Sheila Dixon is a 39-year old, right-handed female who began working for Roadway Express in 1993 as customer service representative in the Iola, Kansas office. In 1997 she moved to Joplin to become the city dispatcher for Roadway Express. She continued that position until 2004. This position required extensive telephone use, computer keyboard use, calculator use, and writing. She worked ten hours a day and took her lunch break while working. In 2002 she did on-site analysis of her position. On one particular day she averaged 170 phone calls in a 10 -hour shift. The phone calls would come in on an average of every $31 / 2$ minutes. The calls lasted anywhere from 20 seconds to 20 minutes.
Ms. Dixon indicate that in June of 2002 she developed numbness and tingling in both her elbows and hands more so on the right than the left. She continued to work thinking her symptoms would improve. When they did not she sought medical attention. On August 14, 2002, Ms. Dixon was examined by her family physician, Dr. Sprenkle. He prescribed Vioxx and a cock-up splint for possible right carpal tunnel syndrome. She also complained of headaches that she felt were triggered by using her neck and head as a cradle to answer the phone. In January of 2003 Ms. Dixon saw Dr. Sprenkle again complaining of sharp pains in her forearms and elbows most of the time. She indicated that they felt bruised. The right side was affected more than the left. Dr. Sprenkle diagnosed bilateral radial tendonitis and migraine headaches. He prescribed a Depo-Medrol dose pack, left and right elbow splints and anti-inflammatories.
In May of 2003 Ms. Dixon saw a chiropractor, Dr. Logan, who examined her for complaints of bilateral elbow pain. He provided physical therapy on three occasions within a week.
In May of 2004, Dr. Sprenkle saw Ms. Dixon for epicondylitis, right carpal tunnel syndrome, and multiple arthralgias. He recommended a cock-up splint and EMG testing. He repeated an arthritis profile and it came back negative.
In June of 2004, Dr. Karges, a physiatrist, examined the employee for continued complaints of pain in her right extensor forearm, migraine headaches that started in the neck and ended behind the eyes, decreased strength in both hands and her left hand falling asleep at night. Dr. Karges performed an EMG study that showed acute denervation in the distal and proximal C6, C7 muscles supporting the diagnosis of early mild acute right C6, C7 radiculopathy. He recommended a myelogram and CT scan. Ms. Dixon testified that she told Fred Pitts at her employer the cause of her pain was due to having too many phone calls. She indicated she did not request treatment due to the fact that she was afraid of losing her job.
A CT scan was performed in July of 2004 and was normal. An MRI also performed of the cervical spine was read as normal. In September of 2004 Dr. Karges reexamined Ms. Dixon. He diagnosed her as having cervical and upper trapezius myofascial strain with myofascial pain and mild cervical disk disease with straightening of the normal cervical lordosis and minimal desiccation on the MRI scan. He recommended physical therapy. In October 0f 2004 Dr. Karges maintained the same diagnosis and added right upper extremity pain with probable forearm tendonitis and possible pronator teres syndrome. He recommended the patient be referred to Bruce Silverberg, a neurosurgeon.
Ms. Dixon indicated that in May of 2003 she asked the employer to provide treatment.
Ms. Dixon was examined by Dr. Silverberg in September of 2005. At that time she was also complaining of a tremor resulting in trembling and weakness whenever she would try to write or grab objects. Dr. Silverberg diagnosed residual weakness and trembling in the right arm following repetitive motive labor activities. He did not feel she had a surgically correctable problem and recommended an neurologist.
Ms. Dixon testified that currently she experiences tingling in both hands. She has a tremor in the right hand. She experiences pain in between her shoulders up into the neck and has headaches. Her hands tingle when he claps or applauds and she has pain in the hands when gripping. She indicated that the tremor is embarrassing and she finds it difficult to eat with it. She has problems with driving especially for longer periods and she finds personal grooming difficult.
On cross-examination Ms. Dixon indicated that she in November of 2004 had worked as a clerk at her husband's auction business. She also testified that she worked three auctions since she left her employment at Roadway Express. The last auction she worked was in May of 2005 and of the three she had worked since she left Roadway Express one was a twohour auction, one was a half-day auction, and one was all day during which she suffered from a migraine. She currently
works as a real estate agent. She also admitted that on a couple of occasions she had indicated she had no further problems with the left arm.
After performing an independent medical examination Dr. Robert Paul indicates in his opinion that the patient's employment at Roadway Express is the substantial factor in the employee developing stress-related headaches, bilateral epicondylitis, and right wrist tendonitis with overuse syndrome resulting in chronic weakness. He is of the further opinion that the chronic weakness has resulted in an intention tremor. He also indicated that she had been diagnosed as having an acute irritation of the right C7 nerve root. He felt that she had reached maximum medical improvement with the possible exception of a neurological workup. He did give an opinion as to her permanent partial disability and rated her at 5 percent of the body as a whole due to residual cephalgia; 5 percent of the body as a whole due to residual complaints of pain in the upper thoracic, upper and mid back; 20 percent of the right wrist at the 175 -week level due to tenderness, numbness, and weakness with an intention tremor; and 15 percent of the left wrist at the 175 -week level due to residual weakness and numbness. These ratings combined would come to a total of 101.25 weeks.
The employer/insurer offered the Notice of Intent of Dr. Lennard's report which was admitted into evidence.
Dr. Ted Lennard, a physical medicine doctor, performed an independent medical examination on behalf of employer. Dr. Lennard indicates in his August 25, 2006, report that "Ms. Dixon's complaints of neck and right upper extremity pain appear to correlate with her work while employed for Roadwa