Claimant is a 61-year-old man who was born in Sicily, Italy. He learned to read and write in Italian even though he left school when he was approximately 11 years old to begin his working career. In his homeland, he had laborer and truck driving jobs. Claimant came to the United States in 1967, but continues to rely on his native tongue to communicate. Although he can understand spoken English, he does not read or communicate well in English, and he has always worked with or for other Italian-speaking people. He is able to drive, shop, and generally function independently even with the language barrier. Claimant's daughter was present at hearing and provided assistance as a translator under oath.
Claimant has worked for Employer for over 20 years. Initially a laborer, Claimant worked as an ironworker since 1990. Claimant was able to complete his training as an ironworker by watching demonstrations of new techniques and talking with other workers in his native tongue. On a daily basis, Claimant's job as an ironworker involved pushing and pulling steel rods up to 100 pounds, lifting up to 20 pounds several hundred times a day and using tools such as power saws, hammers, pliers, and torches. Claimant is right hand dominant. Prior to his right upper extremity problems, Claimant only had minor injuries that left no lasting disability: he sliced the tip of his right index finger, and broke his collar bone.
In the mid-1990's, Claimant developed right upper extremity symptoms of pain, numbness, tingling and burning. After his family doctor diagnosed carpal tunnel syndrome ("CTS") in 1999, Claimant underwent a surgical release by Dr. Kostman at the direction of Employer on January 7, 2000. Dr. Brown, who saw Claimant in follow up, found cubital tunnel problems on April 7, 2000, provided conservative treatment, and released Claimant to return to work on April 11, 2000. Claimant returned to work as an ironworker through May 23, 2000, and worked several job, including Bridge Data, MCIWorld Com, YMCA, BJC, and Home Depot. ${ }^{[2]}$ During this time, he had some assistance, and limited the use of his right hand where possible, but he did the work of an ironworker, was sometimes the only ironworker at the job, used tools such as bolt cutters and pliers, and received his fully salary. The pain and swelling he was having in the right hand continued and got worse during this time. Claimant did not work any job after May 24, 2000.
Under the care of Dr. Benz, Claimant had a second surgery on June 27, 2000, and pursuant to the Temporary Award, Employer was ordered to pay benefits from June 6, 2000 to December 27, 2000. On December 28, 2000,Dr. Benz released Claimant from care. Dr. Schlafly examined Claimant on February 6, 2001, and suggested surgery, which was ordered in the Temporary Award, and performed by him on October 8, 2001. Dr. Schlafly found Claimant at MMI on February 1, 2002, and Employer, through Amerisure, paid TTD from the date of surgery to February 3, 2002. Since February 2002, Claimant has not received any workers' compensation benefits, nor has he had further treatment to his right upper extremity.
Since his last surgery, Claimant reports improvement in that his fingers open a bit more and his elbow is O.K., but he still has problems with his right upper extremity, including pain and tingling in his hand, sharp pain when turning the wrist, decreased strength, and painful swelling with use. He can lift no more than 10 pounds with his right hand, and finds it hurts to make a fist. He has a $41 / 2-inch scar on the hand, and a 31 / 2$-inch scar on his elbow. Claimant had bypass surgery in his leg since he stopped working.
On a typical day, Claimant requires help from his wife to get dressed and put on his shoes. He walks every day, lies on the couch, watches television, tends to small tasks the garden, and sleeps. He cannot garden or cut grass like he used to. Standing is not a problem, but sitting for long per