On August 25, 2011, this then 59-year-old claimant, a machine operator, was diagnosed with CMC arthritis and surgery was recommended. She testified she began working for this employer as a packer filling bags with pigment for four or five years. As she did this job, she developed pain in her thumbs and hands. She then performed other jobs, but continued to have pain in the thumbs. In 2000, the claimant returned to the packing job and the painful condition in her thumbs worsened over the next several months. In 2010, she consulted her primary care physician, who referred her to an orthopedic surgeon, Dr. Ungacta. On August 10, 2011, Dr. Ungacta performed injections into her thumbs, though she received no significant relief. See Exhibit 18. Dr. Ungacta referred her to Dr. Goldfarb. On August 25, 2011, Dr. Goldfarb
diagnosed CMC arthritis. See Exhibit 22. On August 31, 2011, Dr. Goldfarb performed a right thumb trapezial excision, suspensionplasty with FCR tendon, and interposition arthroplasty, and he performed the same procedure on the claimant's left thumb on December 14, 2011. See Exhibit 22. The claimant then received extensive physical therapy. The claimant worked up until the first surgery on August 31, 2011, and returned to work on May 21, 2012, after the second surgery. See Exhibits 9, 10, 11, 22.
The claimant testified that she has ongoing pain in the thumb and hand pain worse on the right that on the left. She testified that her thumbs hurt and ache, especially with weather changes. She has difficulty opening packages such as small packets of applesauce. She has trouble twisting the tops off of bottles, such as a soda bottle, and has to use pliers. She testified that her hands make it more difficult for her to perform yard work, and how it took three days for her to plant a bush in her yard. She reduces the pain in her hands by rubbing them, holding them under warm water, or applying ice. She exhibited a 2-inch scar on each of her thumbs at the base of the hand.
David T. Volarich, D.O.
On March 5, 2015, Dr. Volarich examined the claimant, took a medical history, and reviewed her medical records. With regard to the occupational disease of August 29, 2011, Dr. Volarich diagnosed overuse syndrome of the hands, causing irreversible aggravation of thumb CMC arthritis, status post trapezial excision with suspensionplasty and tendon interposition arthroplasty. See Dr. Volarich deposition, page 31. He opined that the claimant's work, leading up to August 29, 2011, was the prevailing factor causing these conditions. See Dr. Volarich deposition, pages 31-32. With regard to the occupational disease of August 29, 2011, he opined that the claimant suffered a 30 % permanent partial disability of each hand.
With regard to pre-existing medical conditions, Dr. Volarich diagnosed: (1) Bilateral carpal tunnel syndrome, status post open carpal tunnel releases in 1995; (2) Left elbow ulnar nerve decompression and partial medial epicondylectomy in 1995; (3) Right elbow lateral epicondylitis, status post excision of degenerated common extensor tendon with limited lateral epicondylectomy and muscle flap coverage in 2001; (4) Right long finger laceration and extensor tendon injury, status post arthrotomy at the proximal interphalangeal joint with tendon repair and exploration in 2007; (5) Left shoulder internal derangement, status post arthroscopic biceps tenotomy and subacromial decompression in 2008; and (6) Left knee contusion, resolved in 1999. See Dr. Volarich deposition, pages 38-39. He opined that the claimant suffered the following pre-existing permanent partial disabilities: (1) 25 % of the right wrist due to the carpal tunnel surgery and long finger laceration and exploration; (2) 20 % of the left wrist due to the carpal tunnel syndrome; (3) 25 % of the right elbow due to the lateral epicondylitis; (4) 25 % of the left elbow due to the ulnar neuropathy and decompression; and (5) 20 % of the left shoulder due to the internal derangement and arthroscopic repair. See Dr. Volarich deposition, pages 4042. He opined that all of the disabilities combine with each other to create a substantially greater disability than the simple sum and testified extensively how they combine to create synergism. See Dr. Volarich deposition, pages 42-44.
Andrew M. Wayne, M.D.
On June 30, 2015, Dr. Wayne examined the claimant and opined that repetitive job duties were the prevailing factor compelling the claimant's bilateral thumb surgical requirements. He opined that the claimant suffered a 7 % permanent partial disability of the right thumb and a 10 % permanent partial disability of the of the left upper extremity based on surgery involving the left thumb; separately a 3 % permanent partial disability rating at the right upper extremity due to persistent mild pain and stiffness in the right wrist. He did not indicate a need for future medical treatment. See Exhibit 2.