Decision #03/00 - Type: Workers Compensation
A Non-Oral File Review was held on January 11, 2000, at the request of the employer.
Whether or not a Medical Review Panel should be convened.
That a Medical Review Panel should be convened.
In September 1997 the claimant submitted an application for right and left hand/wrist difficulties, which he related to his employment activities as a mail services courier.
On August 26, 1997, the employer advised that the claimant was right hand dominant and that he performed a variety of duties, none of which would be performed over an extended period of time. It was the employer's position that the claimant's work duties did not expose his wrists to excessive forces, direct pressures, gripping or positioning at maximum angles. The employer firmly believed that the claimant's condition did not arise out of and in the course of employment.
Medical documentation consisted of the following reports:
- A Doctor's First Report, dated June 30, 1997, noted a diagnosis of bilateral carpal tunnel syndrome (CTS). Under "Workers History of Injury", the physician indicated that the claimant never missed work but noted numbness at work in 1995. Job duties listed were lifting parcels and driving.
- Nerve Conduction Studies (NCS) performed on May 12, 1997 revealed severe bilateral CTS.
- In a letter, dated July 18, 1997, a neurologist reported that the claimant was seen on April 4, 1997. The claimant advised that he had been well until about 10 days ago when he noticed his right middle finger was swollen. He could not bend the finger. The claimant was treated with NSAID with some improvement. A couple of days later his right shoulder became sore and he could not lift it. The claimant stated his mother had arthritis. He also advised the physician that his hands seemed to go to asleep and that this symptom had been present for several years.
- The neurologist's impression was that the claimant had a migratory polyarthralgia-polyarthritis of unknown cause. The neurologist indicated, "I felt that he also had bilateral carpal tunnel syndrome ."
- A report from the Hand Clinic, dated September 15, 1997, indicated that arrangements were being made for the claimant to undergo carpal tunnel release on the right hand.
At the request of primary adjudication, a Workers Compensation Board (WCB) medical advisor reviewed the case on October 9, 1997. In response to questions posed by primary adjudication, the medical advisor indicated the following:
- that the claimant likely developed classic CTS.
- in addition to CTS, the claimant possibly had migratory polyarthralgia.
- the claimant's job duties did not cause the development of bilateral CTS.
- the CTS condition could possibly be attributed to a condition of migratory polyarthralgia.
In a letter to the claimant, dated November 7, 1997, primary adjudication was of the opinion that the claim for compensation was not acceptable. This decision was based on Sections 4(1) and 1(1) of the Workers Compensation Act (the Act). This decision was appealed by the claimant's union representative on December 22, 1997.
On January 29, 1998, the case was reviewed once again by a WCB medical advisor in response to the union representative's appeal. In brief, the medical advisor indicated that "the diagnosis of carpal tunnel syndrome through nerve conduction studies does not establish causation; history and collateral information need to be reviewed in order to establish a relationship, and it is my view that this is not satisfied in this situation. There is sufficient information on file to suggest that there are other symptomatology and signs found on examination which cannot be explained on the basis of the workplace duties." A copy of the medical advisor's comments/memo was forwarded to the union representative for information. On February 18, 1998, primary adjudication confirmed that the claim for compensation was not acceptable.
In a letter, dated June 1, 1998, the union representative submitted additional medical information to primary adjudication. Specifically, a report prepared on February 22, 1998, from a rheumatologist and from the family physician, dated April 22, 1998. The union representative requested the convening of a Medical Review Panel (MRP) pursuant to section 67(4) of the Workers Compensation Act (the Act). The union representative asked that the MRP address the issue of "diagnosis and relevancy of migratory polyarthralgia-polyarthritis, the issue of osteoarthritis of the hands, the impact of extra-curricular activities versus the physical requirements of work in the development of CTS, the involvement of systemic medical conditions and the development of CTS."
On July 16, 1999, a job site assessment was carried out and videotape was taken of the claimant's job duties.
On July 29, 1999, the case was reviewed by a WCB medical advisor along with the videotape. In response to questions posed by primary adjudication, the medical advisor indicated the following:
- nerve conduction studies, dated May 12, 1997, suggest severe CTS. These could be repeated now at 2 years for reassessment and confirmation.
- job description and videotape were reviewed. The claimant apparently spends 20 minutes on sortation. The remainder of time involves collection and delivery by motor vehicle. The heavy lifting would not be performed for prolonged time according to information on file (August 26, 1997) correspondence. The medical advisor stated his view that significant vibration would not result from the steering wheel. All activities and duration considered, it was not his view there was a very strong strength of association.
On August 6, 1999, the supervisor from Rehabilitation & Compensation Services wrote to the union representative. In brief, the supervisor indicated that the diagnosis of bilateral CTS had been confirmed. Based on review of the claimant's job duties and videotape it was determined that there was no evidence that the claimant's bilateral CTS was caused by his job activities.
With respect to the convening of an MRP, it was felt that an MRP was not warranted as the diagnosis of CTS had been established and the diagnosis of polyarthralgia-polyarthritis was no longer an issue. The claimant's job duties not being a factor in the development of bilateral CTS was also a factor in making the decision not to convene an MRP.
On September 24, 1999, the Review Office determined that an MRP should be convened. Review Office indicated that the videotape of the claimant's job was reviewed by the WCB orthopaedic consultant to Review Office. The consultant was of the opinion that the videotape along with the job description on file would not promote the development of bilateral CTS. Review Office acknowledged that the claim had multiple WCB physicians providing an opinion that they did not feel the claimant's job duties would provide a source of development for severe bilateral CTS. Review Office quoted the following excerpt from a letter the claimant's physician wrote to the union representative, "To conclude, Mr. [the claimant] does not have osteoarthritis of his hands. He does not have polyarthritis as proven by negative findings and also complete examination by Dr. [the rheumatologist] and myself. He does have Carpal Tunnel Syndrome of a severe nature, both on clinical examination, as well as Nerve Conduction Studies, which I believe to be related to his repetitive work. I don't see any other logical or medical etiology at this point that could account for his Carpal Tunnel Syndrome, except for damage and harm done in the work place."
Review Office concluded there was definitely a difference in medical opinion and that the criteria set out in Section 67(4) had been met. Thus, a MRP was to be convened.
Following Review Office's decision, the employer requested a non-oral file review as it was of the position that a difference of medical opinion consisting of the full statement of facts and reasons with respect to a medical conclusion did not exist on the claim. A non-oral review was then arranged for January 11, 2000.
Section 67(4) of the Act allows a worker to request the convening of a medical review panel where the opinion of a WCB medical officer differs from that of the worker's physician with respect to a medical matter affecting the worker's entitlement to compensation. We unanimously agree with Review Office that such a situation does exist in the present case and therefore a medical review panel should be convened. Accordingly, the employer's appeal is hereby dismissed.
R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
B. Leake, Commissioner
Recording Secretary, B. Miller
R. W. MacNeil - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 17th day of January, 2000