Based on the above exhibits and the testimony of the claimant at the hearing, I make the following findings.
The claimant worked for the employer, Crown Linen Service, Inc., as a napkin presser. The claimant had worked for the employer for approximately 16 years. She testified that as a napkin presser, she lifted napkins out of a tray and placed them into a press. In addition to lifting the napkins into the pressing machine, the claimant would touch a switch when a
napkin was not clean and had to be rejected. She was also required to lift baskets and adjust them to the proper height. She stated that she would press approximately 12,000 to 13,000 napkins each day. The claimant testified that she has not worked for the employer since September 14, 2004. Upon cross-examination, the claimant acknowledged that she was recently approved for Social Security disability benefits due to rheumatoid arthritis.
The claimant testified that on June 1, 1998, she had an injury to her left hand; the injury was surgically repaired. The claimant testified that as a result of the injury to her left arm, she became more right arm dominant. She stated that she developed continuous pain in her right arm, and that in May 2004, she requested medical care from her employer. She indicated that the request was denied, and she subsequently filed a claim for compensation.
The claimant sought medical treatment on her own. An MRI report from Audrain Medical Center, dated May 20, 2004, lists the impression as lucent areas of the distal radius and ulna that appear arthritic in nature. The report also includes the question "Any history of rheumatoid arthritis or crystal deposition disease?" There was also a notation that there is some mild sclerosis present of the lunate, which is suspicious for avascular necrosis.
At the request of the employer, the claimant saw Dr. Eddie Runde on May 24, 2004, and July 16, 2004. Dr. Runde is an occupational and environmental physician. Dr. Runde indicated that the claimant has right wrist arthritis that is "not related to her work activities - either from a causal standpoint or from an aggravation standpoint." Dr. Runde recommended that the claimant not return to job activities involving "repetitive use of her right hand and wrist since those activities will worsen her pain and aggravate her arthritis...."
The claimant saw Dr. James Eckenrode for her right wrist several times, beginning with a visit on June 15, 2004. Dr. Eckenrode had seen her previously for her left wrist. Upon examination, he found that she had some swelling and some mild Capet ulnae syndrome. Dr. Eckenrode determined that the claimant had a rheumatologic condition, and he suggested that she see a rheumatologist. Specifically, he "told her the same thing I told her back in 2000. Ithink she ought to get a medical evaluation for possible rheumatologic disease." He also noted that "I still do not think she believed any of what I am telling her, and I have sort of had a discussion with her about the fact that if she does not believe me then why is she coming in to see me." In addition, he indicated that the claimant is "absolutely 100 % sure that this is caused by her job in a factory and not by any sort of medical or rheumatologic problem."
The claimant was seen by Dr. Bruce Pugatch at Mexico Health Services on or about June 24 and June 25, 2004. The claimant brought her lab results to the visit. Dr. Pugtatch's records indicate that "all laboratories were unremarkable except for a mildly elevated sed rate which can be suggestive of some inflammatory process but is fairly non-specific." Dr. Pugatch recommended that the claimant follow up with an orthopedist.
On June 25, 2004, Dr. Eckenrode examined the claimant again and told her that the blood tests showed that the rheumatoid factor and anti-nuclear antibody were normal, but her sedimentation rate was elevated. He again advised her that she had an abnormal x-ray of her right wrist, and suggested that she try cortisone injections; she was not interested. The doctor also noted that he felt that there was "something beyond just overuse at work that is going on here." Dr. Eckenrode gave her a note for work indicating that she could not do her regular job because of her wrist symptoms, but that she could perform a one-handed job if one was available. Dr. Eckenrode referred the claimant to Dr. Daniel Jost, a rheumatologist.
Dr. Jost examined the claimant on July 12, 2004. His impression was seronegative rheumatoid arthritis. His opinion was that this was not work-related. Dr. Jost examined the claimant again on August 5, 2004. Dr.Jost noted that he agreed with Dr. Eckenrode that the claimant has rheumatoid arthritis. Although the claimant was rheumatoid factor negative, "the anti-CCP antibodies came back high at 176. She was also found to have a hemoglobin of 11.2. Dr. Jost's assessment was that the claimant had "anti-CCP antibody positive rheumatoid arthritis, severe."
Dr. Eckenrode's records from August 13, 2004, indic