Injury No.: 92-188680

Employee: Jack Dickson

Employer: ABB Combustion Engineering Services (settled)

Insurer: National Union Fire Insurance Company of Pittsburgh (settled)

c/o Gallagher Bassett Services

Additional Party: Treasurer of Missouri as Custodian

of Second Injury Fund

Date of Accident: October 21, 1992

Place and County of Accident: Franklin County, Missouri

The Final Award Denying Compensation issued by the Labor and Industrial Relations Commission January 28, 2000, contained a clerical error. The Commission issues its Order Correcting the Award.

Given at Jefferson City, State of Missouri, this 28^th day of January 2000.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

Christopher S. Kelly, Chairman

Christian C.R. Wrigley, Member

Matthew W. O’Neill, Member

Attest:

Secretary

(Affirming Award and Decision of Administrative Law Judge)

Injury No.: 92-188680

Employee: Jack Dickson

Employer: ABB Combustion Engineering Services (settled)

Insurer: National Union Fire Insurance Company of Pittsburgh (settled)

c/o Gallagher Bassett Services

Additional Party: Treasurer of Missouri as Custodian

of Second Injury Fund

Date of Accident: October 21, 1992

Place and County of Accident: Franklin County, Missouri

The above-entitled workers' compensation case is submitted to the Labor and Industrial Relations Commission for review as provided by § 287.480 RSMo Cum. Supp. 1998. Having reviewed the evidence and considered the whole record, the Commission finds that the award of the administrative law judge is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Act. Pursuant to § 286.090 RSMo Cum. Supp. 1998, the Commission affirms the award and decision of the administrative law judge dated October 4, 1999, and awards no compensation in the above-captioned case.

The award and decision of Administrative Law Judge Leslie E.H. Brown, issued October 4, 1999, is attached and incorporated by this reference.

Given at Jefferson City, State of Missouri, this 28^th day of February 2000.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

Christopher S. Kelly, Chairman

Christian C.R. Wrigley, Member

Matthew W. O’Neill, Member

Attest:

Secretary

Employee: Jack Dickson Injury No. 92-188680

Dependents:

Employer: ABB Combustion Engineering (previously settled)

Additional Party: State Treasurer, as custodian of Second Injury Fund

Insurer: National Union Fire Insurance Company of Pittsburgh c/o Gallagher Bassett Services

Hearing Date: 5/21/99 (finally submitted 6/21/99) Checked by: LEHB/bfb

1. Are any benefits awarded herein? No

2. Was the injury or occupational disease compensable under Chapter 287? No

3. Was there an accident or incident of occupational disease under the Law?

No

4. Date of accident or onset of occupational disease: ---

5. State location where accident occurred or occupational disease was contracted: Franklin County, Missouri

6. Was above employee in employ of above employer at time of alleged accident or occupational disease?

Yes

7. Did employer receive proper notice? ---

8. Did accident or occupational disease arise out of and in the course of the employment?

No

9. Was claim for compensation filed within time required by Law? ---

10. Was employer insured by above insurer? Yes

11. Describe work employee was doing and how accident occurred or occupational disease contracted:

Employee was working as a boilermaker

12. Did accident or occupational disease cause death? No Date of death?

---

13. Part(s) of body injured by accident or occupational disease: alleed left hand/wrist

14. Nature and extent of any permanent disability: ---

15. Compensation paid to-date for temporary disability: none

16. Value necessary medical aid paid to date by employer/insurer? ---

17. Value necessary medical aid not furnished by employer/insurer? ---

18. Employee's average weekly wages: maximum

19. Weekly compensation rate: ---

20. Method wages computation: by agreement

21. Amount of compensation payable: None

Unpaid medical expenses:

weeks of temporary total disability (or temporary partial disability)

weeks of permanent partial disability from Employer

weeks of disfigurement from Employer

Permanent total disability benefits from Employer beginning , for

Claimant's lifetime

22. Second Injury Fund liability: Yes No Open

weeks of permanent partial disability from Second Injury Fund

Uninsured medical/death benefits

Permanent total disability benefits from Second Injury Fund:

weekly differential () payable by SIF for weeks beginning

and, thereafter, for Claimant's lifetime

Total: None

23. Future requirements awarded: ---

Said payments to begin --- and to be payable and be subject to modification and review as provided by law.

The compensation awarded to the claimant shall be subject to a lien in the amount of --- of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant:

---

Employee: Jack Dickson Injury No: 92-188680

Employer: ABB Combustion Engineering (previously settled)

Additional Party State Treasurer, as custodian of Second Injury Fund

Insurer: National Union Fire Insurance Company of Pittsburgh c/o Gallagher Bassett Services

Checked by: LEHB/bfb

This is a hearing in Injury Number 92-188680. The claimant, Jack Dickson, appeared in person and by counsel, Robert Bedell. The Second Injury Fund appeared by and through Assistant Attorney General Jennifer Sommers. The claim against the employer/insurer was previously settled; the employer/insurer did not appear at this hearing.

The parties entered into certain stipulations and agreements as to the issues and evidence to be presented in this hearing.

On the date in question: a. the claimant was in the employment of ABB Combustion Engineering in Franklin County, Missouri; b. the employer and employee were operating under and subject to the provisions of the Missouri Workers’ Compensation Law; c. the employer’s liability was insured by National Union Fire Insurance Company of Pittsburgh c/o Gallagher Bassett Services; d. the employee’s average weekly wage was at the maximum.

e. No temporary total disability benefits have been paid. f. No medical aid has been provided.

1. Whether or not the claimant sustained an accident or occupational disease arising out of and in the course of his employment

2. Notice

3. Medical causation

4. Nature and extent of permanent partial disability

5. Liability of the Second Injury Fund

6. Statute of Limitation

a. re: the filing of the primary claim in this case

b. re: the filing of the claim against the Second Injury Fund

The following exhibits were admitted into evidence:

No. A: Deposition transcript of Joseph H. Morrow, Jr., D.O. taken on behalf of the claimant on May 17, 1999 (Admitted subject to the objections therein)

No. B: Deposition transcript of James W. England, Jr. taken on behalf of the claimant on May 19, 1999 (Admitted subject to the objections therein)

No. C: Medical records of James E. Speiser, M.D.

No. D: Medical records of Paul R. Manske, M.D.

No. E: Medical records of Barnes Hospital

No. F: Medical records from St. Louis Orthopedic Institute, Inc.

No. G: Medical records from St. Joseph Hospital

No. H: Medical records of Robert J. Auclair, M.D.

No. I: Medical records of Jeffrey L. Draves, M.D.

No. J: Medical records of Donald King, M.D.

Roman Numeral I: Copy of the Division’s file in Injury Number 92-188680

Jack Dickson, the claimant, testified that he was born on 8/14/34 and would be 65 years old in August. Present medications I am on, Dickson said, were medications for pain, water retentionand now cholesterol. Dickson testified that he has been a boilermaker since 1951. When asked if he had worked most of his years out of a union hall, Dickson answered that he had worked for a company, Boilermakers, for 18 years, then the rest of the years he had worked out of the union hall as a field boilermaker/construction journeyman. He agreed that he did similar work when he worked for the company as when he worked out of the hall. The last company I worked for was Riley Construction, Dickson said, that was a short time after I had been laid off from ABB Construction (hereinafter ABB). He agreed that he was working for ABB when he was at Union Electric at Labadie. My first job at ABB was a general foreman; I held this position for about two months, he said. I gave up the position because I had stress and went back to the duties of a boilermaker, he stated. Dickson explained that his duties as a boilermaker were erecting boiler parts – installing, fitting, tack welding. After components are in place and inspected by the inspector, they are welded out for future use of the boiler function. Dickson was asked if his work involved welding; he answered that he did more or less just tack welding. I was always in basically the fit up, alignment and so forth, he said. Dickson agreed that his work as a boilermaker was hand intensive. He explained that if you are fitting parts you either have to have both hands on a wrench or you’re holding a part while you attach or tack weld the part. At the same time you may be working off of a ladder, 30 feet in the air, so if you’re not holding something you’re holding on, he said. Dickson agreed that this was throughout the day.

Dickson testified that he began having problems with his left hand somewhere in the early 1990’s. He stated that he had agreed if Dr. Auclair’s records reflected that he saw the doctor in June of 1991. I probably had problems prior to that, Dickson stated, but not knowing what it was… He stated that he gave notice to someone at ABB that he was seeing a doctor. The treatment from Dr. Auclair was my trying out medications, such as pain and inflammation medication, to see if it helped or changed the condition I had, Dickson said. After seeing Dr. Auclair, he said, I was off work two or three weeks in June of 1991 trying to recuperate and let the soreness and swelling go out. I’m not sure about the time that I was off, Dickson stated, it could have been maybe three or four days the first time and then I went back and was off again. Dickson said that he believed he returned to work at ABB. He agreed that he continued to treat with Dr. Auclair for some time while he continued to work. Continuing to work aggravated my left wrist, Dickson agreed. It seemed like I wasn’t getting better, possibly getting worse; it took longer to recoop, he said. Dr. Auclair sent me to Missouri Baptist Hospital for a carpal tunnel check, Dickson stated. They ran tests on both hands, he said, and I had carpal tunnel really bad in my left hand and a good start in my right hand. Dr. Auclair referred me to Dr. Tucker at St. Joseph Hospital. Dickson was asked if ABB was aware he was going to Dr. Tucker for carpal tunnel surgery; he answered that they were aware, but he did not remember exactly how, whether it was through his co-workers. I don’t think I directly talked to anybody at ABB about this because at that point the job was over; I was laid off and on my own, Dickson testified. My insurance was handled through Boilermaker International, so there was no need to tell ABB about anything at that point, he said. Dickson agreed that what he was saying was that ABB was aware in 1991 that he was seeing Dr. Auclair, but he was not sure whether ABB was aware he was having surgery by Dr. Tucker. I’m sure ABB knew but I don’t remember me telling them directly, he said, but the union hall knew, my business agent knew. My co-workers knew that I had been having a problem, Dickson stated, that’s why I avoided some work. I’m sure they knew; they would call me at the house to see how I was doing, you know, after I finished my duties with them.

Dickson agreed that he first saw Dr. Tucker in January of 1993, and stated that he agreed with the doctor’s record from January of 1993 that over the past several months he had had increasing amounts of difficulty with swelling, pain and numbness in the left hand. He was asked how his left hand felt after the surgery; Dickson answered that it was very painful and very swollen, and eight days later it had to be lanced. He explained that it was infected and had what they called synovial fluids oozing out. I was instructed to return to the hospital the day after the doctor had lanced the hand for further investigation and the doctor recommended that I be admitted into the hospital that day. A second operation was performed by Dr. Tucker of opening up more area and flushing it out, he said. Dickson agreed that not long after that he had a third surgery and then a fourth surgery performed, I believe, by Dr. Tucker. He agreed that an infection specialist, Dr. King, was called in on the fourth surgery. I then went under the care of Dr. King for the diagnosis of staph infection, Dickson stated, and I had it for some time. The treatment for it was antibiotics through shot and by mouth, he said, and then I had a Clausen’s tube implanted into the main artery in my chest. I was given 56 ccs., three times a day, by a force feeding pump into my system for eight weeks along with other antibiotics and medication as well, he said. Dickson was asked if he had subsequently come under the care of a Dr. Speiser; he explained that Dr. Speiser was called in because he had been told that he possibly had some arthritis not knowing about the carpal tunnel. Dr. Speiser visited me in the hospital, Dickson said, I had lots of leakage, seeping. The doctor said that he couldn’t do anything until the leakage stops, he stated. Dickson was asked if he subsequently came under the care of orthopedic surgeon Dr. Manske; he explained that late in the care by Dr. King he showed the doctor a red spot that had showed up on his hand and Dr. King referred him to Dr. Manske. Dickson agreed that Dr. Manske performed surgery, and that this fifth and final surgery was in 1995. He stated that he has had no treatment for his left hand since the treatment with Dr. Manske in 1995 other than pain medication and antibiotics.

Dickson described the condition of his left hand. He agreed that his left hand is swollen; he explained that the tissue has deteriorated along the joint to slip down approximately a half to three quarters of an inch below alignment. I am unable to make a fist with my left hand, Dickson said. He agreed that he can only bring his fingers in approximately half way and cannot bring his thumb across his hand at all. Dickson said that he does not feel comfortable carrying objects in his left hand. He explained that it pulls then he gets a charley horse in the left forearm, and I’m afraid I’ll drop it. I practice with a plastic bag with water, he said. I hang it on my fingers just to kind of stretch and keep it active because my shoulder slumped down from carrying it so long. Dickson agreed that his shoulder was sore from carrying his hand in because of elbow pain. He was asked if he could pick up a coffee cup with his left hand; Dickson answered that weight-wise he could, but he could not trust it to hold the cup. I just had a great great granddaughter and I’m afraid to hold her, he said. Dickson stated that he does not use his left hand very much when he is eating; I have a lot of slippage, he explained. He agreed that he is right hand dominant. Dickson was asked about driving and answered that he cannot trust himself to steer the wheel. The hand rides on the wheel; I do that to try to keep alignment, he explained. When I turn, that hand goes to try to keep the stroke, Dickson testified, then it gets tired and I have to kind of nuzzle it and do one-handed driving. He was asked if he had any pain in the left hand; he answered that he did all the time. I’ve gotten used to the pain, Dickson stated, I can sleep without the pain keeping me awake. I don’t sleep well, I wake up several times a night, he said. I can sit and talk, carry on a conversation without the pain being my number one priority now where before I couldn’t, Dickson stated. He stated that he has had no subsequent injuries to the left hand.

Prior injuries before the left hand injury, Dickson stated, included a ruptured disc for which I had surgery in 1971. He agreed that this back injury occurred at work. I was off six months for this injury, Dickson stated. He was asked if he had had any problems with his back following his return to work; Dickson responded that he had to try to eliminate or not go out on the jobs where there was a lot of lifting and straining -- skull dragging work. He agreed that from 1952 to 1971 he did the skull dragging work without a problem. I had no further treatment for my back from 1971 until I re-injured it in 1986, Dickson stated. He explained that he fell 20 feet and re-injured his back. I was numb, Dickson testified. My ankles and feet and legs also took quite a beating and my back was numb, he stated, I couldn’t feel anything. At the emergency room I requested to be referred back to Dr. Weber who had performed my surgery in 1971, he said. X-rays were taken and there were no broken bones, and an MRI showed deterioration in the scar tissue area where my prior operation had been, he said. Dr. Weber recommended that it was best to leave it as it was instead of having surgery performed, and that is where it has been, Dickson said. I was off work two or three weeks for the 1986 injury and then returned to light duty, he stated. Following light duty I was generally able to do all the things that I needed to do as a boilermaker only with a different approach, Dickson stated. I really had to choose the work that I did, he said. Quite often my name would come up on the referral list for work and they would explain to me what the job involved. To be fair to everybody, I would refuse to take the job if I felt I couldn’t handle it, he said. After 1986 and before the left hand injury it happened about three times a year that I would refuse a job because I did not feel I was physically able to do it; this meant about five or six months off work, Dickson explained. He agreed that this took place up to the time he hurt his left hand. Concerning his feet and the 1986 fall, Dickson stated that it seems like the swelling never went down. And it seems like my ankles were stretched from the fall such that I had to start wearing bigger shoes. At present the ankles are stiff and tire easily. He was asked if he was comfortable walking, and he answered not really but he tries to walk for exercise. Problems with my back, Dickson stated, is that it is getting back to the pain level that I originally had. There is a lot of pressure on the sciatic nerve going down the hip around and down the back of the leg into the heel and then to the left side of the ankle. I have this pain just about all the time, he said, and I feel better using the cane for safety in case I don’t function well or slip. Using the cane also takes the pressure off my leg especially if I have to stand like at a stop light, he said. Dickson was asked what a typical day was like for him. He answered that it takes him about three hours of a morning to get started. I try to prepare some oatmeal or cereal or something, or I get dressed and go out and eat, he said. Quite often by the time I get around, the breakfast hour is over so I have to find someplace that serves breakfast until noon, he said. Being very active and very strong, Dickson testified, I loved doing my own maintenance on my house and automobiles. I liked to work with my hand, he said. I’ll still find myself buying tools I know I will never use, Dickson stated.

Dickson testified that he has a eighth grade education plus vocational schooling in areas of interest that would help him in his line of work.

On cross examination, Dickson was asked when he last worked for ABB; he answered that he did not remember the dates, but it would have been approximately three weeks before he went to work for Riley Construction. I worked for Riley, I believe, three weeks then I had to go back in for surgery, he said. Dickson explained that when he was able to maybe go back into the position that he had had at ABB, their job was complete. That’s when I went to Riley, he stated. In my last job with ABB I worked as a journeyman boilermaker installing Knox units on boilers, he said. He agreed that at this particular job he was standing and working off of a ladder all the time. Dickson agreed that he did kneeling, stooping and squatting. This job lasted about six to eight weeks, he said. I would say that I was physically able to perform my job duties as a boilermaker satisfactorily during this time, he said. I wasn’t singled out to be laid off, he stated, they laid off the whole crew that night because that was the end of it and then the day crew the next day would finish up. Dickson agreed that he worked the whole six to eight weeks until the job was finished and they laid them off. We worked eight hours a day and then started working ten hours on some portions of the job, he said. He agreed that part of his job duties included climbing ladders, lifting and using tools, lifting on a regular basis objects up to 80 pounds in weight as well as pushing and pulling these objects a lot. To get at my work I had to squat down and also lay down, Dickson said.

During cross examination Dickson described one occasion in which he was reaching through a hole and holding an 80-pound steel sheet in place until a co-worker got into position on his back in order to weld the sheet into place. I pulled my co-worker’s hood down because now he is holding the sheet with his hands and feet, Dickson said. Pulling the hood down is so he can strike an arc and tack weld the sheet, he stated. The co-worker was nervous because the pressure was on; the supervisor was not a pleasant guy, he explained. My co-worker let the steel plate slip and it fell down on my left hand and bent it back, Dickson testified. So, after that is when my pain never ceased up until the surgery, he said. Dickson agreed that this occurred towards the end of his job at ABB and that he was then off work for about three weeks and then worked for Riley for about three weeks. Subsequently, he testified that he thought he was off, had surgery, and then went to work for Riley in the tool position. After I left the ABB job I was hurting, Dickson testified. I told my foreman and I told the steward that this plate had slipped and I had hurt my hand, he stated, and they said we’ll make a record of it. The company was out; you’re laid off, Dickson testified. He stated that sheet of metal falling on his left hand happened the night they got laid off. Dickson was again asked if he was physically able to do the ABB job prior to injuring his left hand when the plate slipped; he answered yes, that was one of the reasons he was on the job, for the layout and the fit up. He was asked if he had told ABB he was going to see Dr. Auclair for a specific reason or did he just tell them he was taking time off for sick leave. Dickson responded that when they got laid off that night, ABB was through with me, they had no more work for me. So then I went back to Riley because they needed someone to look after the new tools. This was after I had surgery, he said. Then I had to have surgery again, and then I didn’t come back, the job was finished.

Dickson was asked during cross examination if his back pain had been getting worse over the last few years. He answered yes, since 1986. When asked if he continued to get worse after 1992, Dickson responded somewhat as he would sit in his chair at the table holding his hand for hours not able to get any exercise. The pain down my leg his gotten worse since 1986; you’re getting older, you’re wearing out, Dickson stated. When asked when he started using his cane, Dickson answered that his back had started getting pretty severe about 8 or 9 weeks ago and about four weeks ago he started using a cane. When I stand for a little while my leg and foot goes numb and that’s why I needed the cane, he stated. He was asked if his problems with his ankles had gotten better, worse or stayed the same in the last seven years; Dickson answered that they had probably gotten a little bit worse as far as swelling. He was asked if he did a lot of hand work during the ABB job. Dickson responded yes, everything you did was with your hands. You were either lifting something, holding something or working on something, he said. I was not welding on the ABB job, Dickson stated, I was tacking. Dickson stated that he had worked as a general foreman with ABB at that time and he was not suppose to be working but rather supervising. I had a little trouble with that, he said, because whenever I saw somebody in a strain I always had a habit of helping them. Dickson was asked if he felt he would have been physically able to do the foreman job if he wasn’t doing the physical labor. He answered no, because you cannot give instructions from down on the ground to someone a hundred feet above you, you have to be able to hold onto a ladder or a crane or a work basket.

On redirect, Dickson was queried that he worked for ABB up to his first surgery; he responded that he worked for ABB, then was laid off, and this is when he got into the carpal tunnel syndrome. He agreed that he did not go to work for Riley until after the first surgery. Dickson agreed that he had testified during cross examination that his back pain had gotten worse after the hand injury because of the way he was sitting for long periods of time holding his hand. He added that he thought that contributed to some of it, but also the jolt that he took on that accident, in his opinion, did some damage to his back as well. Dickson noted, though, that he had a walker just for getting up because he was getting stiff and weak from the lack of exercise and sitting there.

The following medical records were admitted into evidence:

Exhibit No. F) were treatment reports concerning Dickson’s work related back injury in or about July 1988. Included in the initial examination report of September 19, 1988 by Dr. Weber was the following:

In a November 3, 1988 report by Dr. Donald Stronsky, an officemate of Dr. Weber, it was written that Dickson was being seen for a follow-up of injuries sustained when he fell approximately 18 feet. At that time he developed pain and discomfort in the legs and in the low back area, it was written. Further noted was that Dickson had returned to work, but had had a couple of other episodes that had caused recurrent back discomfort and that he had not been able to work since then. Dr. Stronsky’s written impression was low back strain with some possible compressive injury to articular surfaces in the lumbar area and probably in the ankle area from dropping this distance. In a November 25, 1988 examination report, Dr. Weber wrote the following:

Dr. Weber wrote the following in a February 3, 1989 examination report:

In a May 26, 1989 examination report, Dr. Weber wrote that he felt Dickson was at a point where he was not improving, and that continued treatment was not indicated. He has permanent partial disability of the low back in the range of 20 percent permanent partial disability over and above the disability that preceded the accident, Dr. Weber wrote. The doctor further wrote that Dickson had been discharged. Dr. Weber wrote in a November 24, 1988 examination report that Dickson had lost a second job because of his back. I have referred Dickson to a spine surgeon as I feel he probably should have a spinal fusion between L5-S1 with plates. In a June 13, 1990 letter to the employer’s workers’ compensation carrier, Dr. Weber discussed the Dickson’s treatment after the work accident and that he had ultimately referred Dickson to Dr. David Robson for surgery. I have not heard form Dr. Robson so I am not aware if Dickson has seen him; I don’t know anything of his current status since November of 1989, Dr. Weber wrote.

2. Reviewing the medical records described as those of Dr. Jeffrey L. Draves, M.D. (Claimant’s Exhibit No. I) and the medical records of Dr. Ronald J. Auclair, M.D., a Rheumatologist (Claimant’s Exhibit No. H), the earliest document in these records is a May 24, 1991 letter from Dr. Draves to Dr. Auclair in which Dr. Draves writes the following:

Dr. Auclair’s June 10, 1991 examination notes as well as a June 10, 1991 examination report to Dr. Draves were in the records. The following excerpts were included in Dr. Auclair’s June 10, 1991 examination report:

Dr. Auclair noted Dickson’s past medical history including that he is 21 years post-status lumbar laminectomy, and three years ago he had fallen 18-20 feet landing on his feet and developing soft tissue injuries about the ankles associated with swelling and ecchymosis. Examination findings on June 10, 1991, Dr. Auclair wrote, included:

Lumbar vertebrae: Well-healed laminectomy incisional scar.

Hands: Fists: 95%

The remaining joints are within normal limits.

Dr. Auclair wrote the following impressions and recommendations:

the polyarthalgias, suspected arthritis, and positive ANA.

2. Possible local steroid injection beneath the flexor

retinaculum of the right wrist.

should worsen.

4. Gradual tapering of the Prednisone dose.

again on 6/26/91 at which time he had lowered his

Prednisone to 2 mg. o.d. and felt somewhat more achy.

Physical examination was essentially unchanged from

his initial visit. I suggested that he continue with

Prednisone up to several mg. daily for the time being and

that I see him again in approximately three to four

weeks.

Dr. Auclair’s treatment notes indicated that he continued to treat Dickson with medications including Prednisone through 1991, 1992 and 1993 with a last treatment entry of 3-17-93. In an 8-21-91 entry the following was noted:

Physical exam findings on 8-21-91 were: Hands – really essentially unchanged from his initial visit with mild diffuse puffiness of the fingers without tenderness. A 3-12-92 entry noted that Dickson had been working out of town and had been unable to return since his last visit six months earlier but had continued with Prednisone. Also written was:

Examination findings on 3-12-92 included: mild to moderate diffuse puffiness of the fingers of both hands; right 2^nd MCP joint tenderness and swelling; left wrist tenderness swelling dorsally, and limitation of dorsiflexion and palmar flexion; remaining joints are essentially unrevealing. Dr. Auclair wrote that his impressions were the same. The next treatment entry of 12-9-92 noted Dickson’s complaints that he had had progression of his arthritis with involvement of the shoulder, wrists, hands, knees and feet. Also written was: "The worst areas are the left hand and wrist. He has fairly persistent numbness in the fingers primarily of the left 1^st, 2^nd and 3^rd fingers." It was noted that Dickson "had not worked much since his last visit, partially due to the lack of work but also due to his inability to work available jobs requiring much strenuous physical labor. Physical exam findings on 12-9-92 included: diffuse swelling and tenderness in the fingers of both hands; in the right wrist, no tenderness but swelling and limitation of palmar flexion as well as a positive Tinel sign; in the left wrist, tenderness and swelling, and a greater limitation of motion and pain. Physical examination findings continued with:

Included in the recommendations in Dr. Auclair’s 12/9/92 treatment note was: bilateral median nerve conduction studies, and that Dickson was advised to consider a left carpal tunnel release at which time a flexor tenosynovectomy could be performed about the left wrist. A 12-30-92 EMG and nerve conduction report was in the record and reported the following conclusions: "Note prolonged terminal latency of right sensory median orthodromic, left motor median, left sensory median – Findings may reflect a left carpal tunnel syndrome, early right carpal tunnel syndrome." In a January 4, 1993 referral letter from Dr. Auclair to Dr. Robert Tucker, M.D. concerning Jack D. Dickson, Dr. Auclair wrote that Dickson was to see Dr. Tucker on January 14, 1993. Dr. Auclair further wrote that Dickson "has rheumatoid arthritis with bilateral carpal tunnel syndrome, much worse on the left side where extensive tenosynovitis is also present". "I have advised left carpal tunnel release with tenosynovectomy", Dr. Auclair wrote.

Dr. Tucker wrote of his evaluation of Dickson’s left hand in a January 14, 1993 report to Dr. Auclair (See Claimant’s Exhibit No. F). The following was included in Dr. Tucker’s report:

After discussing his examination findings, Dr. Tucker wrote in his January 14, 1993 evaluation report his impressions:

3. Records from St. Joseph Hospital (Claimant’s Exhibit No. G) included the voluminous treatment and numerous hospitalizations and surgeries of Dickson in 1993 beginning with surgery for left carpal tunnel release and flexor tenosynovectomy, and then subsequent surgeries described as addressing septic arthritis. A 2/5/93 admission sheet noted that Dickson was admitted with a diagnosis of: Rheumatoid arthritis with severe flexor tenosynovitis and median nerve compression, left wrist and hand. The history of present illness in the admission sheet was:

Dickson’s past medical history, current medications, social and family history as well as physical examination findings were discussed in the 2-5-93 admission sheet. The written impression was: Extensive flexor tenosynovitis, left wrist and palm, with secondary median nerve compression. A 2-5-93 operative report noted the following operation performed by Dr. Robert Tucker, M.D.: 1. Carpal tunnel release, left wrist; 2. Extensive flexor tenosynovectomy including the palm to the small finger; 3. Debridement of fat necrosis, left wrist. The history of illness noted in the 2-5-93 operative report was:

The preoperative diagnosis in the 2-5-93 operative report was: Rheumatoid arthritis with: 1. Flexor tenosynovitis, left wrist and palm, 2. Carpal tunnel compression. The postoperative diagnosis was: 1. Extensive flexor tenosynovitis, left wrist and palm; 2. Median nerve compression, left wrist; and 3. Fat necrosis, left wrist.

A 3/10/93 admission sheet noted that Dickson was admitted with a diagnosis of: Rheumatoid arthritis with possible wound infection, left wrist. The history of present illness in the 3/10/93 admission was:

Surgery was performed by Dr. Tucker during Dickson’s 3/10-14/93 hospitalization. The operative procedure was: incision and drainage of synovial fluid loculation, left wrist. The final diagnosis in the operative note was: synovial fluid loculation/fistula, left wrist.

Dickson was again admitted on 5/12/93 for the diagnosis of septic arthritis, left wrist and rheumatoid arthritis. Dr. Tucker wrote the following in the history section of the admission sheet:

In a 5/13/93 consultation report Dr. J. Speiser wrote the following history of illness:

Dr. Speiser’s written impression was:

In addition to a recommendation for postoperative steroid coverage of Prednisone, further written recommendations by Dr. Speiser were:

The surgical procedure performed by Dr. Tucker on 5/12/93 was: incision and drainage of left wrist and mid carpal joints with incision and drainage of operative wound left wrist. The postoperative diagnosis was: septic arthritis left wrist. Another operation was performed during Dickson’s 5/12-20/93 hospitalization on or about 5/18/99. The surgical procedure performed by Dr. Tucker was an incision and drainage of soft tissue left wrist. The postoperative diagnosis was: synoval fistula or fat necrosis left wrist.

4. The medical records of Dr. Donald King, M.D. (Claimant’s Exhibit No. J) indicated that this doctor began treating Dickson following a 5-14-93 consultation during Dickson’s hospitalization in St. Joseph Hospital. In his 5-14-93 consultation report, Dr. King included the following in the history of present illness section:

After discussing physical examination and laboratory findings, Dr. King’s written impression was that he agreed with Dr. Tucker that Dickson had a septic arthritis involving his left wrist, and that the Staph could be treated directly.

Dr. King’s record indicated that he continued to treat Dickson for an infected wrist into 1994. A March 8, 1994 treatment entry noted that Dickson had an infected left wrist and complaints of ankle swelling. Dickson’s continued complaints of ankle swelling were noted in the May 17, 1994 entry. Maintenance of the left wrist infection was also noted. A treatment entry noted that the left wrist was beginning to fuse. The last treatment entry of 7-19-94 noted maintenance of wrist infection. Also written was: concerning hand, rheumatoid arthritis with septic in the past.

5. The records of Dr. James Speiser, M.D. of the Arthritis Associates, Inc. (Claimant’s Exhibit No. C) noted in a January 1, 1994 treatment entry the following history, x-ray findings and the doctor’s treatment recommendations:

Dr. Speiser noted in a 3-9-94 treatment entry that Dickson has rheumatoid arthritis and that he was just taking Naprosyn. His left wrist does feel better when he takes the Naprosyn, Dr. Speiser wrote. In the last treatment entry in Dr. Speiser’s record, dated 6/22/99, the following was included:

6. The records of Dr. Paul R. Manske, M.D. (Claimant’s Exhibit No. D) (See, also, Claimant’s Exhibit No. E – Barnes Hospital records) began with a January 17, 1995 evaluation report which noted that Dickson was referred for evaluation of swelling and purulence on the volar surface of the left wrist. The doctor noted that Dickson had had a surgical release of his left carpal tunnel in February of 1993 and had postoperatively presentation of purulence which required drainage. Subsequent treatment of the purulence was discussed by Dr. Manske. Of interest, the doctor wrote, is the patient’s history of arthritis for which he currently takes Naprosyn, and in the past he took Prednisone. Examination findings on January 17, 1995 included that Dickson had a significant wrist deformity both clinically and radiographically. For the diagnosis of acid fast microbacteria infection of the left wrist, Dr. Manske performed on February 1, 1995 the surgery of: debride wrist joint and distal radial ulnar joint, partial wound closure three drainage sites. A February 9, 1995 x-ray noted the following impressions:

In subsequent post-operative follow-ups, Dr. Manske wrote that Dickson had limited wrist motion and limited finger motion and the wrist was swollen, but there was no erythema and no tenderness. The doctor noted that x-rays showed significant loss of carpal bones and space. Dr. Manske’s record indicated that the last appointment with Dickson was on July 11, 1995.

Dr. Joseph H. Morrow, Jr., D.O., an osteopathic physician and surgeon, testified by deposition on behalf of the claimant. Dr. Morrow stated that he examined the claimant on the claimant’s behalf on January 24, 1996 concerning an injury of October 21, 1992. Medical records he reviewed were discussed by Dr. Morrow. The doctor identified the examination report he had prepared at the time of his examination of Jack Dickson (Claimant’s Deposition Exhibit 2. Ruling: Second Injury Fund’s objection to the admission of Claimant’s Deposition Exhibit 2 is overruled. Morrow Dp. pg. 9)

Dr. Morrow was given a hypothetical question from the claimant which noted that "…on or about October 21^st, 1992 while Jack Dickson was working at the Labadie Union Electric Power Plant he injured his left wrist. His work involved repetitive use of his hands and he began to get stiffness in his left wrist in October of ’92. He came under the care of Dr. Auclair…" (Morrow Dp. pp. 10-11) The hypothetical question continued with the treatment Dickson had had including that he had had a left carpal tunnel release and extensive flexor tenosynovectomy performed by Dr. Tucker on February 5, 1993 and subsequent surgeries concerning staph auerus infection. Further noted in the hypothetical was that Dickson had had bilateral wrist and hand arthritic problems treated by Dr, Auclair in 1991, and had injured his back and undergone disk removal and spinal fusion at L5-S1 in 1971 with additional treatment in September and October of 1988. Dr. Morrow was then asked his diagnosis. The doctor answered:

Dr. Morrow stated that the condition he diagnosed was causally related to Dickson’s employment at ABB Combustion. The doctor stated that he rated Dickson at 95% permanent partial disability of the left upper extremity at the level of the wrist as a result the October 1992 work injury while working for ABB Combustion. It was Dr. Morrow’s further opinion that Dickson had sustained preexisting permanent partial disability of "…25 percent of the body as a whole referenced to the prior hernia (sic) of the lumbar disk and the need for the discectomy and spinal fusion at L5-S1.." for the 1971 surgery. (Morrow Dp. pg. 15. Ruling: Second Injury Fund’s objection on grounds of hearsay, relevance, that Section 287.190.6 is not applicable in this case and Seven Day Rule upon Dr. Morrow’s opinion on preexisting disability concerning the back is overruled. Morrow Dp. pp. 15 and 16) The doctor further agreed and opined that Dickson’s preexisting permanent partial disability regarding his low back combined with his work permanent partial disability to the left wrist to provide a greater overall disability. (Ruling: Second Injury Fund’s objection on grounds of Seven Day Rule upon Dr. Morrow’s opinion on combination of disabilities is overruled. Morrow Dp. pg. 16) Dr. Morrow was asked if he had an opinion as to whether Dickson was permanently and totally disabled and the doctor testified:

On cross examination by the Second Injury Fund, the following testimony was given by Dr. Morrow concerning the work history at ABB Dickson had given him:

Dr. Morrow admitted during cross examination that he did not examine Dickson’s back when he saw him in 1996. The doctor stated that he was under the assumption that Dickson worked the normal shift as all other employees when he got injured at ABB Combustion. The following testimony then occurred about his understanding of Dickson’s ability to work with regards to his back: