Page 1 before the iowa industrial commissioner ____________________________________________________________ : CHARLES R. MEEKS, : : Claimant, : File Nos. 876894, 944018 : 930535, 966544 vs. : 966545, 966546 : 966547 FIRESTONE TIRE & RUBBER CO., : : Employer, : A R B I T R A T I O N : and : D E C I S I O N : CIGNA, : : Insurance Carrier, : Defendants. : ___________________________________________________________ STATEMENT OF THE CASE Claimant, Charles R. Meeks, seeks benefits under the Iowa Workers' Compensation Act and has filed seven petitions in arbitration against Firestone Tire & Rubber Company, employer, and Cigna, insurance carrier, as defendants. The files were consolidated, and a hearing was held on January 28, 1992 at Des Moines, Iowa. The record in these cases consists of the testimony from the claimant, Dwayne Ables, Carma Mitchell and Michael Baker; and joint exhibits 1 through 28. The agency files reveal the following information: 1. December 15, 1987: Right shoulder injury (agency File No. 876894); 2. January 5, 1989: Lower back injury (agency File No. 966544); 3. March 13, 1989: Left hip injury and low back injury (agency File No. 944018); 4. September 15, 1989: Lower back injury (agency File No. 930535); 5. April 10, 1990: Left hip injury (agency File No. 966545); 6. September 23, 1990: Right shoulder injury (agency File No. 966546); and, 7. October 1, 1990: Cumulative injury to the left hip (agency File No. 966547). With respect to the first injury (December 15, 1987, Page 2 File No. 876894), the sole issue to be determined is the extent of entitlement to permanent partial disability benefits. The second alleged injury (File 966544), the parties submit the following issues for resolution: 1. Whether claimant sustained an injury on January 5, 1989, which arose out of and in the course of his employment; 2. Whether there is a causal connection to the injury and claimant's disability; 3. Whether claimant is entitled to temporary total or healing period benefits (although the parties stipulated that claimant did not incur any time off from work due to this alleged injury); 4. Whether claimant is entitled to permanent partial disability benefits, and whether claimant sustained an injury to the body as a whole or to a scheduled member; and, 5. Whether claimant is entitled to medical benefits, as governed by Iowa Code section 85.27. The defendants have raised the following affirmative defenses: 1. Lack of proper notice under Iowa Code section 85.23; 2. Failure to file the claim under the proper statute of limitations, as governed by Iowa Code section 85.26; and, 3. Unauthorized medical expenses. The next case (File No. 944018) contains the following issues for resolution: 1. Whether claimant received an injury on March 13, 1989 which arose out of and in the course of his employment; 2. Whether there is a causal connection to the injury and claimant's disability; 3. Whether claimant is entitled to temporary total or healing period benefits (the parties stipulate that claimant was off work from September 29, 1990 through March 17, 1991); 4. Whether claimant is entitled to permanent partial disability benefits, and whether these benefits are based on an injury to the body as a whole or an industrial disability; and, 5. Whether claimant is entitled to medical benefits under Iowa Code section 85.27. Defendants assert that claimant failed to give notice Page 3 of the injury, as required by Iowa Code section 85.23, and further submit that medical expenses incurred were unauthorized. The fourth case (File No. 930535) offers the following issues for resolution: . Whether claimant sustained an injury on September 15, 1989, which arose out of and in the course of his employment; . Whether there is a causal connection to claimant's injury and his disability; . Whether claimant is entitled to temporary total or healing period benefits (although the parties have stipulated that claimant was off work and seeks either temporary total disability or healing period benefits from September 30, 1989 through October 1, 1989); . Whether claimant is entitled to permanent partial disability benefits, including whether claimant sustained an injury to a scheduled member or to the body as a whole; and, . Whether claimant is entitled to medical benefits, as governed by Iowa Code section 85.27. Defendants assert that claimant failed to give proper notice, as required by Iowa Code section 85.23, and submit that he has incurred unauthorized medical treatment. The next case (File No. 966545) contains the following issues for resolution: . Whether claimant sustained an injury on April 10, 1990, which arose out of and in the course of his employment; . Whether there is a causal connection to the injury and claimant's disability; . Whether claimant is entitled to temporary total or healing period benefits (the parties stipulate that claimant was off work from September 29, 1990 through March 17, 1991); . Whether claimant is entitled to permanent partial disability benefits, and whether claimant has sustained a permanent injury to a scheduled member or the body as a whole; and, . Whether claimant is entitled to medical benefits, pursuant to Iowa Code section 85.27. Defendants raised the following affirmative defenses: . Lack of proper notice of the injury, as required by Iowa Code section 85.23; and, . Medical expenses incurred were unauthorized. Page 4 The sixth case (File No. 966546) discloses the following issues for resolution: . Whether claimant sustained an injury on September 23, 1990, which arose out of and in the course of his employment; . Whether there is a causal connection to the injury and claimant's disability; . Whether claimant is entitled to temporary total or healing period benefits (the parties stipulated that claimant did not lose any time from work due to these injuries); . Whether claimant is entitled to permanent partial disability benefits, and if so, whether claimant has sustained an injury to a scheduled member or to the body as a whole; and, . Whether claimant is entitled to medical benefits, as governed by Iowa Code section 85.27. Defendants assert the following affirmative defenses: . Failure to give proper notice of the injury, as required by Iowa Code section 85.23; and, . Medical expenses incurred were unauthorized. Finally, the last case (File No. 966547) contains the following issues for resolution: . Whether claimant sustained a cumulative injury in October of 1990, which arose out of and in the course of his employment; . Whether there is a causal connection to claimant's Page 5 injury and his disability; . Whether claimant is entitled to temporary total disability or healing period benefits (the parties stipulate that claimant was off work from September 29, 1990 through March 17, 1991); . Whether claimant is entitled to permanent partial disability benefits, and if so, whether claimant has sustained an injury to a scheduled member or to the body as a whole; and, . Whether claimant is entitled to medical benefits, as governed by Iowa Code section 85.27. Defendants raise the following affirmative defenses: . Lack of proper notice, as required by Iowa Code section 85.23; and, . Unauthorized medical expenses. Interestingly, defendants also dispute that claimant's injuries to his rotator cuff, low back and hip are injuries to the body as a whole, yet offer no guidance as to which part of the schedule applies. This agency has routinely held that these types of injuries are to be compensated on an industrial basis, and shall be in the present cases. findings of fact The undersigned deputy, having reviewed all of the evidence received, finds the following facts: Charles Meeks was born on December 15, 1933, and at the time of the hearing was 58 years old. He is a 1952 high school graduate, and has taken additional courses in welding and math at Des Moines Technical Institute and during the service. He has also attended several seminars sponsored by NAPA Auto Parts regarding the latest technology on cars. Claimant entered the United States Army in April 1955, and received an honorable discharge in March of 1958. While in the service, he was sent to Fort Benning, Georgia, and worked as an offset printer. After his discharge from the army, claimant began work as a door-to-door salesperson for Fuller Brush. After three or four years of selling household products, he obtained employment with O.K. Tire on a part-time basis, where his duties included repairing, balancing and installing tires. During this time, claimant also worked as a fireman for the Des Moines Fire Department. In August of 1965, claimant secured employment with Firestone Tire & Rubber Company (herein after called Firestone). He has always worked in the plant in Des Moines, and his initial employment was in the curing department. In this position, claimant was required to bag tires. After three years, claimant moved to the passenger Page 6 tire building department where he worked for four to five years. Claimant was then transferred to the intermediate tractor tire and heavy duty tire departments. Eventually, claimant was able to work in both departments due to his seniority and expertise. The intermediate tire tractor department builds tractor tires of six feet or taller, weighing between 100 to 600 pounds. The heavy duty tire department produces tires which are used on earth movers, with the tires weighing in excess of 1000 pounds, and anywhere from six to ten feet in height. On December 15, 1987, claimant was working in the heavy duty tire department. He was attempting to take a jack out of a drum which was being used to build a tire and felt a tear in his right shoulder area. He reported the incident to the company nurse at the end of his shift, and was seen by the company doctor at the plant. Claimant was assigned to light duty work, and in February of 1988 underwent surgery for repair of a rotator cuff. Marvin Dubansky, M.D., performed the surgery and released claimant to return to regular duties in August 1988. Prior to the right shoulder work injury, claimant on two occasions had injured his right shoulder. Neither injury required extended medical treatment nor surgery. On January 5, 1989, claimant was again working in the heavy duty tire department. He had been assigned to help build the largest floatation tire manufactured at the plant. As claimant was leaning over the center, he felt a "pull" in his lower back. Claimant reported the incident to the company nurse, and was examined by the company doctor who diagnosed a pulled muscle. Apparently, claimant was taken off of regular duties until January 9, 1989 (Jt. Ex. 13, p. 12). The next incident alleged by claimant is an injury on March 13, 1989. At the hearing, claimant testified that he was working in the heavy duty tire building department, and was attempting to stretch a tire over a collapsed drum. In so doing, claimant states that he was pushing and flipping a large tire and hurt his left hip and low back. Claimant reported the incident to the company nurse and was sent to the company doctor (Jt. Ex. 13, p. 12). Eventually, claimant was referred to Dr. Dubansky (Jt. Ex. 13, p. 13). Office notes from Dr. Dubansky dated April 25, 1989, indicate that claimant was complaining of a painful low back and left hip. Claimant had seen a chiropractor for right leg pain which had subsided at the time of his appointment with Dr. Dubansky. Upon examination, claimant was able to perform straight leg raising bilaterally. External rotation, abduction and adduction were equal, and x-rays showed narrowing in the left hip area. Dr. Dubansky injected the left hip and scheduled a two week follow-up visit (Jt. Ex. 1, p. 19). Claimant continued to see Dr. Dubansky in May and June of 1989. He was treated with Voltaren and pool therapy at Mercy Hospital. Claimant was continuing to work on light Page 7 duty, and on July 18, 1989, claimant was released to return to work for regular duty. Dr. Dubansky's notes indicate that claimant's problems constitute an arthritic manifestation (Jt. Ex. 1, pp. 19-20). Furthermore, Dr. Dubansky indicated that claimant's work injury of March 13, 1989 was a minor aggravation of a preexisting arthritic condition which did not substantially aggravate his underlying condition (Jt. Ex. 3, p. 8). In July of 1989, claimant returned to his regular job duties, again in the heavy duty tire building area. He testified that on September 15, 1989, he hurt his low back while trying to remove a tire from a drum. Again, he reported the incident to the company nurse and was seen by the company physician, James Blessman, M.D. (Jt. Ex. 13, p. 14). Dr. Blessman recommended light duty work, and sent claimant to the Methodist Clinic for injections to the sciatic nerve. Claimant was scheduled for a CT scan was referred to Robert Jones, M.D., for consultation (Jt. Ex. 11, p. 1). The CT scan was scheduled for November of 1989, and the results showed a central bulging disc at the lumbosacral area of the spine. Dr. Jones commented that the condition did not warrant surgery at this time, and recommended further conservative treatment. Dr. Jones also noted that claimant had degenerative disease of the left hip (Jt. Ex. 2, p. 1). Claimant returned to Dr. Blessman for follow-up treatment, and was released to return to regular duty on January 18, 1990. Dr. Blessman noted that if claimant was "not able to tolerate at this time, I would recommend a permanent tire building restriction on him as he has had a number of problems with it and may need to make a permanent change." (Jt. Ex. 11, p. 2). The next injury date alleged by claimant is that of April 10, 1990. Claimant testified that he injured his left hip while trying to avoid being hit by a tire. This incident is reflected in Dr. Blessman's notes dated April 11, 1990. Dr. Blessman also states that: "It was my sense that he may need a permanent restriction from tire building if he gets into significant time off or limited duty this time would go ahead and put him on a permanent restriction as it is obvious he is going to continue to reinjure himself doing this work." (Jt. Ex. 11, p. 2). Although claimant testified that he then went to see Richard Evans, D.O., his family physician for further treatment on his left hip, the notes indicate that claimant actually saw Dr. Evans for left hip pain on January 12 and April 3, 1990. Dr. Evans' overall assessment of claimant's condition was that of degenerative joint disease of the left hip (Jt. Ex. 10, pp. 1-3). Claimant was referred to several other physicians including Joshua Kimelman, D.O., Rodney Johnson, M.D., and Richard Johnston, M.D. The next injury alleged by claimant is to his right Page 8 shoulder. Claimant stated that on September 23, 1990, as he was working light duty at the plant, he was performing overhead work and felt a tear in his right shoulder. He reported it to the company nurse, and was sent to Dr. Dubansky (Jt. Ex. 13, p. 16). Claimant was told to continue on light duty. Finally, the last injury date alleged is a cumulative injury occurring in October of 1990 with respect to claimant's hip condition. Claimant underwent a total hip replacement in October of 1990. This replacement was performed by Dr. Kimelman, who kept claimant off of work from September 29, 1990 through March 17, 1991. The parties have obtained numerous expert opinions with respect to claimant's numerous ailments and whether they are a result of his work activities at the Firestone Tire & Rubber Company plant. On December 1, 1989, Dr. Jones made the following assessment: I saw your patient, Mr. Meeks in the office on November 27 with the problem of low back pain extending into the left groin and without leg pain. He said this came on after he hurt himself building tires at work in March, 1989 and he saw Dr. Dubansky at that time....He then re-hurt his back on the job in September of this year and developed pain in both legs and saw you....I note he is on Voltaren for his knuckles which he says is related to his years of tire-building. It also helps his hip. He did have a fractured femur in 1954. The Ct of the lumbar spine showed a central bulging disc at lumbosacral with early stenosis. .... I thought he had a central bulging disc with early stenosis at lumbosacral which I did not think was surgical at this time. He also has degenerative disease of the left hip helped by Voltaren. (Jt. Ex. 2, p. 1) On May 31, 1990, Dr. Johnson performed an examination and evaluation with the following results: Charles Meeks is a 56 year old individual who works at Firestone. He has worked at Firestone for the past 25 years. His job is building the large tires of the earth mover tractors and he has done this for 25 years and there obviously is a significant amount of lifting, pushing, pulling, stooping that he has done repetitively over a long period of time. He has had discomfort with his left hip, significant discomfort at least for Page 9 approximately one year.... .... It is my impression that his work has contributed to the degenerative joint disease that he has and his injury one year ago while lifting aggravated this condition to the present time where he is having pain almost continuously. (Jt. Ex. 6, pp. 1-3) Dr. Johnston made the following assessment on June 25, 1990: Mr. Meeks is a 56 year old tire builder at Firestone who comes in for evaluation of his painful left hip. He dates the onset of his symptoms to an episode at work building a very large tire in March of 1989. Since that time he has had increasing pain in his left hip and now has rather severe pain in his left hip with activity and at rest in spine of Voltaren and Tylenol #3.... .... ...Mr. Meeks is markedly disabled by his painful left hip. He is quite convinced that his problem was caused by his work. I told him that I did not believe that his work caused the primary degenerative arthritis in his hip but I certainly would agree with him that his situation was significantly aggravated by his work episode. (Jt. Ex. 7, pp. 1-3) On April 2, 1991, Dr. Kimelman, who performed the hip replacement, made the following assessment: I believe that from March of 1989 until the time of Mr. Meeks' hip surgery there was significant progression of his left hip condition which may be related to an injury sustained on or about March 13 of 1989 and certainly repeated work activities materially aggravated his left hip condition. ...I'm unable to assess how much deterioration was caused by that injury in the fact of rather marked progress of his hip disease during that interval. ...I believe that Mr. Meeks had a rapid deterioration of his left hip between March of 1989 and his eventual surgery in October of 1990. Progressive activity would cause progressive deterioration of the joint. As my office record on March 8, 1991 indicated, Mr. Meeks has had a good relief of pain from his hip joint replacement and now has a functional Page 10 range of motion in the hip. I believe he has sustained permanent impairment as his hip obviously is no longer "normal." The greatest amount of his impairment is secondary to his restrictions from heavy lifting, pushing, pulling, etc. as the unknown issue with hip replacement is the question of longevity. (Jt. Ex. 4, pp. 1-2) In May of 1991, Dr. Kimelman supplemented his opinion: Finally in answer to Mr. Meeks' permanent impairment as regards his total hip, I did not assess a percentage rating and I believe that according to the AMA Guide, a good functioning total hip such as Mr. Meeks condition represents 20% permanent impairment of the lower extremity. (Jt. Ex. 4, p. 4) Dr. Jones contributed the following opinion on June 3, 1991: I feel that at least the injury at work in March 1989, the injury in September 1989, and probably the injury in January 1989, were all important causal factors in this patient's continued back pain problem. ...I could not put an impairment figure on each one of these injuries; but tied together as a whole, I would estimate his permanent physical impairment to be in the range of 7-10 percent as contained in the AMA guides. I think his back will continue to give him problems, based on the fact that it had given him difficulties for all this time. Physical restrictions would be to avoid bending and lifting, other than in a minor way, and excessive walking, since this appears to bother his low back. (Jt. Ex. 2, p. 2) Dr. Dubansky stated the following opinion on December 18, 1991: 1. I have not recommended any further surgery for Mr. Meek's [sic] right shoulder. In my evaluation of April, 1991 I did increase the impairment rating of the right shoulder from the previous 15% of the right upper extremity to 18% of the right upper extremity. 2. I believe Mr. Meeks could continue working as a forklift driver in jobs which do not require him to do any lifting with the right arm away from the body or above the head. 3. I felt that he had a degenerative arthritis in Page 11 his left hip and was receiving medication for the arthritis before the work injury of March of 1989. I felt this would be a minor aggravation of his pre-existing condition. The accident was not the cause of his arthritis in the hip and I do not feel it was a substantial aggravating factor in his underlying condition which eventually warranted surgery. (Jt. Ex. 3, p. 8) analysis & conclusions of law FILE NO. 876894 - RIGHT SHOULDER INJURY ON DECEMBER 15, 1987 The sole issue to be addressed is the extent of entitlement to permanent partial disability benefits. Although defendants attempt to argue that claimant sustained a scheduled member injury, agency precedence is quite clear that an injury to the shoulder, and more specifically to the rotator cuff, is an injury to the body as a whole. Therefore, claimant's industrial disability must be evaluated. Functional impairment is an element to be considered in determining industrial disability which is the reduction of earning capacity, but consideration must also be given to the injured employee's age, education, qualifications, expe rience and inability to engage in employment for which he is fitted. Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963). Barton v. Nevada Poultry, 253 Iowa 285, 110 N.W.2d 660 (1961). A finding of impairment to the body as a whole found by a medical evaluator does not equate to industrial disabil ity. This is so as impairment and disability are not syn onymous. Degree of industrial disability can in fact be much different than the degree of impairment because in the first instance reference is to loss of earning capacity and in the latter to anatomical or functional abnormality or loss. Although loss of function is to be considered and disability can rarely be found without it, it is not so that a degree of industrial disability is proportionally related to a degree of impairment of bodily function. Factors to be considered in determining industrial dis ability include the employee's medical condition prior to the injury, immediately after the injury, and presently; the situs of the injury, its severity and the length of healing period; the work experience of the employee prior to the injury, after the injury and potential for rehabilitation; the employee's qualifications intellectually, emotionally and physically; earnings prior and subsequent to the injury; 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 Page 12 determination of the degree of industrial disability. There are no weighting guidelines that indicate how each of the factors are to be considered. There are no guidelines which give, for example, age a weighted value of ten percent of the total value, education a value of fifteen percent of total, motivation - five percent; work experience - thirty percent, etc. Neither does a rating of functional impairment directly correlate to a degree of industrial disability to the body as a whole. In other words, there are no formulae which can be applied and then added up to determine the degree of industrial disability. It therefore becomes necessary for the deputy or commissioner to draw upon prior experience, general and specialized knowledge to make the finding with regard to degree of industrial dis ability. See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, March 26, l985). At the time of this injury, claimant was 54 years of age. He is a high school graduate, and has taken additional course work in welding and math courses. Most, if not all, of claimant's employment history has been concentrated in the medium to heavy work categories. He has worked for defendant company for approximately 25 years. Claimant's hobbies include working on cars. Occasionally, he has gained an income from this hobby, although his ability to pursue this activity has been limited due to his physical condition. Claimant has some transferable skills, but it is unlikely that he would be able to secure employment that would compensate him on a level comparable to the hourly wage he was earning while working at Firestone. Claimant has endured a six month healing period due to the injury to his rotator cuff in the right shoulder. However, he was released to return to regular duty work, which he accomplished until his next injury, in January of 1989. However, it is noted that claimant has sustained a 15 percent impairment to the right shoulder due to the injury. As a result, he has sustained a 15 percent industrial disability, and shall be compensated on the basis of 500 weeks. Therefore, claimant is entitled to 75 weeks of benefits at the rate of $481.22 per week. These benefits shall start on August 24, 1988. FILE NO. 966544 - BACK INJURY ON JANUARY 5, 1989. In this file, the first issue to be determined is whether claimant sustained an injury on January 5, 1989, which arose out of and in the course of his employment. An employee is entitled to compensation for any and all personal injuries which arise out of and in the course of Page 13 the employment. Section 85.3(1). Claimant has the burden of proving by a preponderance of the evidence that he received an injury on January 5, 1989, 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. "An injury occurs in the course of the employment when it is within the period of employment at a place the Page 14 employee may reasonably be, and while he is doing his work or something incidental to it." Cedar Rapids Comm. Sch. Dist. v. Cady, 278 N.W.2d 298 (Iowa 1979), McClure, 188 N.W.2d 283; Musselman v. Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967). Claimant testified that as he was leaning over a tire to pull back a ring, he felt a pull in his lower back. He reported to the company nurse, a fact which is evidenced by her notes dated January 5, 1989. Additionally, claimant was taken off regular duty and put on light duty work until January 9, 1989 (Jt. Ex. 13, p. 12). The evidence clearly shows that claimant was performing his regular job duties required by his assigned position during his regular work shift. Nothing indicates that claimant was doing anything other than what was required of him, and it is also clear that the act of pulling a piece of equipment while leaning over something would likely cause back pain. As a result, it is found that claimant sustained an injury which arose out of and in the course of his employment on January 5, 1989. Defendants raise two affirmative defenses for this claim. Specifically, they assert that claimant did not give proper notice as provided for under Iowa Code section 85.23. This code section provides, in relevant part: Unless the employer or the employer's representative shall have actual knowledge of the occurrence of an injury received within ninety days from the date of the occurrence of the injury, or unless the employee or someone on the employee's behalf or a dependent or someone on the dependent's behalf shall give notice thereof to the employer within ninety days from the date of the occurrence of the injury, no compensation shall be allowed. Notice to a company representative, such as a nurse, has routinely been considered notice to an employer. Likewise, claimant was placed on a temporary assignment for light duty work, so it was evident that the supervisor knew of the back problem. As a result, it is found that defendants' claim of lack of notice of the injury is without merit. Defendants also raise the affirmative defense that claimant failed to file his petition within the appropriate statute of limitations. Iowa Code section 85.26 provides the following information: An original proceeding for benefits under this chapter...shall not be maintained in any contested case unless the proceeding is commenced within two years from the date of the occurrence of the injury for which benefits are claimed or, if Page 15 weekly compensation benefits are paid under section 86.13, within three years from the date of the last payment of weekly compensation benefits. A review of the file confirms that claimant's petition was filed on January 4, 1991. Claimant was not paid benefits for this injury, but has complied with the statute as he filed his petition within two years from the date of the injury. As a result, it is found that defendants' second affirmative defense is without merit. The next issue to be addressed is whether there is a causal connection between claimant's disability and his current disability. The claimant has the burden of proving by a preponderance of the evidence that the injury of January 5, 1989, 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 disabil ity. Blacksmith v. All-Amnerican, Inc., 290 N.W.2d 348, 354 (Iowa 1980). There is no indication that claimant missed any work for this injury. He did see the company doctor on several occasions, but no impairment rating was rendered, and no medical restrictions were placed on claimant's activities. Page 16 As a result, it is found that claimant did not sustain a permanent injury, and he is not entitled to receive any temporary disability benefits or permanent partial disability benefits. Although medical expenses were placed in issue, claimant did not incur any medical expenses due to this specific incident, and the issue will not be addressed. FILE NO. 944018 - LEFT HIP AND BACK INJURY ON MARCH 13, 1989 The first issue to be address with respect to this injury is whether claimant sustained an injury on March 13, 1989, which arose out of and in the course of his employment with Firestone. Relevant citations to the law have been set out previously and will not be reiterated. At the hearing, claimant stated that while working on a large tire, he attempted to stretch rubber over a drum, and while pushing and flipping a tire hurt his left hip and low back. Claimant again reported the incident to the company nurse and was sent to the company doctor (Jt. Ex. 13, p. 12). Claimant was eventually referred to another physician for treatment. Once again, the record clearly shows that claimant was performing his regular job duties in a time, place and manner required. And, claimant has consistently described the incident to support a finding that he did sustain 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 connection between claimant's injury and his disability. Law applicable to this issue has been set out previously and will not be reiterated. Defendants argue that claimant's condition on and after March 13, 1989, is attributable solely to an arthritic condition for which claimant had been treated (Jt. Ex. 1, p. 20). Furthermore, defendants rely upon Dr. Dubansky's report dated December 18, 1991, which states that claimant's injury of March 1989 was a minor aggravation of his preexisting arthritic condition (Jt. Ex. 3, p. 4). Furthermore, defendants argue that claimant's complaints centered around his low back, not his hip. Although defendants' arguments are not without some merit, it is also shown by the records that Dr. Dubansky ordered x-rays and injections of the hip in his notations regarding claimant's lower back area (Jt. Ex. 1, pp. 19-20). Claimant relies upon evaluations performed by Doctors Johnson, Johnston, Kimelman and Jones to support a finding Page 17 of a causal connection between claimant's physical condition and the injury in March of 1989. Most notably, Dr. Kimelman, who performed the hip replacement in April of 1991, related claimant's condition to arthritis, but stated that repeated work activities materially aggravated the left hip condition. As stated many times by this agency, an employer takes an employee subject to any active or dormant health impairments, and a work connected injury which more than slightly aggravates the condition is considered to be a personal injury. Ziegler v. United States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591 (1960), and cases cited. 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); Yeager v. Firestone Tire & Rubber Co., 253 Iowa 369, 112 N.W.2d 299 (1961); Ziegler v. United States Gypsum Co., 252 Iowa 613, 106 N.W.2d 591 (1960). See also Barz v. Oler, 257 Iowa 508, 133 N.W.2d 704 (1965); Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 N.W. 35 (1934). Although there is some evidence in the record which indicates that claimant received some medication for his arthritic condition, it was not shown that claimant had missed any work due to this condition. Given the repetitive and heavy lifting nature of the position at Firestone, it seems logical that claimant would have aggravated his condition by performing his job duties. As a result, it is found that there is a causal connection between claimant's injury and his condition. Due to the complexities and volume of the cases filed on behalf of claimant, and due to the overlapping of physical ailments and issues in the cases, claimant's permanency and entitlement to industrial disability will be discussed in conjunction with claimant's other low back and left hip injuries. FILE NO. 930535 - BACK INJURY ON SEPTEMBER 15, 1989 Once again, the first issue to be addressed is whether claimant sustained an injury on September 15, 1989, which arose out of and in the course of his employment. Once again, claimant's testimony is corroborated by medical records from both the company nurse and the company physician, Dr. Blessman (Jt. Ex. 13, p. 14; Jt. Ex. 11, p. 1; Jt. Ex. 2, p. 1). As a result, it is found that claimant did sustain an injury to his low back in September of 1989. The next issue to be addressed is whether claimant is entitled to temporary total or healing period benefits as a Page 18 result of the injury. The parties stipulated that claimant was off of work on September 30 and October 1, 1989. In order to receive any type of temporary total disability benefits, claimant would have had to have missed more than three days of work. Likewise, in order for claimant to receive any type of healing period benefits, claimant would have to show that he sustained a permanent injury. In this respect, claimant has failed to sustain his burden of proof for this particular injury and takes nothing for this file. Page 19 FILE NO. 966545 - LEFT HIP INJURY ON APRIL 10, 1990 Again, the defendants deny that claimant sustained an injury on April 10, 1990, which arose out of and in the course of his employment. The evidence clearly shows that claimant was in the course of his employment when he again aggravated his left hip condition. He reported the incident to the company nurse. As a result, it is found that claimant did sustain an injury on April 10, 1990, which arose out of and in the course of his employment with Firestone. The next issue to be addressed is whether there is a causal connection to the injury and claimant's disability. As shown in Dr. Blessman's notes, he recommended that claimant obtain employment other than tire building due to his hip condition. In fact, he states that claimant will "continue to reinjure himself doing this work." (emphasis added) There appears to be absolutely no question and no doubt that claimant's condition is related to his work. Although defendants are continually trying to argue that this can all be blamed on claimant's arthritic condition, and it has been shown that claimant certainly does have an arthritic condition, there is absolutely no evidence that suggests claimant's preexisting condition foreclosed any work activities. Therefore, it is found that claimant's condition is causally related to the injuries, and he is entitled to healing period benefits for the time he was off work. FILE NO. 966546 - RIGHT SHOULDER INJURY ON SEPTEMBER 23, 1990 Once again, defendants deny that claimant sustained an injury on September 23, 1990, which arose out of and in the course of his employment. Once again, the evidence is clear that he did receive such an injury (Jt. Ex. 13, p. 16). Claimant did not miss any work for the injury, but continued in a light duty capacity. Dr. Dubansky increased the impairment to claimant's shoulder from 15 percent to 18 percent. Claimant is awarded additional permanent partial disability benefits due to this accident in the amount of 15 weeks (3 percent of 500 weeks). Page 20 FILE NO. 966547 - LEFT HIP INJURY IN OCTOBER OF 1990 Finally, the seventh petition filed by claimant indicates that he sustained a cumulative injury in October of 1990, which arose out of and in the course of his employment. Once again, defendants have refused to accept any responsibility for the injury. Again, the medical evidence is quite clear that claimant's condition was substantially aggravated by his employment. Therefore, it is found that claimant's cumulative injury arose out of and in the course of his employment. With respect to all of the injuries to claimant's left hip, it is found that there is a causal relationship between the injuries he sustain while working for Firestone, and his current disability. He certainly has a permanent disability, as reflected in the opinions previously set out in this opinion. Therefore, his industrial disability is to be determined based upon his loss of earning capacity. Perhaps the most difficult aspect of this case is determining which injury caused claimant's industrial disability. The undersigned takes some solace in the fact that even the treating physicians were unable to pinpoint which incident at work caused the most substantial aggravation to claimant's preexisting arthritic condition. Claimant obviously sustained a series of accidents while at work that substantially aggravated his condition, and eventually led to surgery. After considering the evidence received, the undersigned can render a determination of claimant's industrial disability based on the cumulative effect of all of the injuries to the hip. In considering claimant's industrial disability, the undersigned has considered claimant's age, skills and employment options carefully. Although claimant has few employment skills that are transferable outside the Firestone plant, some of the evidence suggests that claimant would be able to drive a forklift. It is unreasonable to expect claimant to initiate a business that requires him to repair and restore cars, as it is difficult to believe his physical condition would tolerate the constant bending, stooping and lifting required. After considering all of the factors that comprise an industrial disability, it is found that claimant has sustained an additional 50 percent industrial disability related to the hip injuries and replacement. On six of the seven files, defendants have advanced the defense that claimant's medical treatment was unauthorized. For almost twenty years, this agency has consistently held that if the employer denies compensability of an injury, it cannot assert that an employee's medical treatment was unauthorized. Therefore, defendants' assertion that Page 21 claimant's medical treatment is unauthorized is rejected. order THEREFORE, it is ordered: That defendants shall pay claimant healing period benefits for the time he was off of work for each of the injuries. That for file No. 876894, defendants shall pay claimant permanent partial disability benefits for seventy-five (75) weeks at the rate of four hundred eighty-one and 22/100 dollars ($481.22) per week beginning August 24, 1988. That for file Nos. 944018, 966545 and 966547, defendants shall pay claimant permanent partial disability benefits for two hundred fifty (250) weeks at the rate of five hundred four and 71/100 dollars ($504.71) per week beginning March 18, 1991. That for file No. 966546, defendants shall pay claimant permanent partial disability benefits for fifteen (15) weeks at the rate of five hundred fifteen and 58/100 dollars ($515.58) per week beginning September 24, 1990. That defendants shall pay the costs of claimant's medical treatment, as provided by Iowa Code section 85.27. That defendants shall pay accrued weekly benefits in a lump sum. That defendants are entitled to a credit for benefits previously paid. That defendants shall pay interest on benefits awarded herein as set forth in Iowa Code section 85.30. That defendants shall pay the costs of this action, pursuant to rule 343 IAC 4.33. That defendants shall file an activity report upon payment of this award as required by this agency, pursuant to rule 343 IAC 3.1. Signed and filed this ____ day of April, 1992. ________________________________ PATRICIA J. LANTZ DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr Phillip C Vonderhaar Attorney at Law 840 5th Ave Page 22 Des Moines IA 50309 Mr Jeffrey M Margolin Attorney at Law Terrace Ctr Ste 111 2700 Grand Ave Des Moines IA 50312 Page 1 before the iowa industrial commissioner ____________________________________________________________ : WILLIAM A. WESLEY, : : Claimant, : : vs. : File No. 930620 : HIGHWAY CARRIER/ : A R B I T R A T I O N ACE TRUCK LINES, : : D E C I S I O N Employer, : : and : : LIBERTY MUTUAL INSURANCE : COMPANY, : : Insurance Carrier, : Defendants. : ____________________________________________________________ statement of the case This is a proceeding in arbitration brought by William A. Wesley against his former employer, Highway Carrier Corporation, also referred to as Ace Truck Lines, and its insurance carrier, Liberty Mutual Insurance Company, based upon an injury that occurred on September 27, 1989. Wesley seeks healing period compensation, permanent partial disability compensation and payment of medical expenses in connection with that September 27, 1989 injury. The case was heard at Des Moines, Iowa on January 24, 1991. The record in this proceeding consists of testimony from William A. Wesley, joint exhibits A through D and claimant's exhibits 1 through 4. findings of fact Having considered all the evidence received, together with the appearance and demeanor of the witness, the following findings of fact are made. William A. Wesley is a 55-year-old man who did not complete high school. All his working life has been performed in jobs which entail a substantial amount of physical labor. He has worked in the fields of automobile radiator repair, moving and storage, commercial electric signs and truck driving. Wesley completed a truck driving school in June 1989 before commencing his employment with Highway Carrier Corporation later that same month. Wesley worked for Ace Lines as an over-the-road truck driver. His pay was based upon the number of miles he traveled and the fees generated by the loads which he hauled. His average gross earnings were approximately $500.00 per week. The work required unloading materials. Page 2 On or about September 27, 1989, Wesley injured his back while unloading tires at Rock Island, Illinois. He reported the incident and was directed to drive to Cleveland, Ohio to obtain another load. Claimant decided to return to the terminal at Altoona, Iowa and did so. There is a dispute in the record with regard to whether claimant told the dispatcher he was capable of going to Cleveland or whether claimant requested to return to Altoona and see a doctor. Resolution of that dispute is not necessary in order to determine the issues in this case. Claimant returned to Altoona, removed his personal gear from the truck and went home. The following afternoon, he sought medical treatment, was taken off work and was placed in physical therapy. The following morning he contacted his employer to report the results of his medical appointment and was told that his employment had been terminated because he had returned to the Altoona terminal contrary to the employer's directions. Claimant was then referred to the company physician, David T. Berg, D.O. Dr. Berg prescribed treatment in the nature of physical therapy, medication and taking claimant off work. After approximately a month of conservative treatment and diagnostic tests, Dr. Berg released claimant to return to work. When released, Dr. Berg had scheduled claimant for additional physical therapy (exhibit 1, page 3). Claimant did not feel recovered and sought authorization to see a different physician, but the request was denied. Claimant then sought treatment on his own initiative through Des Moines orthopaedic surgeon William R. Boulden, M.D. Dr. Boulden diagnosed claimant's condition as facet tropism with degenerative joint disease (exhibit 2, page 4). He felt that the symptoms claimant was experiencing at that time were causally connected to the September 27, 1989 injury and characterized that injury as an aggravation of a preexisting condition (exhibit 2, page 4). Dr. Boulden indicated that claimant was unable to return to his previous work and had been similarly disabled since the onset of symptoms on September 27, 1989. Dr. Boulden maintained claimant in a conservative treatment program including physical therapy and projected a functional capacities evaluation. On February 19, 1990, claimant's functional capacity evaluation was performed and claimant finished the stabilization program designed by Dr. Boulden. Dr. Boulden reported that claimant had achieved maximum medical improvement. He classified claimant as being capable of work in the light-to-medium category. He stated that claimant's work should not involve prolonged standing or sitting and that claimant should avoid repetitive bending or twisting of his back. Those restrictions would effectively prohibit the claimant from working as an over-the-road truck driver, from performing automobile repair work or from working as a mover in the moving and storage business. Dr. Boulden assigned a seven percent disability rating under the Page 3 AMA guidelines (exhibit 2, page 5). On March 15, 1990, Dr. Boulden confirmed that the claimant's restrictions and disability were related to the October [sic] 27, 1989 injury (exhibit 2, page 6). The assessment of this case made by Dr. Boulden is accepted as being correct. Dr. Boulden provided the most extensive, effective treatment of William Wesley. Further, Dr. Boulden is an orthopaedic surgeon with more expertise in the field of back injury than that which the record shows to be held by the other physicians who treated the claimant. Wesley obtained employment with Gordon's Wholesale on or about April 1, 1990. He drives an Isuzu van and delivers food and other merchandise to gas stations and convenience stores. The job initially was part-time, but eventually became full-time. He makes 20-25 deliveries per day, works four days per week and is currently paid $6.35 per hour. He handles weights which are commonly in the range of 10-25 pounds, but on occasion may lift as much as 50 pounds. He drives approximately 200 miles per day. At hearing, Wesley estimated his gross weekly earnings to be in the range of $350-$375, including overtime pay. Exhibit 4 shows claimant's earnings during the last 26 weeks to have averaged $308.66 per week gross earnings, an amount significantly less than the estimate voiced by claimant at the time of hearing. The records contained in exhibit 4 of actual pay are found to be more accurate than claimant's verbally expressed estimate. It is found that Wesley's current employment is quite appropriate in view of his age, education, general qualifications and physical condition. It accurately reflects his earning capacity. In obtaining treatment for his back injury, claimant incurred expenses for physical therapy with Manual Therapy Center in the amount of $717.00 and also incurred expenses for treatment with Central Iowa Orthopaedics in the amount of $277.00 (exhibits 1 and 2). At the time Wesley requested additional medical treatment, immediately prior to commencing treatment with Dr. Boulden, his request was denied. The only physician whom the company had authorized to treat the claimant had released him to return to work. That assessment of the case was incorrect. The assessment made by Dr. Boulden has been previously found to be correct. The employer was given an opportunity to provide services, but declined to do so. The arrangements which claimant made for obtaining care with Dr. Boulden were suitable and appropriate. The employer failed to provide reasonable treatment. conclusions of law The first issue to be addressed is claimant's medical expenses with Central Iowa Orthopaedics. Based upon the findings previously made regarding the employer's failure to provide adequate treatment, the claimant was fully entitled to seek treatment on his own, particularly since that Page 4 treatment was effective. Richards v. Dep't of Gen. Servs., Vol. 1, No. 3, State of Iowa Industrial Commissioner Decisions 684 (App. Decn. 1985); 2 Larson Workmen's Compensation Law, sections 61.12(a) and (e). Further, at the time claimant commenced treatment with Dr. Boulden, the employer was denying liability for the claimant's condition. This constitutes a waiver by the employer of its right to direct or control the care. Barnhart v. MAQ, Inc., I Iowa Industrial Commissioner Report 16 (App. Decn. 1981). Defendants are therefore responsible for payment of claimant's medical expenses with Manual Therapy Center in the amount of $717.00 and Central Iowa Orthopaedics in the amount of $277.00 together with any increase in those charges which has resulted from the lack of timely payment. An injured employee is entitled to recover healing period compensation until the first of the three events in Code section 85.38(2) which end the healing period entitlement. In this case, it has previously been found that Dr. Boulden's assessment of the case is correct. It was on February 19, 1990 that Dr. Boulden stated that claimant had reached maximum medical improvement. That date also marked the end of the active treatment which Dr. Boulden had provided. Since claimant had not previously returned to work or been identified as having recovered to the extent that he was able to engage in substantially the same employment as he had been performing at the time of the injury, the healing period is ended by maximum medical improvement. Claimant's entitlement to healing period compensation therefore runs from the date of injury, September 27, 1989, through February 19, 1990, a span of 20 and 6/7 weeks. If claimant has an impairment to the body as a whole, an industrial disability has been sustained. Industrial disability was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 593, 258 N.W.2d 899, 902 (1935) as follows: "It is therefore plain that the legislature intended the term `disability' to mean `industrial disability' or loss of earning capacity and not a mere `functional disability' to be computed in the terms of percentages of the total physical and mental ability of a normal man." Functional impairment is an element to be considered in determining industrial disability which is the reduction of earning capacity, but consideration must also be given to the injured employee's age, education, qualifications, experience and inability to engage in employment for which he is fitted. Olson v. Goodyear Service Stores, 255 Iowa 1112, 1121, 125 N.W.2d 251, 257 (1963). Industrial disability or loss of earning capacity is a concept that is quite similar to impairment of earning capacity, an element of damage in a tort case. Impairment of physical capacity creates an inference of lessened earning capacity. The basic element to be determined, however, is the reduction in value of the general earning capacity of the person, rather than the loss of wages or earnings in a specific occupation. Post-injury earnings Page 5 create a presumption of earning capacity. The earnings are not synonymous with earning capacity and the presumption may be rebutted by evidence showing the earnings to be an unreliable indicator. DeWall v. Prentice, 224 N.W.2d 428, 435 (Iowa 1974); Carradus v. Lange, 203 N.W.2d 565 (Iowa 1973); Holmquist v. Volkswagon of America, Inc., 261 N.W.2d 516 (Iowa App. 1977) A.L.R.3d 143; Michael v. Harrison County, Thirty-fourth Biennial Report of the Industrial Commissioner 218 (1979); 2 Larson Workmen's Compensation Law, sections 57.21 and 57.31. Claimant's actual earnings have been reduced from approximately $500 per week to approximately $300 per week in view of his change in occupations. The restrictions recommended by Dr. Boulden would effectively eliminate claimant from over-the-road truck driving due to the prolonged sitting which is involved in that occupation. Even if the employer had not terminated claimant's employment, he would still be unable to resume that line of work with the defendant employer or any other trucking company. While much of claimant's reduction in weekly income is attributable to the fact that he is working less hours, it is also recognized that the injury has made him unable to perform the type of work in which he was given the opportunity to work extended hours each week. Claimant's current earnings involve a considerable amount of overtime pay. Claimant is able to perform his present job and it does not appear to significantly aggravate his back. It is a very appropriate employment situation which accurately reflects claimant's actual earning capacity. It is noted that an over-the-road truck driver incurs a number of personal expenses for meals and the like which are not incurred with claimant's current employment. When all the pertinent factors of industrial disability are considered, it is determined that William A. Wesley experienced a 25 percent reduction in his earning capacity as a result of the September 27, 1989 injury. This entitles him to recover 125 weeks of permanent partial disability compensation payable commencing February 20, 1990 under the provisions of Code section 85.34(2)(u). order IT IS THEREFORE ORDERED that defendants pay William A. Wesley twenty and six-sevenths (20 6/7) weeks of compensation for healing period at the rate of three hundred three and 02/100 dollars ($303.02) per week payable commencing September 27, 1989. IT IS FURTHER ORDERED that defendants pay William A. Wesley one hundred twenty-five (125) weeks of compensation for permanent partial disability at the rate of three hundred three and 02/100 dollars ($303.02) per week payable commencing February 20, 1990. IT IS FURTHER ORDERED that defendants are given credit for all weekly compensation previously paid and shall pay the unpaid accrued balance in a lump sum together with interest pursuant to section 85.30 of The Code computed on Page 6 the accrued unpaid amount from the date each weekly payment came due until the date of actual payment. IT IS FURTHER ORDERED that defendants pay claimant's medical expenses as follows: Manual Therapy Center $ 717.00 Central Iowa Orthopaedics 277.00 Total 994.00 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 ____________, 1991. ______________________________ MICHAEL G. TRIER DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr. Harry W. Dahl Attorney at Law 974 73rd Street Suite 16 Des Moines, Iowa 50312 Mr. Joseph S. Cortese II Attorney at Law 500 Liberty Building Des Moines, Iowa 50309 5-1802; 5-1803; 2501 Filed March 25, 1991 MICHAEL G. TRIER before the iowa industrial commissioner ____________________________________________________________ : WILLIAM A. WESLEY, : : Claimant, : : vs. : File No. 930620 : HIGHWAY CARRIER/ : A R B I T R A T I O N ACE TRUCK LINES, : : D E C I S I O N Employer, : : and : : LIBERTY MUTUAL INSURANCE : COMPANY, : : Insurance Carrier, : Defendants. : ____________________________________________________________ 2501 Claimant injured his back, was treated by the employer's physician and released. Claimant was still symptomatic and sought treatment on his own, after his request for further treatment had been denied by the carrier. Claimant's own chosen orthopaedic surgeon was found to have correctly assessed the case. It was found that the employer had failed to provide adequate care. The employer's defense of lack of authorization failed. The claimant recovered all his treatment expenses. 5-1802; 5-1803 The assessment by claimant's physician was found to be correct as far as ending healing period when claimant reached maximum improvement rather than when he had been released previously. Fifty-four-year-old truck driver, whose injuries precluded him from resuming over-the-road truck driving, the occupation he was engaged in at the time of injury, was awarded 25 percent permanent partial disability. Actual reduction in earnings was approximately 40 percent, but claimant worked less hours in the new employment and did not incur travel expenses in the new employment.