STATE OF WISCONSIN
LABOR AND INDUSTRY REVIEW COMMISSION
P O BOX 8126, MADISON, WI 53708-8126 (608/266-9850)

ROBIN HENNING, Applicant

STA-RITE INDUSTRIES INC, Employer

ZURICH AMERICAN INSURANCE CO, Insurer

WORKER'S COMPENSATION DECISION
Claim No. 2004-047029

Sta-Rite Industries, Inc. and Zurich American Insurance Company (respondents) submitted a petition for commission review alleging error in the administrative law judge's Findings and Interlocutory Order issued in this matter on September 2, 2005. The applicant also submitted a petition for commission review, and briefs were submitted by the parties. At issue are whether or not the applicant sustained compensable occupational wrist and/or occupational elbow injuries. If any injury is found, the nature and extent of disability and liability for medical expense also arise as issues.

The commission has carefully reviewed the entire record in this matter and hereby affirms in part and reverses in part the administrative law judge's Findings and Interlocutory Order. The commission makes the following:

FINDINGS OF FACT AND CONCLUSIONS OF LAW


The applicant, whose birth date is September 29, 1950, first worked for the employer from 1968 to 1975, primarily in sales. Her duties involved some typing. She returned to the employer in 1985, worked for about one year in maintenance, about two years as an administrative assistant, and then for six or seven years in the parts department. She performed some typing duties while working as an administrative assistant. In the parts department she spent approximately half of her day typing or computer keyboarding, and the rest of the time packing parts and acting as a lead person. In 1995, she became a buyer in the employer's purchasing department. This is a salaried position in which the applicant still works between 45 and 50 hours per week. Between 1995 and 2000, she spent approximately six hours per day computer keyboarding. In 2000, the employer installed a new software program that resulted in increased computer duties for the applicant, including use of a computer mouse and dealing with substantial e-mail traffic. Ninety percent of the applicant's day is spent on the computer.

The applicant went to see Dr. Brad Fideler on April 9, 2002, complaining of persistent numbness and tingling in both hands, right worse than left. These symptoms had been bothering her "on and off" for the previous six or seven months. She had informed the employer about the problem and that she was going to see the doctor. Dr. Fideler referred the applicant to Dr. Craig Johnson for EMG studies of her upper extremities. Dr. Johnson opined that the studies showed profound median nerve latencies in the applicant's right wrist, and very significant latencies in her left wrist. He also indicated there were very significant latencies across both elbows. Dr. Johnson diagnosed profoundly abnormal bilateral carpal tunnel syndrome and moderately severe bilateral cubital tunnel syndrome.

Initially, Dr. Fideler focused on the right carpal tunnel syndrome, and indicated the applicant's work activities were most likely a major contributory factor to that condition. On May 8, 2002, Dr. Fideler performed right carpal tunnel release surgery. This had a beneficial result but did not provide complete relief from the applicant's symptoms. She returned to her regular job but continued to experience stiffness and swelling in her fingers with activity, as well as some aching in her wrists and lower arms. Dr. Fideler completed a WKC-16-B on August 10, 2004, that indicated occupational causation for the bilateral carpal tunnel syndrome, but assessed no permanent disability.

The applicant's left upper extremity symptoms increased and she returned to Dr. Johnson for a follow-up EMG on December 3, 2004. Dr. Johnson's findings based on his EMG testing were persistent bilateral carpal tunnel syndrome, bilateral cubital tunnel syndrome, and minimal cervical findings (any cervical claim the applicant may have is not at issue in this proceeding). The applicant returned to Dr. Fideler on January 10, 2005, complaining of ongoing pain and numbness in her left hand, as well as some sensitivity around the right wrist incision and intermittent numbness in her right fingers. On February 2, 2005, Dr. Fideler wrote a letter indicating that he had not expected residuals from the applicant's right carpal tunnel release, but she was still experiencing sensitivity over the incision, some difficulty with grip strength, and intermittent numbness in her hands and fingers. Because of these residuals he changed his opinion and assessed 10 percent permanent partial disability at the right wrist.

On Friday, February 25, 2005, Dr. Fideler performed a left carpal tunnel release. The applicant had a good enough result that she went back to work the following Monday, although she used a wrist splint. However, she continues to experience symptoms that she describes as stiffness and swelling in her left fingers similar to what she experiences on the right. She also has less grip strength in her left hand than she does in her right. She is able to perform her regular job, although she breaks up her keyboarding with other work activities when her symptoms bother her. She also does fewer activities involving her hands outside of work. Dr. Fideler completed two WKC-16-B's on April 4, 2005, one addressing the right carpal tunnel syndrome and the other addressing the left carpal tunnel syndrome. He found occupational causation for both, assessed 10 percent at the right wrist and indicated the applicant was still healing from the left wrist surgery. Dr. Fideler never addressed the question of cubital tunnel syndrome.

In a letter response to applicant's attorney's questions on December 12, 2004, Dr. Johnson opined that based on his measured severity of the applicant's bilateral carpal tunnel syndrome and cubital tunnel syndrome, he would assess 7-10 percent permanent partial disability to each of the wrists, and 5-7 percent permanent partial disability to each of the elbows. He advised the applicant to cease all keyboarding, tool use, or repetitive motion of her arms or hands. He completed a WKC-16-B dated December 23, 2004, assigning occupational causation to both bilateral conditions, and reiterating his permanent partial disability assessments. On July 12, 2005, Dr. Johnson completed an updated WKC-16-B with accompanying narrative, indicating that he had performed new EMG testing on May 6, 2005. He opined that healing had plateaued at both wrists by July 12, 2005, and he assessed permanent partial disability of 10 percent at the right wrist, 8.5 percent at the left wrist, 5.5 percent at the right elbow, and 7 percent at the left elbow.

At the insurer's request, Dr. Dennis Brown examined the applicant on July 20, 2005. In his report dated August 3, 2005, Dr. Brown diagnosed right wrist stiffness post-carpal tunnel release, left-hand soreness post-carpal tunnel release, electrophysiologic bilateral cubital tunnel syndrome, cervical degenerative disc disease, and obesity. He opined that typing on a keyboard is not an ergonomic risk for carpal tunnel syndrome, and that the applicant's bilateral carpal tunnel syndromes were manifestations of her underlying conditions, not causally related to her work for the employer. He identified her obesity and her status as a "possible" borderline diabetic as risk factors for nerve entrapment. He further opined that the applicant's electrophysiologic cubital tunnel syndrome became asymptomatic after her carpal tunnel surgeries. Without regard to cause, he assessed 2 percent permanent partial disability at each wrist as residuals from the carpal tunnel surgeries. He further opined that the applicant could perform her regular work without limitation, that she reached a healing plateau from the right wrist surgery on June 4, 2002, and that she reached a healing plateau from the left wrist surgery on March 25, 2005. He opined that there was no permanency associated with the cubital tunnel syndrome.

Dr. Brown's statement that repetitive keyboarding can never affect the onset of carpal tunnel syndrome is not credible, and the applicant had significant keyboarding work exposure. The commission finds credible the opinion of Dr. Fideler and Dr. Johnson that the work exposure was causative of the bilateral carpal tunnel syndrome, with the date of injury for both occupational injuries being April 9, 2002. The cubital tunnel syndrome diagnosis was made on the basis of EMG abnormalities, rather than any substantial clinical treatment. The applicant did mention elbow discomfort to Dr. Johnson; however, no such complaints are recorded in the medical records submitted from Dr. Fideler, and the applicant's testimony was vague concerning her elbow symptoms. The commission finds credible Dr. Brown's opinion that the electrophysiologic bilateral cubital tunnel syndrome did not result in any permanent disability.

On March 28, 2005, Dr. Fideler indicated that the applicant still had significant swelling at the left wrist surgical site, but her numbness and tingling had resolved, she had returned to work, and she continued to see Dr. Johnson for follow up. Dr. Fideler's WKC-16-B dated April 4, 2005, indicated the applicant was still healing and continued to treat with Dr. Johnson. On July 12, 2005, Dr. Johnson credibly opined that the wrist healing periods had ended.

Dr. Johnson's assessments of permanent partial disability at the wrists are found to be slightly higher than warranted, based on the degree of the applicant's residual symptoms and the fact that she has been able to return to her regular employment. At the same time, Dr. Brown's permanent partial disability assessments are found to be too low, based again on the degree of residual symptoms and on the fact that those symptoms require her to alternate her keyboarding activities with other work activities. After weighing all the relevant medical evidence, the commission finds that as a result of her bilateral occupational carpal tunnel syndrome the applicant sustained 5 percent permanent partial disability at each wrist. This results in 20 weeks of compensation for each wrist, at the applicable rate of $212.00 per week, for a total of $8,480.00. The applicant's attorney is entitled to a 20 percent fee against the award for permanent partial disability.

All the medical expenses claimed in applicant's exhibit E are referred to the dispute resolution process under Wis. Stat. § 102.16, with the exception of reimbursement due the applicant for $1,181.00 that she paid to providers directly, as well as $154.05 in mileage expense.

Dr. Johnson has indicated that additional medical treatment and/or disability may result from one or both carpal tunnel injuries, and jurisdiction will be reserved with respect to those injuries.

NOW, THEREFORE, this

INTERLOCUTORY ORDER

The Findings and Interlocutory Order of the administrative law judge are affirmed in part and reversed in part. Within 30 days from this date, respondents shall pay to the applicant as compensation for permanent partial disability the sum of Six thousand seven hundred eighty-four dollars ($6,784.00); to Attorney Mark P. McGillis, fees in the amount of One thousand six hundred ninety-six dollars ($1,696.00); to the applicant as reimbursement for medical expense the sum of One thousand one hundred eighty-one dollars ($1,181.00); and to the applicant as reimbursement for mileage expense the sum of One hundred fifty-four dollars and five cents ($154.05).

Jurisdiction is reserved with respect to the possibility of additional medical treatment and/or disability attributable to either carpal tunnel wrist injury.

Dated and mailed April 14, 2006
henniro . wpr : 185 : 8 ND § 3.42

/s/ James T. Flynn, Chairman

/s/ David B. Falstad, Commissioner

/s/ Robert Glaser, Commissioner


MEMORANDUM OPINION

The commission's partial reversal of the administrative law judge's decision was based on analysis of the medical opinions and on the applicant's testimony, which both the administrative law judge and the commission found credible.

cc:
Attorney Mark P. McGillis
Attorney Edward W. Stewart

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