Public Decisions | The Appeal Commission

Decision #73/00 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on June 28, 2000, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on June 28, 2000.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable.

Background

In October 1992 the claimant filed an application for compensation benefits indicating that he had developed poor circulation in both of his hands due to the cold temperatures working in a freezer.

On October 3, 1999, the employer contended that if the claimant had problems with his hands it was due to self inflicted behavior by not wearing his special mitts when in the freezer area. The employer believed there was no basis of proof that an injury occurred on the company's premises.

On October 13, 1999, the Workers Compensation Board (WCB) sent the claimant a questionnaire in order to obtain additional information regarding his claim. In response to the questionnaire, the claimant indicated the following:

he experienced numbness, pain and tingling in his fingers and sometimes the palms of both his hands. The claimant indicated that his fingers turn white between the knuckles and that temperature greatly affects his hands. His employer had restricted him to working in the freezer department and he was exposed to sub-zero temperatures on a daily basis.
the duties performed in the freezer involved picking orders and repacking partial cases or "splits". All dairy products must be placed in dry ice to prevent thawing upon delivery. Numbness sets in first. When coming out of the freezer for breaks, the claimant indicated that the numbness subsides resulting in a tingling feeling similar to that of having your foot fall asleep, though not as intense. When feeling is restored, a burning sensation is felt throughout the affected fingers. The numbness remains until he has an opportunity to warm up. The pain can last the remainder of the day.

A doctor's first report dated October 1, 1999, diagnosed the claimant's condition as Raynaud's phenomena. Restrictions were outlined for the claimant to avoid cold environments.

On November 21, 1999, a vascular medicine specialist indicated that the claimant gave a work history that was consistent with Raynaud's phenomenon which developed in 1998. Additional circulatory studies were arranged and the specialist commented, in part, "If there is no evidence of an underlying condition to which Raynaud's phenomenon would be secondary, then it is possible that his vasospastic disorder may be related to his work. It certainly would be aggravated by it and I do not think that he should be working in a cold environment."

File documentation also contained correspondence submitted by the employer from the claimant's personnel file. In addition, statements were also obtained from the claimant and from the employer.

In a follow up report dated December 2, 1999, the vascular medicine specialist outlined the claimant's test results as follows:

x-rays of the chest were negative and there were no cervical ribs.
the peripheral vascular function studies revealed no evidence of organic obstruction and the vessels were able to provide good blood flow to the skin of the fingertips when the patient is warm. The claimant did not demonstrate evidence of cold sensitivity. It was noted that the test gave 20% of false negative results. The fact that the claimant had not worked in the cold environment may have contributed to the result.
the blood work results (CBC and platelet count, TSH, rheumatoid and nuclear antibody) showed either negative or within normal limits.

The specialist concluded his report by stating, "It is quite likely that his problems are related to him having worked in a very cold environment and handled frozen foods. The reasons for this opinion is that such conditions are considered to be compensable in Minnesota and because they have been reported in people who work under those conditions."

The medical reports on file were reviewed by the WCB's internal medicine consultant on January 11, 2000. In response to questions posed by primary adjudication, the consultant indicated the following:

the medical evidence suggested some vascular problem in the hand, which was diagnosed as Raynaud's phenomena. There is, however, no confirmation by objective method.
since the diagnosis was not confirmed by objective method, the WCB's consultant indicated that he was unable to offer a diagnosis and its cause. He noted that the claimant was a smoker and that many people develop symptoms of numbness and cold on exposure to cold weather. Raynaud's phenomena was clinically manifested by sequential development of digital blanching, cyanosis, and erythema of the fingers or toes, followed by cold exposure and subsequent rewarming. The sequential development of symptoms were not noted in the symptoms reported by either of the doctors.
if the claimant suffered from Raynaud's disease, exposure to cold can precipitate an episode.
wearing good thermal gloves would avoid recurrences of the episodes.

On January 18, 2000, the claimant was informed by the WCB that his claim for compensation was denied as a relationship could not be established between his condition and an accident at work. This decision was appealed by the claimant's union representative on February 9, 2000.

Prior to considering the case, Review Office referred the case to the WCB's internal medicine consultant for a review of the union representative's submission and to provide his opinion with respect to the claim. On March 15, 2000, the WCB's consultant responded as follows:

a typical attack of Raynaud's phenomena consisted of sudden onset of cold fingers or toes in association with sharp demarcation of color changes, either skin pallor or cyanotic skin. On re-warming, the skin blushes, meaning it turns red in 15 to 20 minutes. The attack begins usually in a single finger and then spreads to the other fingers of both hands. This may be associated with pins and needles sensation, numbness or clumsiness of the hand. The symptoms are completely reversible on re-warming. Neither doctor's noted on file obtained this typical history. It appeared from the worker's advocate's statement that when the claimant went out of the building, his hands turned white within five minutes.
as noted earlier, there was no confirmation from the tests done by the specialist. There was no cold induced vasospasm and there was no evidence of obstruction. The statement made by the claimant on November 26, 1999, only mentioned numbness and some temperature changes. The consultant therefore concluded that the history was not typical of Raynaud's phenomena.
the consultant suggested that the claimant seek medical attention from a neurologist and to undergo nerve conduction studies to rule out carpal tunnel syndrome or perineural neuropathy.

On March 31, 2000, Review Office determined that the claim was not acceptable and that the claimant was not entitled to the payment of wage loss benefits. Review Office based its decision on the medical reports that were submitted by the claimant's physician and vascular specialist as well as the opinions expressed by the WCB's internal medicine consultant. Review Office was of the view that it had not been established that the claimant had Raynaud's Phenomena and it was uncertain as to what was the exact diagnosis. There was also difficulty in establishing that the claimant had sustained an accident as defined by the Workers Compensation legislation.

On April 17, 2000, the union representative appealed Review Office's decision and an oral hearing was convened.

Reasons

Section 4(1) of The Workers Compensation Act (the Act) provides for the payment of compensation benefits to a worker where he or she sustains personal injury by accident arising out of and in the course of employment. "Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment is caused to a worker, compensation as provided by this part shall be paid by the board out of the accident fund, subject to the following subsections." In accordance with this section, the Panel must, initially, be satisfied that there has been an accident within the meaning of Section 1(1) of the Act. That is, "a chance event occasioned by a physical or natural cause; and includes

(b) any

(ii) thing that is done and the doing of which arises out of, and in the course of, employment, and

and as a result of which a worker is injured."

A vascular medicine specialist conducted a series of investigations (peripheral vascular function studies) in an attempt to diagnose the claimant's condition. The specialist reported to the treating physician on December 2nd, 1999:

"There is no evidence of organic obstruction and the vessels are able to provide good blood flow to the skin of the fingertips when the patient is warm. He did not demonstrate evidence of cold sensitivity. However, note that this test gives 20% false negative results. Also, the fact that the patient has not worked in the cold environment may have contributed to this result. It is quite likely that his problems are related to him (sic) having worked in a very cold environment and handled (sic) frozen foods." (Emphasis ours)

In arriving at our decision, we also considered certain comments of the WCB's internal medicine consultant, which are contained in a memorandum dated March 15th, 2000. He stated in part:

"Approximately 15% of the male population suffer from primary Raynaud's phenomena and the episodes can be brought on by exposure to cold air. This brings in the question of a pre-existing problem made worse by exposure to the cold environment in the freezer. The attacks could be minimized or prevented by wearing warm clothing, as well as thermal mitts."

The claimant testified at the hearing that he was provided thin leather mitts with cotton liners.

We attached considerable weight to the fact that the tests conducted by the specialist, although not conclusive in confirming a definite diagnosis, nevertheless had a 20% false negative component. We have no difficulty in concluding that the claimant has a predisposition to a condition suspiciously similar to that of Raynaud's phenomenon or whitehands disease. We find based on the weight of evidence that the claimant's hand problems are, on a balance of probabilities, causally related to his cold working environment. Accordingly, we further find the claim to be acceptable.

Panel Members

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 26th day of July, 2000

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