The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on March 15, 2001, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on March 15, 2001.

Issue

Whether or not responsibility should be accepted for the claimant's right wrist ganglion.

Decision

That responsibility should be accepted for the claimant's right wrist ganglion.

Background

On March 10, 2000, the claimant submitted a claim for compensation benefits describing her injury as follows:

"Sometime around mid Nov. 1999 - I strained my R wrist due to daily work routine. It goes on & off - the pain sometimes goes away. Around mid January 2000 my R wrist was swollen for days and the pain stayed for weeks. Due to repetitive strenuous work my wrist was not getting any better. My left wrist is now affected and now both wrists are injured."

The claimant reported her injuries to the employer on February 17, 2000, and her last day at work was March 8, 2000.

The Employer's Report of Injury form dated March 1, 2000, indicated the following:

"We wish to protest - The worker claims her work duties have caused her condition. She has been performing same job for over 5 years. There has been no changes in duties or hours and I find it difficult to believe that now all of a sudden she claims her work duties is the cause. For these reasons we protest this claim - no specific accident."

On February 17, 2000, the attending physician noted a small mass to the dorsum of the claimant's right wrist and tenderness over the lateral epicondylitis. The differential diagnosis were query tendonitis to the wrist, query lateral epicondylitis and mass to the wrist. The physician was of the view that both conditions were related to over use syndrome as a direct result of work. In a report dated April 12, 2000, the attending physician noted a ganglion to the dorsum of the wrist which was slightly tender.

In April 2000, the claimant was referred to a second physician for assessment. He noted that the claimant presented with a history of a nodule on the right wrist along with pain at the base of both thumbs, especially severe when she tried to do any fine work. He summarized that the claimant had a ganglion of the right wrist as well as possible osteoarthritic changes of the thumbs.

On May 24, 2000, a Workers Compensation Board (WCB) medical advisor was asked to provide his opinion with respect to a diagnosis and its relationship to the compensable injury. Following review of the case together with a description of the claimant's job duties, the medical advisor diagnosed the claimant with early osteoarthritis to both thumbs and a right wrist ganglion, which he felt could not be related to the claimant's work activities.

The case was again reviewed by the above medical advisor on March 30, 2000, in conjunction with the WCB's policy on ganglia. It was noted that the WCB pursuant to the policy accepted highly repetitive movement especially when a weight was involved. The medical advisor did not feel that the claimant's work duties were highly repetitive considering there were a variety of movements/activities involved, unlike an assembly line type of work.

On June 15, 2000, primary adjudication advised the claimant that the WCB was accepting responsibility for time loss as well as medical treatment related to her wrist difficulties, which had been diagnosed as tendonitis. No responsibility would be accepted, however, in relation to her ganglion condition or the difficulties with her thumbs as there was no evidence to support that these conditions were related to her work activities.

On September 6th and October 6, 2000, the claimant's union representative appealed primary adjudication's decision of June 15, 2000. The union representative was of the position that the claimant's work demands were very similar to assembly line work. She stated that the attending physicians had supported a history of repetitive work in providing their diagnoses of tendonitis, lateral epicondylitis and the small mass to the dorsum of the right wrist. The union representative noted that the attending physician's report of February 17, 2000, related both conditions to overuse syndrome as a direct result of the claimant's work. The mass in the right wrist therefore arose out of the repetitive work and was acceptable, in accordance with WCB policy 44.10.20.20, Adjudication & Compensation of Ganglia.

Prior to considering the appeal, Review Office sought the advice of a WCB orthopaedic consultant. In a memo dated October 17, 2000, the orthopaedic consultant stated, "I do not think it has been established that a ganglion arising from the right wrist occurred as a result of her work. Number 1 and 2 of the policy statement [ganglion policy] have not occurred. It is noted that initial wrist problems were bilateral. It could still be related to OA [osteoarthritis] (early) with normal x-rays or can be idiopathic (common)."

On October 20, 2000, Review Office confirmed that no responsibility would be accepted for the claimant's right wrist ganglion. Review Office took into consideration the WCB's policy concerning ganglia and noted that no accident had been established involving a blow to the worker's right wrist. The compensability of the worker's ganglion was therefore predicated on medical opinion establishing a relationship between her work activities and the development of a ganglion. Based on the comments expressed by a WCB medical advisor and those of a WCB orthopaedic consultant, Review Office concluded that it had not been presented with any medical opinion contending a relationship existed between the development of a ganglion and the claimant's work activities. On November 29, 2000, the union representative appealed Review Office's decision and an oral hearing was then 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

(a) A wilful and intentional act that is not the act of the worker,

(b) any

(i) event arising out of, and in the course of, employment, or

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

(c) an occupational disease and as a result of which a worker is injured.”

According to the attending physician’s patient chart notes of February 17^th, 2000, the claimant had been experiencing pain to the dorsum of her right wrist for approximately four months. He detected a noticeable small tender mass or ganglion on the dorsum of the right wrist. This ganglion was causing sufficient pain to the claimant that she found it necessary to wear a splint while performing her job duties.

The attending physician referred the claimant to a specialist for a second opinion. The specialist reported the following: “On examination of the patient’s wrist, she has a ganglion on the dorsum of the right. The mass is mobile and 1.5 ´ 1.5 cm in size. It also varies in size due to the connection with the wrist itself.”

A ganglion is medically defined as a “cystic tumor developing on a tendon or aponeurosis; sometimes occurs on the back of the wrist.” The WCB has instituted a specific policy (44.10.20.20) that deals with the adjudication and compensation of ganglia. This policy states as follows:

“The Board will accept a claim for a medically diagnosed ganglion where it is probable that the condition was caused or aggravated by an accident arising out of and in the course of employment. Where there is a medical diagnosis of a ganglion, the following shall be used as criteria for acceptance:

1. A history of prolonged, highly repetitive movement of the area affected, usually the wrist, particularly if a weight is involved; or

2. A well established accident involving a blow to the area where the ganglion later appears.

3. Medical opinion indicates that the ganglion is a result of work-related activity or injury.”

A medical advisor to the WCB offered his opinion with respect to the claimant’s condition on May 30^th, 2000. He did not think the ganglion could be related to the claimant’s work duties. This conclusion was largely based on his impression that her work was not highly repetitive “…considering there are a variety of movements/activities involved unlike an assembly line type of work.”

A WCB orthopaedic consultant also felt it had not been established that the claimant’s right wrist ganglion occurred as a result of her work. In a memorandum to file dated October 17^th, 2000, he stated in part: “#1 & #2 of the policy statement have not occurred.”

It is difficult for us to know for sure, but it certainly would appear from the language used by this physician that he regards criterion #1 and #2 of the policy must be both applicable before a ganglia claim can be accepted. It should be pointed out, however, that criterion #1 is expressed in the alternative (ie.“or”) to criterion #2 and #3.

The claimant gave evidence at the hearing with respect to her job duties. We are satisfied that these duties were repetitive in nature and involved the lifting and carrying of weights ranging anywhere from 8 to 30 pounds. The claimant would regularly climb up and down a short ladder while holding large trays of product with both hands.

We are satisfied based on the weight of evidence that the claimant’s ganglion condition was, on a balance of probabilities, either caused or aggravated by an accident arising out of and in the course of her employment. We find that the claimant’s case falls squarely within criterion #1 of WCB policy 44.10.20.20. Accordingly, the claim for the worker’s right wrist ganglion is 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 24th day of April, 2001