Decision #26/02 - Type: Workers Compensation

Preamble

A non-oral file review was held on February 5, 2002, at the request of an advocate, acting on behalf of the claimant.

Issue

Whether or not the claimant is entitled to payment of wage loss benefits beyond April 9, 1997.

Decision

That the claimant is not entitled to payment of wage loss benefits beyond April 9, 1997.

Decision: Unanimous

Background

The claimant filed a claim with the Workers Compensation Board (WCB) on August 14, 1996, for difficulties she experienced during the course of her employment as a clerical worker. The claimant described her difficulties as follows:
    "January 1996 - started soreness in left neck shoulder area. By March 1996 wrists up to elbows were painful with pulling sensation. By July, hands were swelling and numbness in thumb with next two fingers."
Initial medical information revealed that the attending physician referred the claimant to a neurologist. The neurologist noted that the claimant's difficulties were due to a type of arthralgia and that some of her nocturnal paraesthesia may be related to a mild carpal tunnel syndrome (CTS), although she had complaints that were not consistent with this condition. EMG and nerve conduction studies were later found to be normal.

On August 13, 1996, the attending physician completed a CTS medical questionnaire, which indicated that the claimant had tennis elbow in view of the normal EMG studies. On August 20, 1996, a physiotherapy referral form noted that the claimant had bilateral lateral epicondylitis.

In a progress report of September 3, 1996, the attending physician documented that the claimant had secondary depression. Examination findings revealed that the claimant was tender over the lateral epicondyles bilaterally. Range of motion showed a slight decrease in flexion at both elbows.

Arrangements were made, through the attending physician, for the claimant to attend the Pain Clinic. A report from the Pain Clinic dated October 18, 1996 noted that the claimant had developed fibromyalgia.

On October 10, 1996, a WCB medical advisor assessed the claimant to determine her current status and functional capabilities. The medical advisor concluded his examination report with the following commentary:
    "I agree that the claimant's symptoms are compatible with a diagnosis of fibromyalgia. She displays multiple tender points throughout all four quadrants of her body. Due to the claimant's present degree of irritability it is difficult to determine if there are underlying myofascial trigger points which may be related to her workplace incident. Therefore, I will arrange for [doctor's name], a physical medicine specialist and consultant to the WCB, to assess the claimant. In the interim the claimant should continue her exercise regime and Manerix as a treatment for her depression."
A WCB physical medicine and rehabilitation consultant (physiatrist) assessed the claimant on November 12, 1996.

In a memo dated December 11, 1996, primary adjudication asked the WCB physiatrist to review his examination findings of November 12, 1996 along with the claimant's blood test results and to respond to several questions regarding the claimant's condition. His responses were as follows:
  • the claimant had likely recovered from the effects of her compensable injury which was diagnosed as bilateral tennis elbow.

  • the claimant's fibromyalgia syndrome was not likely related to the compensable injury.

  • the consultant agreed with the specialist from the Pain Clinic that the claimant should be assessed by a WCB psychologist to address questions regarding her depression.
A WCB psychologist interviewed the claimant on March 12, 1997, and expressed the following opinion:
    "Her Affective Disorder has resulted from a range of events set in motion by the physical symptomatology with the experience within the workplace as, in her description, at high workplace demands, the absence of rest periods, the maintenance of a single posture during data entry, and that with the physical symptomatology this led in turn to sleep disturbance and affective symptoms, with subsequent worsening of symptoms.

    While there is no direct or one-to-one relationship between mood disturbance onset and any specific event, there is some chain of causation here, with the mood disturbance being related to the symptomatology that arose in the workplace and the workplace stressors."
In a letter dated April 2, 1997, primary adjudication rendered the following decision:
  • after reviewing the examination notes of the WCB psychologist, primary adjudication concluded that the claimant was suffering from depression due to workplace stressors and that stress not caused by an acute reaction to a traumatic event, was not covered by the WCB;

  • the claimant had essentially recovered from her compensable injury based on the examination notes of the three WCB medical advisors and the reports received from her attending physician. Wage loss compensation would be paid to April 9, 1997 inclusive and final.

  • as the claimant's depression would be a factor preventing her from successfully returning to the work environment. Sessions with a psychologist would be arranged.
On October 2, 1997, a worker advisor submitted new medical information received from an independent physiatrist dated August 11, 1997, and requested primary adjudication to reconsider its decision to deny wage loss benefits beyond April 9, 1997. The worker advisor pointed out the independent physiatrist's opinion that the claimant was suffering from myofascial pain syndrome and not fibromyalgia.

Following consultation with a WCB medical advisor on December 3, 1997, primary adjudication responded to the worker advisor's appeal on January 21, 1998. It noted that two WCB physicians and an outside consultant had diagnosed the claimant with fibromyalgia and that it was not until nine months later when she was diagnosed with myofascial pain syndrome by the independent physiatrist. Primary adjudication acknowledged that the claimant may be suffering from another medical ailment but it was unrelated to the compensable injury as there were different findings from the time of the WCB examinations and that of the independent physiatrist. On June 2, 1998, an advocate for the claimant appealed the decision and the case was referred to Review Office.

On July 24, 1998, Review Office determined that no responsibility could be accepted for the claimant's myofascial pain syndrome, her fibromyalgia condition or for clinical depression as these conditions were considered unrelated to the claimant's workplace activities.

Review Office accepted the diagnosis of fibromyalgia and clinical depression as these two diagnoses had been made by the physician at the Pain Clinic and confirmed by the two WCB medical advisors who examined the claimant on October 30, 1996 and November 12, 1996. Review Office indicated that since the findings of the physiatrist varied from the findings of the physicians who examined the claimant on previous occasions, no other conclusion could be drawn other than the symptoms described by the physiatrist were unrelated to the claimant's work activities and to the injury for which she had received wage loss benefits. It was therefore decided that the claimant was not entitled to payment of wage loss benefits beyond April 9, 1997.

On December 11, 2001, an appeal form was received from the claimant's advocate in regards to Review Office's decision together with additional medical information prepared by a Rheumatologist and Epidomiologist dated October 5, 2001 and September 24, 2001. On February 5, 2002 a non-oral file review was held.

Reasons

As the background notes indicate, the claimant contends that she is entitled to the payment of wage loss benefits beyond April 9th, 1997. In support of this contention, the claimant relies on opinions provided by two physicians subsequent to the termination of her benefits by the WCB.

On July 23rd, 1997, a rehabilitation medicine specialist carried out an independent medical evaluation of the claimant. The specialist prepared a lengthy 9-page report, in which she recorded the following comments:
    "Finally the findings of taut bands, tender trigger points, local twitch responses and referred pain symptoms elicited by irritating trigger points are not present in fibromyalgia and are pathognomonic of myofascial pain syndrome. Therefore, she definitely has myofascial pain syndrome in muscles documented in my physical exam. She does not currently have fibromyalgia and I do not feel that fibromyalgia has ever been a reason for her initial or-ongoing pain complaints, muscle dysfunction or disability." (Emphasis ours)
A physician specializing in rheumatology and epidemiology examined the claimant on September 24th, 2001. In part, his impression was as follows:
    "This woman initially appears to have had a (sic) repetitive strain injuries to both upper extremities which subsequently became more chronic generalized musculoskeletal pain and now meets the full criteria for fibromyalgia. I believe the fibromyalgia is her primary problem at this time. She has panic attacks and depression which are being appropriately treated." (Emphasis ours)
In contrast to the foregoing medical opinions, we note that the working diagnosis accepted by the WCB with respect to the claimant's injury was bilateral epicondylitis of the elbows (tennis elbow). We accept the WCB medical advisor's opinion that this condition had resolved by the time the claimant's benefits were terminated. The diagnosis of myofascial pain syndrome did not make an appearance in the claimant's medical history until approximately one year subsequent to the compensable injury. In addition, we note that previous examinations by the treating physician and the WCB medical consultants have ruled out a diagnosis of myofascial pain syndrome. We are, therefore, of the view that this condition is not, on a balance of probabilities, causally related to the compensable injury.

The medical evidence is less than convincing whether or not the claimant does in fact have fibromyalgia syndrome. We accept the WCB's physical medicine and rehabilitation consultant's opinion that this condition is "not likely related" to the claimant's compensable injury. If, however, it can be confirmed that the claimant does have fibromyalgia syndrome, then we find based on the weight of evidence that such condition did not, on a balance of probabilities, arise out of or in the course of her employment. We note that the claimant is currently being treated for psychological difficulties, which in our view also have no relationship to the original compensable injury.

After thoroughly reviewing and considering all of the evidence, we find that the claimant is not entitled to payment of wage loss benefits beyond April 9th, 1997. Accordingly, the claimant's appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

R. W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 25th day of February, 2002

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