A Medical records, report, Hand Surgery Associates, P.C.
B Medical records, Orthopaedic \& Rheumatology Associates, PC
C Medical records, Trinity Family Medical Associates
D Medical records, Callaway Community Hospital
E Medical records, Select Physical Therapy
F Medical records, Fulton State Hospital/Mid-Missouri Mental Health
G Medical records, Arthur Center/Options Unlimited
H Medical records, Neurology Consultants, PC
I Medical records, University Physicians Callaway
J Medical records, Women's Health Associates, Inc
K Division of Workers' Compensation dated February 4, 2010
L Records, Covington City Public Schools dated April 16, 2010
M Stipulation for Compromise Settlement for Injury No. 08-095300
N Deposition of A.E. Daniel, MD
O Deposition of Phillip Eldred, MS
P Deposition of Dr. David T. Volarich, D.O.
Q Medical report, Dr. Russell, Columbia Orthopedic Group
Gloria G. Stiers, Claimant herein, testified in her own behalf. Claimant is 39 years of age at the date of hearing and lives in Fulton, Missouri, in an apartment which is rent free and for which Claimant pays the utilities only, as a qualified disabled person. Claimant is not employed and has not worked since October 23, 2008.
The Claimant was employed by the Employer as a seamstress where she worked fulltime, eight hours a day, and was involved in the process of manufacturing plastic liners. As a part of her job task, she would sit at a sewing machine and push or pull large pieces of fabric through a machine. The pieces of fabric were heavy and from time to time required a coemployee to assist in running the fabric through the machine. The Claimant was employed by the Employer for several different periods over several years. She testified that she would
Employee: Gloria G. Stiers
Injury No. 08-095300
frequently have depression, anxiety and other psychiatric issues which would keep her from steadily maintaining her employment.
Prior to working at Production Products Mfg., the Claimant was a Security Aide at Fulton State Hospital for approximately a year and a half. She reported that she did have some lower back pain and one instance of a back strain while employed there, but she did not file a workers' compensation claim. Claimant testified that she resigned her employment from the Fulton State Hospital because she was having anxiety attacks and depression. Other previous employment of the Claimant included cleaning for a restoration company, working as a cashier at a gas station, working at other factories as a seamstress, and working in restaurants as a cook, waitress, and dishwasher.
Claimant testified that all of her prior employment was sporadic and that over the course of her entire employment history, she has had difficulty maintaining a job. Claimant testified that she attributes her inability to maintain steady employment to her long standing psychiatric issues which made her anxiety level strong enough that she was unable to leave the house on several occasions, which resulted in excessive absenteeism.
Claimant testified that she attended school up until the $9^{\text {th }}$ grade when she dropped out and got married at the age of 15 . She testified that she always had difficulty reading and comprehending school work and that she also had problems with numbers, particularly with inverting them and reading them backwards. Claimant testified that she was placed in special education classes during her school career and that once she became old enough to quit school, she immediately did so because of her long standing and significant struggle with all academics. The Claimant reported that she studied for the GED on several occasions, but never took the test.
Claimant testified that her learning disabilities made it very difficult for her to perform
Employee: Gloria G. Stiers Injury No. 08-095300
the job as cashier at a gas station since she had difficulty counting change. She also testified that there was a specific incident while working at the gas station where she became so paranoid and anxious that she was pacing throughout the store during her shift. Her anxiety and behavior caused her employer to send her home and to tell her she would be on medical leave. She was not allowed to return to work.
Claimant reported a troubled childhood as well as adolescence, and stated that her depression, anxiety, and paranoia began as a teenager. She reported that her behavior was a concern of her parents, but that they didn't know what to do and did not get her into treatment. She testified that as a teenager she burned a house down and was involved in the juvenile justice system. She struggled with agoraphobia and paranoia regarding driving, so much so that she did not obtain her driver's license until the age of 26 . She reported that there were occasions when she would pull the car over feeling paralyzed and unable to continue driving. These instances also resulted in the loss of jobs over the years.
Claimant reported that her depression began as a teenager, and that when she was the age of 24 , she made her first suicide attempt. She was hospitalized soon after that and began taking the medication Effexor. The medication made her drowsy, and she then struggled with maintaining jobs due to the side effects of the medication. She reported episodes of staying in bed for days at a time, followed by manic episodes where she would stay up all night and be unable to control her racing thoughts. This would be followed by another depressive episode where she would be unable to function. Following a second suicide attempt, the Claimant began taking Trazodone, Klonopin, and Cymbalta. Claimant has treated with a psychiatrist in Fulton, both outpatient and inpatient, and remains on medication.
Claimant testified that in 1999 she was trying to exit through a window during a domestic disturbance when she was tackled to the ground. She testified that she fell flat on her tailbone and immediately felt pain, leading to nausea and a feeling of "seeing stars." She reported that within two weeks, she felt like her left hip was out of place and was going numb. She felt a radiating pain from her low back into her tailbone and down her left hip. Claimant was treated by a chiropractor for her back and leg pain complaints. She reported ongoing difficulty sitting for long periods of time. Claimant testified that following this incident, she began bringing a pillow to work to alleviate some of her discomfort while sitting. She also would sit with her leg underneath her to take some pressure off of the left side of her buttocks. She did report the pain was less severe when she was working at a cashier job, which required more standing. However, she reported longstanding pain and difficulties in her low back, hip, and tailbone area when working at the various factories as a seamstress. She reported that the pain wakes her at night and that she often sleeps on the couch, which is more comfortable than the bed.
Claimant testified that in 2000 she was lifting heavy tents while working as a seamstress and suffered severe pain in her left arm. She also indicated ongoing pain in the left hand and arm in 1993 and 1994 when she was working at a different sewing job than this Employer. No surgery or treatment was ever provided for carpal tunnel syndrome at that time.
Claimant testified that on October 23, 2008, she felt ongoing pain in both arms, and on that day she felt a pain in her right arm at which time her right arm "locked up" and she was unable to move it. The Claimant reported the injury and was sent for medical treatment where she was diagnosed with right lateral epicondylitis and was advised to use a non-steroid antiinflammatory. She was also sent for physical therapy. In a follow-up appointment, it was noted that she had bilateral wrist and hand pain with numbness, as well as decreased range of motion.
Employee: Gloria G. Stiers
Injury No. 08-095300
She was diagnosed with bilateral carpal tunnel syndrome and received an injection in the left wrist.
In February of 2009, an EMG showed mild to moderate carpal tunnel syndrome in the right hand and mild carpal tunnel syndrome in left hand. On April 13, 2009, an open carpal tunnel release was performed on both wrists. Following the surgery Claimant continued to complain of right wrist pain and swelling, with tingling to the fingertips. In May of 2009, Claimant complained of pain in the right palm with loss of movement, for which she received physical therapy. The medical records indicate that in June 2009 there was numbness and tingling in the fingers, which was worse at night, and Claimant was restricted from all lifting. In August 2009 Claimant underwent surgery for right cubital tunnel release on her right elbow. Claimant was released in December 2009 by Dr. Ripperger with permanent restrictions of no repetitive gripping, pushing or pulling, and no lifting more than 20 pounds.
Dr. Garth Russell provided an independent medical evaluation which included a history from Claimant, review of medical records, and a physical examination. Dr. Russell diagnosed Claimant with chronic synovitis of the upper extremities bilaterally with aggravation of prior chronic synovitis with physical activity. Dr. Russell further reported that Claimant had a long history of chronic anxiety bipolar type II disorder with depression. Dr. Russell reported that Dr. Ripperger's permanent restrictions were correct, and the Claimant should not perform activities which require extensive use of Claimant's upper extremities.
Dr. David Volarich testified by deposition. Dr. Volarich testified that he performed an independent medical evaluation of the Claimant and that he authored a report dated July 19, 2010, following the evaluation. Dr. Volarich diagnosed Claimant with overuse syndrome of the upper extremities at the wrists, bilaterally. In addition, he diagnosed overuse syndrome of the
Employee: Gloria G. Stiers
Injury No. 08-095300
right upper extremity at the elbow causing cubital tunnel syndrome and lateral epicondylitis, as well as overuse syndrome of the left upper extremity at the elbow causing cubital tunnel syndrome and lateral epicondylitis.
Dr. Volarich rated Claimant's permanent disability at 35 % of the right upper extremity at the wrist; 35 % of the left upper extremity at the wrist; 35 % of the right upper extremity at the elbow; and 40 % of the left upper extremity at the elbow. Dr. Volarich further opined that due to the combination of Claimant's injuries, a multiplicity factor of 10 % of the total number of weeks of disability should be added.
Dr. Volarich gave Claimant restrictions with regard to her hands, wrists, and elbows. Claimant's restrictions included minimizing repetitive gripping, pinching, squeezing, pushing, pulling, twisting, and rotary motions; avoiding impact and vibrating use of hands; no lifting more than two pounds with either upper extremity alone with arm extended; no lifting more than ten pounds.
Dr. Volarich's report set out diagnoses for Claimant's pre-existing conditions of repetitive strain of bilateral wrists with carpal tunnel syndrome; chronic lumbar syndrome secondary to bulging disk at L5-S1; and depression, anxiety and bipolar disorder. Dr. Volarich rated Claimant's pre-existing conditions at 10 % of the right upper extremity at the wrist; 10 % of the left upper extremity at the wrist; and 20 % of the body as a whole, referable to the lumbar spine. Dr. Volarich deferred any rating for Claimant's psychiatric conditions to a specialist. Dr. Volarich did opine that the simple sum of Claimant's various conditions and injuries created a substantially greater disability.
Dr. Volarich also set out restrictions for the Claimant's pre-existing lumbar condition which included no bending, twisting, lifting, pushing, pulling, carrying, or climbing, except to
Employee: Gloria G. Stiers
Injury No. 08-095300
tolerance; lifting weights to tolerance; maintaining fixed positions to tolerance; changing positions as needed.
Dr. A.E. Daniel testified by deposition. Dr. Daniel testified that he performed a psychological evaluation of the Claimant on May 3, 2010, and on May 11, 2010. He testified that he took a history and performed certain tests, as well as reviewing certain medical records identified in his report.
Dr. Daniel reported that Claimant's history included sexual abuse, including rape; a history of "suicidal gestures;" and a long history of treatment, including, but not limited to, psychotropic medications. Dr. Daniel diagnosed Claimant with Generalized Anxiety Disorder with panic attacks and paranoia; major depressive disorder, chronic; and possible post-traumatic stress disorder. He also found that Claimant had a learning disorder. He opined that Claimant's Global Assessment of Functioning score was 45.
Dr. Daniel opined that Claimant had significant psychiatric impairment due to depression, anxiety, panic attacks, and paranoia, all of which contributed to affect her concentration, persistence, and pace in the workplace, which resulted in partial disability in her work as a seamstress, as well as at other jobs.
Dr. Daniel opined that Claimant's physical and psychiatric impairments combined to cause Claimant to be unable to compete in the open labor market and that Claimant should be considered permanently totally disabled as a result of Claimant's "significant and exhaustive preexisting psychiatric conditions and the most recent work-related injury."
Mr. Phillip Eldred testified by deposition. Mr. Eldred testified that he performed a rehabilitation consultation and evaluation of the Claimant and issued a report of his evaluation
E
dated August 3, 2010. Mr. Eldred reviewed certain medical and other records furnished by Claimant's attorney, administered certain tests to Claimant, and interviewed Claimant.
Mr. Eldred reported that after reviewing work restrictions set out by Drs. Schlafly, Ripperger, and Russell, Claimant was restricted to the sedentary work level. Mr. Eldred opined that, based on his evaluation, Claimant's pre-existing conditions constituted a hindrance or obstacle to employment; Claimant is unable to perform any of her past work; it is highly unlikely that any reasonable employer in the normal course of business would hire Claimant for competitive, gainful employment; Claimant lacks any transferable job skills for the sedentary work level; Claimant would have a difficult time retraining due to constant pain, lack of high school education and low academic test scores; Claimant is unemployable in the open labor market; and Claimant is permanently totally disabled as a result of her injury of October 23, 2008, combined with her pre-existing mental condition.
The Second Injury Fund presented no live testimony at the hearing. The Second Injury Fund offered, and there was admitted without objection, Exhibit I, which sets out a functional capacity evaluation dated December 28, 2009. The result of the evaluation was that Claimant would be employable on a full time basis within the medium physical demand level. The evaluation was ordered by Dr. Ripperger.