All evidence presented has been reviewed. Only testimony and evidence necessary to support this award will be summarized.
- Claimant is 66 years old and retired from employment. She worked for Employer from September 1991 until January 2012, but for the last 10 years of her employment she worked as a Packing Machine Operator (packer). Claimant worked approximately 48 hours per week.
- During her early years as a packer Claimant operated a machine requiring her to lift 50 to 60 pound rolls of plastic film from the floor to her shoulder level approximately 3-4 times per day. She was also required to load blank boxes from pallets to shoulder level that weighed a few pounds during the day. Approximately 6 years prior to the end of her employment, Employer
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[^0]: ${ }^{1}$ Claimant has an open companion case \#10-048656 involving injury to her hands/trigger fingers, but the only case presented for trial is \#11-107122 for which Claimant seeks treatment of an alleged occupational disease to her right shoulder.
${ }^{2}$ Claimant did not object to issuance of a final award if she did not prevail on her request for a temporary award.
installed a lift jack on each packing machine and after the installation Claimant rarely had to lift the plastic film rolls, but used her right arm to wind/pump the operating jack. Occasionally, Claimant had to lift partially filled boxes if the packing machine did not fill it properly. This event happened as often as 0-4 times per shift. If the packing machine was running properly, Claimant would stand and observe it. If product fell from the packing line, Claimant would stop the line and repack the box. Claimant also kept the line area clear of debris and would collect and shovel waste into tubs that were emptied as needed. To empty the waste tubs, Claimant lifted the tubs above her shoulders.
- During June 2010, Claimant developed right long and ring finger triggering (Injury \#10048656). Employer authorized medical treatment for Claimant with Dr. Ollinger, a hand surgeon who had previously performed her carpal tunnel releases. Dr. Ollinger suggested use of an antivibratory glove, and administered a cortisone injection into the right ring finger. Claimant responded to treatment and was discharged from care on October 25, 2010.
On February 28, 2011, at Claimant's request, she was examined by Dr. Bruce Schlafly, a hand surgeon. Claimant informed Dr. Schlafly that the administered cortisone injection stopped the right ring finger clicking, but did not relieve her pain. She informed Dr. Schlafly that her work required her to raise heavy film, perform frequent twisting of a roller, and frequently open boxes. Dr. Schlafly diagnosed right long and ring trigger fingers, left long trigger finger, and mild left ring trigger finger. Dr. Schlafly recommended surgical release of the right trigger fingers, and cortisone injections of the left long and ring fingers. Employer returned Claimant to Dr. Ollinger, who following examination agreed with Dr. Schlafly, and Claimant received the suggested treatment during June 2011.
- On November 21, 2011, Claimant returned to Dr. Schlafly. ${ }^{3}$ During the course of the visit, Claimant informed Dr. Schlafly she had been experiencing pain in her right shoulder for the past 6 months. Dr. Schlafly rated Claimant's trigger finger injuries, and suggested she be seen by an "orthopedic shoulder specialist" for further evaluation of her right shoulder complaints. Dr. Schlafly indicated a right shoulder MRI "would be appropriate," and opined Claimant's repetitive work for Employer was the prevailing factor in her need for right shoulder treatment.
- Upon receiving Dr. Schlafly's report, on December 18, 2012, Employer had Claimant examined by Dr. Rende, an orthopedic surgeon. Claimant provided Dr. Rende with a detailed job description, and was provided a description of Claimant's job duties from Employer. Following his physical examination, Dr. Rende obtained x-rays of Claimant's right shoulder. Dr. Rende indicated the x-rays demonstrated severe degenerative osteoarthritis accompanied by large inferior spurs at the humeral head and marked narrowing of the glenohumeral joint. Dr. Rende opined the arthritic process was of long-standing duration, and had been present for 10-15 years. Dr. Rende further opined Claimant's work was not the prevailing factor in causing the condition. Dr. Rende opined Claimant's aging was the cause of the degenerative process.
- On April 30, 2013, Claimant obtained the right shoulder MRI at her own expense. The MRI demonstrated the following: severe arthritic changes; severe supraspinatus and infraspinatus tendinopathy with partial thickness tearing of both as well as a full thickness supraspinatus tear; and long head biceps tendinopathy with tearing. Following the MRI, on June 20, 2013, Claimant's attorney contacted Dr. Schlafly who reviewed the MRI scan and report. Dr.
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[^0]: ${ }^{3}$ This visit is presumably for a rating examination post-surgery, but the body of the report does not explicitly state this.
Schlafly's opinion regarding medical causation remained unchanged, and he opined Claimant's repetitive work was the prevailing factor in Claimant's need for right shoulder medical treatment.
- On September 16, 2013, Dr. Rende reviewed Claimant's right shoulder MRI and Dr. Schlafly's June 20, 2013 report. Following his review, Dr. Rende opined Claimant's MRI demonstrated "cuff tear arthropathy," or "chronic cuff tear arthropathy." Dr. Rende described the arthropathy as follows:
Shoulders are not weightbearing joints thus they wear out in a different fashion than the weightbearing joints such as knees or hips. When a shoulder wears out as a result of the aging process typically the rotator cuffs slowly and steadily tear resulting in loss of normal lubrication to the glenohumeral joint and thus, the development of severe glenohumeral osteoarthritis. The process is not related to an injury but to the normal process of aging. (Exhibit 6)
Dr. Rende reported his original causation opinion remained unchanged and was strengthened by the information contained in the MRI. Dr. Rende noted Claimant's need for treatment was due to the normal aging process and not by her work for Employer.
- Claimant has a history of preexisting right shoulder complaints. During 1997, Claimant complained of right shoulder pain at the end of her shift. Claimant was given work restrictions from her primary care physician. On September 18, 1998 Claimant settled her claim with employer for 7.5 % PPD referable to the right shoulder. During 2006, Claimant complained of bilateral shoulder, forearm, and elbow pain. During 2006, x-rays of Claimant's right shoulder demons