The claimant, Tommy Ray Lingo, was born in 1952, obtained his GED while in the military and, with the help of his GI bill, went to Linn Technical College and attended Auto Diesel School. Thereafter, Mr. Lingo worked as a mechanic for a Chevrolet dealer and as a laborer, prior to being hired at Midwest on February 23, 1994.
Mr. Lingo's duties at Midwest included bagging cement. The cement came out of a bagging machine into a bag which, when properly filled, would weigh 94 pounds. The bags were described by Mr. Lingo as having a plastic lining and paper exterior. When overfilled, the bags would burst, creating a shotgun-like sound and distributing cement into the area.
On July 21, 1994, Mr. Lingo described carrying a bag, which was overfilled to 200 pounds, to a pallet. When the bag burst, Mr. Lingo described having his head turned to the side as he was carrying the bag, with his right ear about a foot from the bag. Mr. Lingo does not recall the events immediately after the bag burst, but remembers being outside, completely covered with cement.
Mr. Lingo also recalls feeling nauseous and dizzy and having bleeding from his right ear. Mr. Lingo saw Dr. Eric Caywood the day of the accident. Dr. Caywood noted Mr. Lingo's right ear complaints; however, Dr. Caywood's notes are difficult to decipher and, therefore, not of great value. Mr. Lingo was to return for a follow-up visit with Dr. Caywood five days later, on July 26, 1994, but apparently did not return for this appointment.
The following day, July 22, 1994, Mr. Lingo saw Dr. Edward Becka, a D.O. and ear, nose and throat specialist. Dr. Becka's notes from his July 22, 1994, examination of Mr. Lingo reflect a history of the accident as follows: "He was working at his place of employment where they make concrete mix materials and was working on a machine that fills bags of concrete and one of the bags exploded near his head on the right side and got this premix material in his ear and also in his eye. He said it happened with great force." Dr. Becka noted that Mr. Lingo "was examined according to my initial new patient office protocol." Dr. Becka found that the "left tympanic membrane and external canal appears normal." However, the "right external canal is exquisitely swollen. There was debris and particle matter, looked like concrete, kind of powder grayish stuff." Dr. Becka cleaned out additional material from the right ear. Dr. Becka diagnosed "traumatic myringitis, infected external auditory canal, diffuse hyperemia and some hearing loss bilateral, the cause of which is now not specifically determined."
When Dr. Becka saw Mr. Lingo again on July 25, 1994, his notes reflect that an exam of the "left tympanic membrane is normal" while the right membrane had improved. Mr. Lingo continued to complain of dizziness and nausea and Dr. Becka recommended that he see Dr. Larry Nichols, D.O.
Dr. Nichols' records reflect that he saw Mr. Lingo from August 2, 1994, through March of 1995, and that his main focus during that time period was Mr. Lingo's elevated blood pressure. However, when Dr. Nichols initially saw Mr. Lingo, he noted that Mr. Lingo complained of nausea and disequilibrium, which Dr. Nichols felt was secondary to the ear injury. Dr. Nichols described the examination of the right ear as revealing "the right TM to still be rather injected" with fluid "at the very bottom behind the TM" and "a small perforation at about 6 o'clock midway down the lower quadrant" and "a greenish type of exudate which may be either this compound or an infection remaining on the eardrum as well." Dr. Nichols reported that "the other ear was unremarkable."
In a January 25, 1995, letter to a claim representative, Dr. Nichols stated that the July 21, 1994, injury exacerbated Mr. Lingo's hypertension and caused his perforated right eardrum, as well as the inflammation of the mastoid air cells shown on the MRI on the right side.
Mr. Lingo saw Dr. David Marty, M.D., an ear, nose and throat specialist as early as August 8, 1994, at which time Mr. Lingo complained of difficulty hearing, dizziness, and nausea. Dr. Marty found "a very small perforation in the central part of his drum" and "high frequency sensorineural hearing loss" consistent with old noise induced hearing loss. On November 29, 1994, Dr. Marty wrote a letter stating that Mr. Lingo was unable to work due to persistent vertigo and disequilibrium associated with nausea and vomiting; Dr. Marty suggested surgical exploration and intervention of "an inner ear fistula as a result of the high pressure injury which occurred to his ear."
Mr. Lingo initially saw Dr. Jacques Herzog, M.D., otologist and neurologist, on May 9, 1995, following the explosion of a "cement bag". At the time of the initial evaluation Dr. Herzog found the left tympanic membrane intact. The right tympanic membrane, however, was perforated, the right middle ear and mastoid had become infected, and "it was felt that labyrinthine involvement was present due to the reported symptoms of vertigo as well as the positive finding of vertigo on tympanometry, suggesting the possibility of a perilymphatic fistula."
Mr. Lingo underwent a right tympanomastoidectomy performed by Dr. Herzog on May 30, 1995; the tympanic membrane healed and the graft used to reconstruct the perforation was successful. In addition, a "round window fistula" was repaired on the same day.
By the end of July of 1995, Mr. Lingo's symptoms improved, according to Dr. Herzog, with only isolated episodes of vertigo. Pneumatic otoscopy in the right ear caused no dizziness. Complaints of disequilibrium
continued. Dr. Herzog recommended Platform Posturography on August 22, 1995, which "suggested the possibility of a vestibular etiology" (see Herzog letter of January 22, 1996). A November 26, 1995, audiogram revealed normal hearing in the right ear while the left ear "revealed decreased thresholds with mild vertigo noted on tympanometry, although pneumatic otoscopy revealed no evidence of dizziness" (see Herzog letter of January 22, 1996).
Dr. Herzog suggested in his January 22, 1996, letter that Mr. Lingo was experiencing new symptoms in the left ear, which Dr. Herzog described as Meniere's Disease. Dr. Herzog stated that most cases of Meniere's Disease are idiopathic. Dr. Herzog went on to say that although Meniere's Disease can be due to a head injury, the delayed symptoms in the left ear following trauma to the right side of the head "would be very difficult t