Claimant is a 59 year old married man who graduated from high school in 1966, attended St. Ambrose College for two years, and served as an instrument technician in the United States Air Force for four years. As an instrument technician, Claimant was trained to troubleshoot, update, and maintain instrument systems on the F-106 fighter aircraft.
Over the years, Claimant's vocational history has consisted mostly of management positions in the food service industry and work as a cashier. In the mid to late 1990's, Claimant worked as a manager at various restaurants, including a Pizza Hut in Illinois. Thereafter, he worked several months as a Convenience Food Mart cashier where he sold cigarettes, checked out customers, mopped the floor, and stocked shelves.
Before 1998, Claimant underwent a series of surgical interventions to his shoulders. Treatment of the left shoulder by Dr. Serot included a July 21, 1986 arthroscopy to repair a frayed rotator cuff; surgical treatment for left shoulder impingement syndrome on February 6, 1987; and an August 26, 1987 surgery to repair a torn rotator cuff and labrum. On September 23, 1986, on the right shoulder, Dr. Serot performed a surgical arthroscopy, open acromionplasty with excision of outer end of clavical and release of coroco acromion to address the diagnosed impingement syndrome. According to Dr. Kappel, in September 1986, Dr. Serot debrided inflamed tissue, but did not repair Claimant's torn right rotator cuff.
Claimant testified that following the series of surgeries in the mid 1980's, he was able to return to work at full duty with no restrictions, discomfort, or problems. However, in 1995, when staffing problems required him to do heavy work at Pizza Hut, Claimant saw his personal doctor for right shoulder pain. He testified with conservative treatment and a return to his normal duties, the pain in his right shoulder resolved. Away from work, Claimant testified that he was able to do all activities he needed. For example, prior to 1998, Claimant washed windows, cleaned ceiling fans, and dusted corners in his house. His hobby was assembling electronic kits, and he cooked for his family. He did various types of yard work, including cutting the grass, planting, gardening, and decorating for every holiday.
In November of 1998, Claimant began working for Employer as a cashier in the main cage, where his job was to wait on guests getting or exchanging tokens. In the beginning, he worked forty hours per week with some overtime, and had no physical restrictions. The job required him to use his upper extremities to push or pull up to ten pounds, lift up to forty pounds, stand, reach above his head, bend and twist, perform work quickly, and process cash transactions. When a customer turned in his or her winnings, Claimant dumped the coins to the jet sort machine for sorting. Claimant bent down to seal the filled bag, picked it up, and stored it in a cabinet behind him or placed it on a cart, which he pushed to the vault. Claimant testified he filled up to 130 bags a day, and lifted each bag once or twice, depending on how busy he was. Most of the lifting was performed at or below waist level.
In addition to lifting coin bags, Claimant had to use his upper extremities to comply with Employer's "highfive" policy. The high-five policy required an employee to raise his or her hand to strike another's raised hand as a form of greeting or congratulations. Giving a high-five to fellow employees as part of the pre-shift routine was always mandatory, but beginning in 2001, it became company policy for employees to high-five customers as well. Claimant testified he averaged one hundred high-fives per shift.
With the lifting and high-five activities, Claimant started to develop right shoulder pain in late 2000 and early 2001 (the 2001 Right Shoulder Case). Claimant told his supervisors the activities aggravated his symptoms, but Employer did not provide Workers' Compensation benefits. Claimant saw Dr. Kruse on June 12, 2001, who referred him to Dr. Kappel for his shoulder. An MRI of the right shoulder revealed a large rotator cuff tear, and after trying injections, Dr. Kappel performed surgery to repair the tear on September 19, 2001. Following his 2001 right shoulder surgery, Claimant returned to his same job in the cashier's booth. On December 10, 2001, Dr. Kappel imposed restrictions of no lifting or reaching over head.
In addition to sending Claimant to a shoulder surgeon, Dr. Kruse also referred Claimant to a neurologist, Dr. Berger, for his hands. Claimant had noticed hand numbness, worse at night. In July 2001, Dr. Berger diagnosed bilateral carpal tunnel. Employer ultimately accepted liability, and authorized treatment with Dr. David Brown. After unsuccessful conservative treatment, Dr. Brown performed carpal tunnel releases on June 3 and 17, 2005. Dr. Brown placed Claimant at MMI as of September 26, 2005, and released Claimant to full duty without restrictions. Employer paid all benefits in the primary portion of the Bilateral Wrist Case, including medical treatment and a Compromise Lump Sum Settlement in an amount representing 1712\% PPD of each upper extremity at the wrist. Claimant testified that following surgery, his hands were not as good as before he started working for Employer. He has trouble picking things up, and experiences swelling in his hands.
On January