Ms. Barbrow, 45 years old as of the date of hearing in this matter, began her employment with Leonards Metal, Inc. (hereinafter referred to as "employer") on 2/24/00. Employer subcontracts with major aerospace contractors to provide them with airplane parts. Ms. Barbrow worked as an "aerospace assembly mechanic", riveting, routing, hand sanding, orbital sanding, and otherwise finishing airplane parts made of an aluminum alloy. Ms. Barbrow performed such sanding in "Work Center 40", one of the work areas at a facility located in St. Charles, Missouri. The claimant relates that approximately 40 % of her time working in assembly was spent performing sanding, and that approximately 75 % of the time some other assembler in the work center is performing sanding of parts.
As a part of the process of applying for social security SSI disability benefits (Employer and Insurer's Exhibit No. 6), Ms. Barbrow provided the following work history in order of most recent:
Aerospace Assembly Mechanic;
Shipping Recvg Forklift Operator;
Assistant Manager, Retail;
Produce Prep., Grocery;
Cook;
Attendant, Self \& Full Svc Laundry; and
U.S. Army Administrative Specialist.
The claimant quit her employment with the employer on 2/04/02 and moved to Farmersville, Texas to live with her sister. Ms. Barbrow testified that she lived there for 9 months, and thereafter moved to Grants, New Mexico and lived with another sister for approximately a year. The claimant then moved back to Texas and stayed with her parents in Terrell, Texas before marrying her husband, Wayne Barbrow, and in 2005 relocating to Springfield, Missouri.
Medical records indicate that while working for the employer Ms. Barbrow suffered a series of relatively minor injuries that did not cause her to miss time from work, until such time in January of 2001 when the claimant began making complaints as to her right arm at the elbow. On 1/30/01 Ms. Barbrow was provided with a tennis elbow strap for what was diagnosed as a lateral epicondylitis. Thereafter Ms. Barbrow was rotated through jobs at least every four hours, but her complaints worsened, and in April of 2001 in order to calm her symptoms she was provided with injection into the epicondyle of the elbow. In May of that year the claimant began suffering severe complaints in the elbow, leading to a lateral epicondyle release and partial epicondylectomy performed by Dr. Emanuel on 8/31/01. Post-op Ms. Barbrow spent four months or so either off duty or on light duty prior to a full release by Dr. Emanuel on 1/03/02. In a follow up note dated 1/28/02, Dr. Emanuel states that the claimant complained of the employer assigning her heavy work, and of having suffered elbow swelling, crackling, some soreness, and throbbing type of discomfort. Dr. Emanuel recommended restrictions for the next three weeks, and on 2/5/02 documented a telephone conversation in which he was informed that the claimant had quit her employment, and that further work restrictions were no longer an issue.
Ms. Barbrow has not worked since she left her employment in February of 2002. When asked at her deposition on 11/25/03 why she had stopped working, Ms. Barbrow responded "Because I was still having issues with my arm that had been worked on that made me unable to go find another job. I mean, I couldn't find another job because I was still broken." (Employer and Insurer's Exhibit No.7, at pp 16-17).
Ms. Barbrow relates that the act of sanding aluminum parts created an aluminum dust that would settle onto her clothes and on her body, including into her ears and into her nose. Claimant further relates that on certain days the silver dust would cause her to look like a tin man. The only protective clothing provided by the employer was as follows; shoes; face shield and arm sleeve protectors when performing work that causes aluminum chips to fly; ear plugs; and paper face masks for the discretionary use by employees as respiratory protection. Ms. Barbrow acknowledged that she used the face mask at her work. Ms. Barbrow claims to have suffered an aluminum toxicity as a consequence of a work related exposure to aluminum dust particles.
Mark Atkinson, testifying on behalf of the employer, acknowledges that from 1996 to 2007, approximately eleven of the thirty years that he has been employed with the employer, he served as a supervisor and as a manager. Mr. Atkinson confirms that during the course of the employment of Ms. Barbrow from 2000 to 2002, he was the supervisor of those employees, including Ms. Barbrow, in Work Center 40 who performed fabricating and small assembly. Mr. Atkinson notes that entry level assembly workers start out performing deburring and sanding of parts. The witness relates that the routing, drilling, and filing of parts creates aluminum chips; that riveting creates no residuals; and that the sanding of parts creates an aluminum dust. Mr. Atkinson acknowledges that an employee after sanding can look like a tin man from the exposure to the aluminum dust, but suggests that such a scenario is not a weekly event. Mr.
Atkinson recalls an instance where the claimant had been finishing door skins for Lear jet parts, and was covered up and down the front with aluminum dust.
Extensive medical records, Social Security administration records, and the testimony of Ms. Barbrow at hearing document the following medical conditions/health history complained of by Ms. Barbrow that preexisted her exposure to aluminum dust with the employer;
Temporary depression post the delivery of her two sons;
Major Depressive Disorder;
History of two suicide attempts;
Use of Xanax, Tranxene, Trazodone, Prozac for anxiety;
Removal of gallbladder following acute attack of gallstones;
Minor asthma;
Pack a day smoker, started smoking at age fifteen;
Irritable bowel syndrome (with family history, mother)
Ulcers with use of Zantac;
Metal taste in mouth from use of Zantac;
Gastroenteritis and enteritis;
Sinusitis, bronchitis;
Tubal ligation;
Chronic diarrhea;
Weight fluctuation from 113 to 191 pounds;
Occasional complaint of blurred vision;
Ambien for sleep problems;
Tailbone and low back pain;
Phlebitis;
Dizziness;
Memory loss;
Post-concussive syndrome;
Migraines, Severe Headache and Extreme Fatigue;
Chest pain;
Hiatal Hernia;
Removal of Barthelin gland;
Bilateral hip dysplasia;
Swelling of body, beginning with right leg.
Ms. Barbrow testified that she has suffered the following conditions post her employment with the employer:
- Operated lateral epicondylitis, right elbow;
- Weight fluctuation;
- Worsening headache, onset of migraines;
- Worsening of depressive problems;
- Fatigue;
- Hair loss (alopecia);
- Generalized bone and body, joint ache and pain;
- Memory loss;
- Loss of concentration;
- Problem with arteries, blood flow;
- Lymph node swelling;
- Worsening asthma;
- Vision complaints;
- Aluminum toxicity.
Ms. Barbrow believes that the above enumerated complaints, and/or the worsening of the preexisting conditions, and with the exception of the epicondylitis, are related to an aluminum toxicity suffered at work with the employer.
Claimant became concerned about the constellation of her complaints and sought an evaluation at Farmersville Medical Family Center, Farmersville, Texas, on 4/1/03. Claimant was evaluated by Dr. Gamboa (subsequently married, name change to Parsley prior to visit on 4/22/03), and blood/serum testing at Labcorp on 4/01/03 revealed an aluminum plasma/serum level of 21 micrograms per liter ( $21 \mathrm{mcg} / \mathrm{L}$ ). The Labcorp report further noted that the normal environmental exposure to aluminum resulted in a blood serum level of $0-9 \mathrm{mcg} / \mathrm{L}$. Ms. Barbrow testified that this was her first evidence of aluminum toxicity, and she filed her claim for compensation with the Division of Workers' Compensation on 6/18/03; an answer to the claim for compensation was filed by the employer on 7/03/03.
Medical Doctors Tipu Sultan (Claimant's Exhibit AA); Maria Carter (Claimant's Exhibit W); and Dr. Rebecca Tominack (Claimant's Exhibit Z), opined as to diagnosis and medical causation with respect to an aluminum toxicity. Ms. Barbrow met with Dr. Sultan on 9/13/05, and his report was prepared that same date. Dr. Carter began treating the claimant on or about 1/24/06, and continued to treat through 9/17/07, with her causation report prepared on 6/19/06. Dr. Tominack did not meet and evaluate the claimant, but rather prepared a diagnosis and causation report dated 7/19/06 based on a medical records review. Dr. Tominack argued that at the point that she was asked to render an opinion in 2006, a clinical evaluation of Ms. Barbrow in person would not have been informational, given the lapse of time from the exposure to the year 2006. The claimant also sought a toxicology evaluation from Terry Tyler Martinez. Ph.D., prepared on 9/19/04.
Drs. Sultan and Carter concluded that the claimant suffered a work related aluminum toxicity from her employment with the employer. Dr. Carter recommended treatment in the form of Chelation therapy to rid the claimant of aluminum in her body. Dr. Tominack concluded that the lab report, with a serum/blood level of $21 \mathrm{mcg} / \mathrm{L}, did indicate an increased aluminum level beyond the level of under 10 \mathrm{mcg} / \mathrm{L}$ expected in the general population, but denied that the lab results showed or concluded that the claimant suffered an aluminum toxicity; argued that the serum level in the lab report suggested that Ms. Barbrow was in a "free from risk" range; that the claimant did not suffer an aluminum toxicity; and that all of the complaints of Ms. Barbrow were pre-existing conditions that were not caused or exacerbated by her work exposure to an aluminum alloy dust.
Terry Tyler Martinez, Ph.D, offered his expert opinion in toxicology. Dr. Martinez concludes that aluminum toxicity from a work exposure was a significant contributing cause of certain muscle, bone, and nervous condition symptoms suffered by Ms. Barbrow. Dr. Martinez acknowledges that he is not a medical doctor; that he did not meet personally with Ms. Barbrow; and that he can not otherwise recall if he interviewed Ms. Barbrow at any time. He further opines as to the manner in which aluminum dust was transported to the brain, and provides his opinion as to a medical causal relationship between aluminum toxicity transported to the brain and a resultant dysfunction and cognitive defect.
Drs. Sultan and Carter provided expert medical opinions exclusively through their written reports; Dr. Tominack and Dr. Martinez had their expert opinions scrutinized through their depositions taken on 11/20/2006 and 8/29/2008 respectively (Employer and Insurer's Exhibit Nos. 3 \& 4). Dr. Tominack offered her direct testimony; Dr. Martinez offered his expert opinion via cross-examination by the employer/insurer.