypertrophy and congestive heart failure. Notwithstanding the existence of this heart disease, Dr. Chambers opined, and Drs. Herbeck and Mock agreed, that the atherosclerosis and the organized thrombosis were not the cause of the fatal arrhythmia that killed decedent. All three doctors agree that the fatal arrhythmia was caused by the confrontation and struggle which occurred at the time he was arresting the elderly shoplifters. Mr. Shatswell's sudden death occurred in the context of an intensely emotional and stressful situation of an arrest. Dr. Chambers, a highly qualified cardiologist opined that a stressful event can precipitate ventricular arrhythmias and cause severe physiologic changes in the heart. Dr. Draur agreed: Q Isn't it recognized in cardiology that stress can precipitate or trigger or cause a fatal ventricular arrhythmia? Page 6 A Yes, it is. Q Would that not be particular true in the case of an individual with an underlying coronary artery disease? A Certainly. (Depo. Ex. 19, p. 10, ll. 7-14) Substantial medical evidence in this case indicates that the cause of claimant's "sudden death" was a fatal arrhythmia. According to Dr. Mock, arrhythmias can be caused by a blow to the chest, stress, anxiety or any irritant that increases epinephrine making the heart more irritable. It was his opinion that an event occurred that was "out of the ordinary for him to cause the heart to fibrillate" (Ex. 18, pp. 32-33). Dr. Chambers testified that: Q. Well, but you've indicated that emotional stress is commonly known to cause an arrhythmia, right? A. Can certainly precipitate arrhythmias, as a general rule. Q. And you indicate that with a -- you need to know a particular individual's -- I guess something about them to know how stress is going to affect them, don't you? A. Yes, sir. Q. In other words, some events may affect one person more than another as far as emotional stress, right? A. Yes, sir. Q. And do you know some facts which would indicate that this was a particularly stressful situation for Mr. Shatswell, other than we do know, obviously, that he did have a cardiac arrest, but just do you know other facts besides that which would indicate he was stressed by the situation? A. The fact that he was involved in a physical con frontation, despite the size difference, one never knows whether weapons are going to be involved. I can imagine a number of things that would make that situation much more stressful than anything one would normally encounter in daily life, particularly when, I believe, -- the person he was involved with had a spouse that was also present. (Ex. 17, p. 8, l. 25 - p. 9, ll. 1-25) The question to be resolved in this case is whether decedent encountered greater stress in performing his work activity on Page 7 October 22, 1989, than he would have experienced in his normal, nonemployment life. It is difficult to imagine any type of nonemployment activity comparable to work as a law enforcement officer. On October 22, 1989, decedent was called to the scene of a shoplifting crime at Keystone Medicine Chest store. The perpetrators were an elderly couple. Kim Coonrod, a thief inves tigator for Keystone, was at the scene of the crime when decedent arrived. He testified in his deposition that the female perpe trator resisted orders from decedent in relinquishing the stolen property. Mr. Coonrod testified that decedent had to pull her away and out of her vehicle by grabbing her at the shoulders. Her husband sat in the front sit of the car during this encounter and appeared fairly passive (Ex. 16, pp. 12-27). Mr. Johnny Stevens, another eye witness to the incident, testified in his deposition that when decedent was guiding the same female perpe trator toward the curb, she struck him in the chest (Ex. 15). As Chief of Police, decedent was infrequently involved in arrest situations and was involved primarily in administrative and public relations duties. Although he was an experienced police officer, and not easily intimidated, the circumstances surrounding the incident on October 22, 1989, were not the usual, run-of-the-mill warrant arrest. Decedent found himself in a con frontational situation with a 62-year-old female shoplifter who was accompanied by a male companion, neither of whom were famil iar to decedent as both were from out-of-state. Decedent had to forcefully pull the shoplifter from her vehicle and confront her regarding relinquishment of the stolen property. Ordinarily, this may appear as a routine arrest situation. However, it proved to be a traumatic event that was out of the ordinary suf ficient to cause an erratic heart beat and fatal arrhythmia which resulted in decedent's death. After considering all of the above factors, the undersigned concludes that decedent sustained an injury arising out of and in the course of employment with employer on October 22, 1989 and his employment substantially caused his death. Claimant sus tained her burden of proof by a preponderance of the evidence that decedent's preexisting heart condition was aggravated by his employment. Nicks v. Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 (1962). Claimant sustained her burden of proof by a preponderance of the evidence that decedent's death was caused by work-related stress. Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965); and Lindahl v. L. O. Boggs Co., 236 Iowa 296, 18 N.W.2d 607 (1945). order THEREFORE, IT IS ORDERED: Pursuant to Iowa Code section 85.31, defendants shall pay to claimant, Janet Shatswell, surviving spouse of Cole B. Shatswell, Jr., death benefits at the stipulated rate of two hundred ninety-eight and 89/l00 dollars ($298.89). Pursuant to Iowa Code section 85.65, defendants shall pay to the Treasurer of the State of Iowa the appropriate amount for the Page 8 benefit of the Second Injury Fund of Iowa. Pursuant to Iowa Code section 85.28, defendants shall pay burial expenses. All accrued benefits shall be paid in a lump sum together with statutory interest thereon pursuant to Iowa Code section 85.30. The costs of this action shall be assessed to defendants pursuant to rule 343 IAC 4.33. Defendants shall file claim activity reports as requested by this agency pursuant to rule 343 IAC 3.1. Signed and filed this ____ day of July, 1991. ______________________________ JEAN M. INGRASSIA DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr. Jacob John Peters Attorney at Law 233 Pearl St P O Box 1078 Council Bluffs IA 51502 Mr. Gregory G. Barntsen Attorney at Law P O Box 249 Council Bluffs IA 51502 5-1108.10; 5-1805 July 12, 1991 JEAN M. INGRASSIA before the iowa industrial commissioner ____________________________________________________________ : JANET SHATSWELL, : : Claimant, : : vs. : : File No. 930291 CITY OF ONAWA, IOWA, : : A R B I T R A T I O N Employer, : : D E C I S I O N and : : EMPLOYERS MUTUAL COMPANIES, : : Insurance Carrier, : Defendants. : ___________________________________________________________ 5-1108.10; 5-1805 This claim for death benefits was brought by decedent's surviving spouse. Decedent, Chief of Police, City of Onawa, Iowa, had a fatal arrhythmia during the course of arresting two elderly shoplifters. Decedent had a preexisting heart condition and a recent subendocardial myocardial infarction. Three physicians attributed claimant's sudden death from a malignant ventricular arrhythmia to the confrontation and struggle which occurred at the time he was arresting the elderly shoplifters. Defendants' expert cardiologist stated that the confrontation between decedent and shoplifters was not so stressful as to precipitate the fatal ventricular arrhythmia. Claimant met her burden that decedent's heart condition was aggravated by his employment and the death was caused by work-related stress which is greater than he would have experienced in his normal, nonemployment life. Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974). Page 1 before the iowa industrial commissioner ____________________________________________________________ : SUSAN SCOTT, : : Claimant, : : vs. : : File No. 930373 PITNEY BOWES, : : A R B I T R A T I O N Employer, : : D E C I S I O N and : : THE TRAVELERS COMPANIES, : : Insurance Carrier, : Defendants. : ___________________________________________________________ statement of the case This is a proceeding in arbitration brought by Susan Scott as a result of injuries to her low back which occurred on August 15, 1989. Defendants denied compensability for the injury, paid weekly benefits and paid some medical benefits through its group health plan. The case was heard and fully submitted at Des Moines, Iowa, on April 16, 1991. The record in the proceeding consists of claimant's exhibits 1 through 7, defendants' exhibit 5 and testimony from claimant. issues The issues presented for determination are as follows: 1. Whether claimant sustained an injury on August 15, 1989, arising of out and in the course of employment; 2. Casual connection to temporary total disability or healing period beginning August 18, 1989 through February 11, 1990; 3. Causal connection to permanent disability and the extent of disability under Iowa Code section 85.34(2)(u); and 4. Claimant's entitlement to Iowa code section 85.27 medical benefits. findings of fact Having considered all the evidence received the following findings of fact are made: Page 2 Claimant, Susan Scott, began working for employer Pitney Bowes on December 1, 1988, as a sales representative. In that capacity she called on clients to sell office equipment. Her duties consisted of sales, set up, demonstration and removal of office equipment. On August 12 and 13, 1989, claimant moved to a new residence with the assistance of a number of friends. While moving her personal belonging she sustained an injury to her low back which is best described as a backache. This injury was not related to her employment. On August 15, 1989, while performing duties for employer, claimant sustained an aggravation of her low back condition. On that date claimant was removing a mailing machine from a client's premises. The machine weighed about 38 pounds. Claimant carried the machine up a flight of stairs and out to her car. During the process claimant felt a very sharp burning pain start in her low back and radiate into her left leg. At the time of injury claimant was five feet and one inch tall and her body weight was 88 to 90 pounds. Claimant went off work on August 18, 1989, due to the severe back pain. She was initially treated by Mark D. Kelly, D.O., who recorded a history of backache occurring while moving furniture at home (claimant's exhibit 2, page 1). Defendants contend that the history taken by Kelly is in conflict with claimant's allegation of a work injury. It is found that based upon the evidence presented, claimant's history is not so conflicting that it causes her case to fail. No evidence was offered which refuted claimant's body weight as 90 pounds on August 15, 1989. No evidence was offered to refute that claimant carried a 38 pound machine out of a basement on August 15, 1989. Furthermore, Dr. Kelly's office notes of August 17, 1989, indicate a sharp pain which began "in last couple days." This statement coincides with the date of injury (cl. ex. 2, p. 1). Claimant was off work between August 18, 1989 and February 11, 1990, due to the low back pain. She was examined and treated by numerous doctors who differed in their diagnosis of her back pain. The initial treating doctor, diagnosed her low back problem as lumbosacral strain (cl. ex. 2, p. 5). William R. Boulden, M.D., is an orthopedic specialist who also acted as a treating physician. He diagnosed claimant's injury as sacroiliac joint dysfunction (cl. ex. 1, p. 4). Jeffrey M. Farber, D.O., saw claimant in consultation with Dr. Kelly. Farber assessed her problem as left sacroilitis (cl. ex. 3, p. 1). Ronald K. Bunten, M.D., also examined claimant and came to the opinion that claimant likely aggravated some preexisting asymptomatic degenerative disc disease in the back (cl. ex. 4, p. 1). Page 3 Finally, Peter D. Wirtz, M.D., examined claimant at the request of defendants and diagnosed her back condition as muscular pain and bulging disc L5-S1. The fact that the doctors disagree on the diagnosis does not cause the claim to fail. It is obvious from the reports that claimant was suffering from low back pain during the period of recovery. The severe pain began on August 15, 1989, while carrying office equipment for employer and the medical treatment during the period of recovery was a direct result of having incurred the injury of August 15, 1989. Claimant was released to begin work on February 12, 1990 (cl. ex. 1, p. 8). Her work restrictions are best described as no excessive bending, lifting, twisting, prolonged sitting and prolonged standing (cl. ex. 1, p. 5; cl. ex. 5, p. 7). Dr. Wirtz also imposed a lifting restriction of 35 pounds (cl. ex. 5, p. 7). Claimant did not immediately return to work for employer as her former job had been reassigned to another person. Employer delayed her recall to work until May 7, 1990. Claimant returned to similar duties as a sales person as she had performed prior to the injury. Claimant stated that the back injury plagued her with respect to performing demonstrations of equipment for potential customers. She stated that she had some problem with driving long distances. Claimant was unable to state with any certainty that the back injury had impacted her sales subsequent to her return to work, Claimant voluntarily terminated her employment with employer on April 16, 1991, so as to accept a sales position with the Albert Price Company. Her new job pays a draw upon commission of $450 per week and requires extensive travel throughout Iowa. She will be a sales representative responsible for selling products such as small statues, picture frames and assorted gift items. Claimant stated that she was capable of driving the long distances required in her new job. The first issue to be resolved is whether claimant sustained an injury arising out of and in the course of employment. It is found that on August 15, 1989, claimant sustained an aggravation injury to her low back when she carried an office machine up a flight of stairs in the performance of duties for her employer. Claimant's testimony that she lifted a heavy office machine on August 15, 1989, with resulting exacerbation of low back and left leg pain was convincing. It is very logical to conclude that lifting of a 38-pound machine by a 90-pound individual would, in all likelihood, aggravate a preexisting low back injury. The next issue concerns the causal connection of permanent disability to the August 15, 1989, low back injury. Only one opinion concerning permanent partial Page 4 impairment was offered. Dr. Boulden opined that if any permanent impairment was present, that is was caused by the August 15, 1989, incident (cl. ex. 1, p. 1). Dr. Boulden deferred his opinion on the extent of impairment to Tom Bower, who is a physical therapist, who performs evaluations based upon the AMA Guides to the Evaluation of Permanent Impairment. Mr. Bower rated claimant's impairment at 10 percent to the body as a whole with 5 percent due to a degenerative disc and 5 percent due to a loss of range of motion (cl. ex. 1, p. 2). Defendants contend that the degenerative disc rating of 5 percent preexisted the August 15, 1989, injury. Dr. Bunten opined that the disc preexisted the injury (cl. ex. 4, p. 1). No medical expert found a causal connection between the August 15, 1989, injury and the degenerative disc. It is found that claimant has failed to prove by a preponderance of the evidence that the impairment of the degenerative disc is causally connected to the August 15, 1989, injury. Bower also assessed 5 percent impairment due to loss of range of motion. It is found that the loss of range of motion is the direct result of the aggravation of claimant's preexisting low back injury. Dr. Boulden stated in his letter of March 15, 1990, that the injury of August 15, 1989, was the "contributing factor that caused the symptoms to be present" (cl. ex. 1, p. 1). The logical interpretation of "contributing" is that the August 15, 1989, accident aggravated the preexisting asymptomatic condition. It is also apparent that permanent work restrictions have been imposed by the various examining doctors as a result of the injury (cl. ex. 1, p. 6; cl. ex. 5, p. 7). Having found permanent impairment and work restrictions causally connected to the injury, it follows that claimant sustained permanent disability as a result of the August 15, 1989, injury. The next issue concerns the extent of industrial disability. Factors to be considered include claimant's age, education, experience, impairment and work restrictions. Claimant was age 50 at the time of injury and a 1957 high school graduate. She also completed one year of music classes at Cornell College and has prior training and experience in real estate sales. Claimant also has experience as an accounting clerk, mortgage loan officer and sales representative. Her earnings in 1985 were about $37,000 per year. However, her work since that time appears to be in the earnings range of $18,000 to $23,000 per year. Based upon average weekly wage on the date of injury, claimant earned about $18,000 per year working for Pitney Bowes. Based upon claimant's draw at her new job, she will earn about $23,500 per year. However, claimant's future earnings are speculative and cannot be given great weight. Claimant's impairment rating is in the range of 5 Page 5 percent and her work restrictions prevent prolonged sitting, standing and bending. The work restrictions did, according to claimant, inhibit her in her sales profession by causing difficulty in performing demonstrations of office equipment. It is found that claimant is an intelligent, hard working and highly motivated worker. In all likelihood she will excel in her future endeavors. However, the permanent work restrictions have the effect of limiting her access to the job market. She will undoubtedly be at a disadvantage when competing against younger, healthier and better educated workers. It is found that as a result of the August 15, 1989, injury, claimant is 15 percent industrially disabled. It is noted that surgery for the back injury was not anticipated at the time of hearing. Having found the injury to be a cause of permanent disability, it follows that the lost time must be classified as healing period. The parties stipulated to the period of lost time, but disputed causation. It is found that claimant has proven entitlement to healing period benefits beginning August 18, 1989 through February 11, 1990. The medical exhibits clearly reveal that during the entire period, claimant was under treatment for low back symptoms which first appeared on August 15, 1989. It follows that the healing period is causally connected to the injury of August 15, 1989. The final issue concerns claimant's entitlement to Iowa Code section 85.27 benefits. The parties stipulated to all subissues with the exception of causal connection. Defendants contend that the injury is one that occurred at home while moving furniture. This allegation has been rejected. It is true that claimant had a preexisting injury, but it is also apparent from the record that the August 15, 1989, incident forced claimant to seek treatment. It is found that claimant has proven the causal connection of her medical treatment to the section 85.27 expenses listed by claimant totaling $4,840.10. Claimant is entitled to payment of those medical expenses. However, claimant is not entitled to direct reimbursement for medical bills unless she paid them from her own funds. conclusions of law Claimant has the burden of proving by a preponderance of the evidence that she received an injury on August 15, 1989, which arose out of and in the course of her 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). While a claimant is not entitled to compensation for the results of a preexisting injury or disease, the mere existence at the time of a subsequent injury is not a defense. Rose v. John Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-61 (1956). If the claimant had a preexisting condition or disability that is aggravated, accelerated, worsened or lighted up so that it results in disability, claimant is entitled to recover. Nicks v. Page 6 Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 (1962). Claimant has proven by the preponderance of the evidence that she sustained an injury to her low back on August 15, 1989, arising out of and in the course of employment. An injury to a scheduled member which, because of after-effects (or compensatory change), creates impairment to the body as a whole entitled claimant to industrial disability. Barton v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 (1961). Daily v. Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 (1943). Functional impairment is an element to be considered in determining industrial disability which is the reduction of earning capacity, but consideration must also be given to the injured employee's age, education, qualifications, expe rience and inability to engage in employment for which he is fitted. Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963). Barton, 253 Iowa 285, 110 N.W.2d 660. A finding of impairment to the body as a whole found by a medical evaluator does not equate to industrial disabil ity. This is so as impairment and disability are not syn onymous. Degree of industrial disability can in fact be much different than the degree of impairment because in the first instance reference is to loss of earning capacity and in the latter to anatomical or functional abnormality or loss. Although loss of function is to be considered and disability can rarely be found without it, it is not so that a degree of industrial disability is proportionally related to a degree of impairment of bodily function. Factors to be considered in determining industrial dis ability include the employee's medical condition prior to the injury, immediately after the injury, and presently; the situs of the injury, its severity and the length of healing period; the work experience of the employee prior to the injury, after the injury and potential for rehabilitation; the employee's qualifications intellectually, emotionally and physically; earnings prior and subsequent to the injury; age; education; motivation; functional impairment as a result of the injury; and inability because of the injury to engage in employment for which the employee is fitted. Loss of earnings caused by a job transfer for reasons related to the injury is also relevant. These are matters which the finder of fact considers collectively in arriving at the determination of the degree of industrial disability. There are no weighting guidelines that indicate how each of the factors are to be considered. There are no guidelines which give, for example, age a weighted value of ten percent of the total value, education a value of fifteen percent of total, motivation - five percent; work experience - thirty percent, etc. Neither does a rating of functional impairment directly correlate to a degree of industrial disability to the body as a whole. In other words, there Page 7 are no formulae which can be applied and then added up to determine the degree of industrial disability. It therefore becomes necessary for the deputy or commissioner to draw upon prior experience, general and specialized knowledge to make the finding with regard to degree of industrial dis ability. See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, March 26, l985). Claimant has proven by a preponderance of the evidence that the injury of August 15, 1989, is a cause of permanent disability. Upon considering all the material factors it is found that the evidence in this case supports an award of 15 percent permanent partial disability, which entitles the claimant to recover 75 weeks of benefits under Iowa Code section 85.34(2)(u). Section 85.34(1), Code of Iowa, provides that healing period benefits are payable to an injured worker who has suffered permanent partial disability until (1) he has returned to work; (2) is medically capable of returning to substantially similar employment; or (3) has achieved maximum medical recovery. The industrial commissioner has recognized that healing period benefits can be interrupted or intermittent. Willis v. Lehigh Portland Cement Company, Vol. 2-1, State of Iowa Industrial Commissioner Decisions, 485 (1984). Claimant has proven that the healing period in issue is causally connected to the August 15, 1989, injury. Claimant is entitled to payment for healing period beginning August 18, 1989 through February 11, 1990. The employer, for all injuries compensable under chapter 85 or chapter 85A, shall furnish reasonable surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance and hospital services and supplies; therefore, and shall allow reasonable necessary transportation expenses incurred for such services. The employer has the right to choose the provider of care. Iowa Code section 85.27. "Claimant is not entitled to reimbursement for medical bills unless he shows that he paid them from his own funds." See Caylor v. Employers Mut. Cas. Co., 337 N.W.2d 890 (Iowa App. 1983). Claimant has established the causal connection of medical expenses to the August 15, 1989, injury. Claimant has proven entitlement to payment of the medical expenses listed. Claimant is entitled to direct reimbursement of medical expenses to the extent she paid the bills from her own funds. order IT IS THEREFORE, ORDERED: Page 8 Defendants are to pay claimant seventy-five (75) weeks of permanent partial disability at the rate of two hundred seventeen and 20/100 dollars ($217.20) per week commencing February 12, 1990. Defendants are to pay claimant healing period benefits at the rate of two hundred seventeen and 20/100 dollars ($217.20) for the period August 18, 1989 through February 11, 1990. Defendants are to pay claimant's Iowa Code section 85.27 benefits as outlined in the opinion. It is further ordered that defendants shall receive credit for benefits previously paid. It is further ordered that all accrued benefits are to be paid in a lump sum. It is further ordered that interest will accrue pursuant to Iowa Code section 85.30. It is further ordered that the costs of this action are assessed against defendants pursuant to rule 343 IAC 4.33. It is further ordered that defendants file claim activity reports as requested by this agency pursuant to rule 343 IAC 3.1. Signed and filed this ____ day of May, 1991. ______________________________ MARLON D. MORMANN DEPUTY INDUSTRIAL COMMISSIONER Copies to: Mr. Phillip Vonderhaar Attorney at Law 840 5th Ave Des Moines, Iowa 50309 Mr. Andrew Bracken Attorney at Law 100 Court Ave STE 600 Des Moines, Iowa 50309 Page 1 51100 51802 52500 51803 Filed May 8,1991 Marlon D. Mormann before the iowa industrial commissioner ____________________________________________________________ : SUSAN SCOTT, : : Claimant, : : vs. : : File No. 930373 PITNEY BOWES, : : A R B I T R A T I O N Employer, : : D E C I S I O N and : : THE TRAVELERS COMPANIES, : : Insurance Carrier, : Defendants. : ___________________________________________________________ 51100 51802 52500 Claimant established an aggravation injury of the low back and was awarded healing period benefits and section 85.27 expenses 51803 Claimant, age 50 and a high school graduate, had work experience consisting primarily as a sales person was given impairment at 5 percent and 35-pound work restrictions. Employer offered work. Claimant awarded 15 percent industrial disability.