Decision #27/01 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on November 8, 2000, at the request of the claimant. The Panel discussed this appeal on November 8, 2000 and January 24, 2001.

Issue

Whether or not the problems incurred by the claimant beyond June 22, 1999 are related to the compensable injuries sustained on May 8, 1999.

Decision

That the problems incurred by the claimant beyond June 22, 1999 are related to the compensable injuries sustained on May 8, 1999.

Background

The claimant filed an application for compensation benefits on May 21, 1999, claiming that the problems she experienced with both wrists and thumbs were due to the nature of her employment activities as a cashier/file clerk.

In a letter attached with the application for benefits, the claimant indicated that she had been working with the accident employer for 11 years and that the problems with her elbows, thumbs and wrists became progressively worse. The claimant indicated that she had been treated for symptomatic polyarthritis and that her family felt that her problems were related to a repetitive strain injury.

A doctor's first report dated May 10, 1999, indicated that the claimant had pain in both hands and elbows which were aggravated by the repetitive grabbing of products. The diagnosis rendered was tendonitis of both hands and elbows.

On June 21, 1999, a WCB medical advisor reviewed the case. The medical advisor accepted the fact that repetitive work could cause difficulty in an arthritic patient, however, the aggravation would be short-lived. The medical advisor suggested 4-6 weeks for recovery and that any ongoing difficulties would be attributed to the claimant's pre-existing polyarthritis.

In a letter of August 10, 1999, the treating rheumatologist reported that the claimant had sero negative (RF negative) polyarthritis which was diagnosed pre 1997. Other examinations of the claimant revealed the following:

  • on June 13, 1997, the claimant complained of headaches attributed to her left TMJ (tempomandibular joint). An MRI revealed anteriorly displaced discs. The claimant's headaches were relieved with xylocaine injection into the left TMJ.
  • on February 26, 1998, the claimant complained of 2 hours of morning stiffness in spite of her medication. Examination revealed joint inflammation in the wrists and her right knee. The claimant had epicondular pain and right, more than left, thumb extensor tendon pain.
  • when seen on March 5, 1998, joint inflammation was noted to be much better with only residual right thumb extensor tendon pain.
  • on July 19, 1999, the claimant's left wrist appeared swollen. The examination was dominated by positive Finklestein's test to the thumbs, tendons, and crepitus in the forearm extensor tendons. The claimant had no evidence of epicondular pain and no decrease in shoulder range of movement. The claimant was not on any anti-rheumatic medication at this time.

A bone scan report dated August 17, 1999 indicated that any abnormalities in the wrists and thumbs were considered to be non-specific in nature.

In a decision dated October 21, 1999, Rehabilitation & Compensation Services determined that the claimant had a pre-existing condition which was aggravated by her work duties and that the aggravation would resolve within 4 to 6 weeks. Compensation benefits would be paid for the period May 12 to June 22, 1999, inclusive and final.

Following receipt and review of additional medical information, Rehabilitation and Compensation Services noted on February 7, 2000, that the claimant's range of motion in her wrists were full and that there was resolved swelling of the right thumb extensor tendonitis and in the elbows a lateral epicondylitis. The diagnosis rendered by the attending physician was resolved strain of both wrists. The adjudicator determined that the claimant's current disability was the result of an underlying or pre-existing condition, the progression of which was not enhanced or accelerated by the accident at work. The adjudicator concluded that the WCB would not accept responsibility for any time loss or medical treatment subsequent to June 1999. This decision was later appealed by the claimant and her union representative to Review Office.

On April 28, 2000, Review Office determined that the problems incurred by the claimant beyond June 22, 1999 were not related to the compensable injuries sustained on May 8, 1999. Review Office stated that the claim had been accepted as a temporary aggravation of a pre-existing condition and it was anticipated that the aggravation would resolve within 4 to 6 weeks. Review Office noted that the claim for injuries sustained on May 8, 1999 was for right and left wrists and thumb. The claimant had a pre-existing history of polyarthritis of at least 10 years duration. Review Office made reference to the specialist's findings in a report dated August 10, 1999 and concluded that no further responsibility would be accepted in connection with this case. On June 15, 2000, the union representative appealed Review Office's decision and an oral hearing was convened.

Following an oral hearing which took place on November 8, 2000, the Panel requested additional medical information be obtained prior to rendering a final decision. On January 2, 2001, all parties were provided with copies of the various medical documentation that the Panel received and were invited to provide final comments. On January 24, 2001, the Panel met again to discuss the case and considered all file documentation including a letter from the employer's advocate dated January 5, 2001.

Reasons

The claimant's compensable injury was diagnosed as bilateral tendinitis of the hands and elbows. In addition to this condition, the evidence also confirms that the claimant had a medical history of pre-existing polyarthritis. It should be noted that the anatomical sites of the claimant's tendinitis are the same as those affected by her arthritis. We find that the activities performed by the claimant subsequent to her compensable injury have, on a balance of probabilities, resulted in an aggravation of her pre-existing condition and/or a recurrence of her compensable tendinitis. In our view, the work duties that aggravated the claimant's tendinitis could equally cause a pre-existing arthritic condition to become symptomatic.

In arriving at our decision, we attached considerable weight to the evidence submitted to the WCB by the claimant's treating rheumatologist. Specifically, the specialist advised in his letter of March 23rd, 2000 that the forms of treatment administered to the claimant were directed towards the resolution of job-related soft tissue pain and not inflammatory joint arthritis.

    "The examination findings on February 10, 2000 are even more convincing for job related soft tissue pain and not inflammatory joint arthritis. She told me that since her assignment to light duties in the filing department in May 1999, her Tylenol requirements have been nil. (She told me that past rigorous work at the check stand she consumed 3-6 Tylenol #3 per day.

    Furthermore, Ms. [the claimant] had stopped her prednisone/methotrexate in July 1999. Thus by February 10, 2000 there was ample time for joint inflammation to declare itself and to be detectable by examining [the claimant].

    Instead, on February 10, 2000 as on July 19, 1999, the examination revealed soft tissue pains, forearm muscle belly tenderness, swollen left wrist extensor tendon, positive Bunnell's test for tight hand tendons, positive Finkelstein's test for tight sore thumb extensor tendons. The normal ESR of late reassured one that occult joint inflammation was unlikely to be present.

    Therefore, it is my conclusion upon repeatedly reviewing Ms. [the claimant's] symptoms, examination findings and laboratory tests, that from February 1999 onward, soft tissue pain, not arthritis, was and still is present."

Prior to making our decision, we requested an update from the treating physician with respect to the claimant's current medical status. In a letter dated December 20th, 2000 she responded, in part, as follows:

    "This patient's current diagnosis: resolved strain right and left hand, right and left wrist and right and left elbow epicondylitis. There has been persistence of right thumb extensor tenosynovitis of mild to moderate degree. It's quite obvious that her symptoms settled when off repetitive, heavy manual work."

After having taken into consideration all of the evidence, we are satisfied that the problems incurred by the claimant beyond June 22, 1999 are, on a balance of probabilities, related to the compensable injuries sustained on May 8, 1999. Accordingly, the claimant's appeal is hereby allowed.

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 15th day of February, 2001

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