Decision #45/02 - Type: Workers Compensation

Preamble

A non-oral file review was held on March 12, 2002, at the request of a worker advisor, acting on behalf of the claimant.

Issue

Whether or not the claimant's right rotator cuff injury is related to the compensable injury of November 13, 1974; and

Whether or not the WCB should accept responsibility for the September 11, 2001 right shoulder surgery.

Decision

That the claimant's right rotator cuff injury is not related to the compensable injury of November 13, 1974; and

That the WCB should not accept responsibility for the September 11, 2001 right shoulder surgery.

Decision: Unanimous

Background

While performing the duties of a gravel crush operator on November 13, 1974, the claimant caught his right hand between a belt and a pulley which resulted in a crushed hand and a pulled right shoulder. Subsequent examinations revealed that the claimant sustained a brachial plexus injury to his right shoulder. The Workers Compensation Board (WCB) accepted the claim and benefits were paid to December 1, 1975 when it was determined that the claimant had recovered from the effects of his injury.

In April 1978, the claimant wrote to the WCB to advise that his right arm has not gotten any better and that time has not improved his condition. The claimant was requesting that his case be re-opened for further consideration.

Following receipt of additional medical information and a statement from the claimant, the WCB determined on July 28, 1978 that his current right shoulder condition was not in any way related to the 1974 compensable accident.

In July 2001 the claimant wrote to the WCB again, asking that his claim be re-opened as he was booked for rotator cuff surgery.

On September 20, 2001, a WCB adjudicator contacted the claimant. The claimant stated that he was retired, that he had always had problems with his shoulder and that one year ago the pain was so bad he couldn't sleep. The claimant advised that he does no outside activities as he lives in a condo and does not garden, shovel snow or cut grass. The claimant was claiming for medications, the surgery and post-operative physiotherapy treatments.

In view of the above, primary adjudication obtained medical reports from the attending physician dated April 18, 2001 and May 11, 2001. On May 11th, the attending physician indicated that an arthrogram showed evidence of an old complete rotator cuff tear and that the claimant was being referred to an orthopaedic surgeon, who specialized in shoulder injuries.

On June 26, 2001, the orthopaedic surgeon noted that the claimant was seen regarding his right shoulder. Following examination and review of x-rays, the surgeon's impression was that the claimant had a "large full thickness right shoulder cuff tear. This is likely an acute on chronic event with an acute tear of about 6-7 months ago with a history of chronic impairment syndrome for many years. There may have been previous injury in 1974 that has contributed." Recommendations were made for an open acromioplasty, AC joint resection arthroplasty, and rotator cuff repair. This procedure was later carried out on September 11, 2001.

In a subsequent response to a WCB enquiry, the attending physician stated on September 30, 2001, that in his opinion, there was no question that the claimant's symptoms were related to the original injury of November 13, 1974.

On October 24, 2001, primary adjudication wrote to the claimant and was advised that all the information on his file had been reviewed by a WCB medical advisor, who expressed an opinion that the claimant's current problems to his right shoulder were not related to the 1974 compensable accident. It was therefore the opinion of primary adjudication that there was, on a balance of probabilities, no cause and effect relationship between his current symptoms and the workplace injury of 1974. On December 17, 2001, this decision was appealed by a worker advisor to Review Office.

In a report dated November 15, 2001, the orthopaedic surgeon noted that the claimant had uncovered some documentation that his original injury on November 13, 1974 occurred when he was working as a crusher operator and that on January 30, 1975 he was diagnosed with a torn right shoulder rotator cuff. The surgeon stated it was quite likely that the present large rotator cuff tear was a result of a previous injury, which had been quite chronic and slowly progressive.

In a decision of February 1, 2002, Review Office determined that the WCB would not accept responsibility for the claimant's September 11, 2001 right shoulder surgery for the following reasons:
  • On October 16, 2001, the case had been reviewed by a WCB medical advisor who noted that none of the right shoulder examinations after the 1974 shoulder injury provided any positive signs of a rotator cuff tear. The WCB medical advisor concluded that there was no cause and effect relationship between the 1974 shoulder injury and the 2001 examination findings, which led to the September 11, 2001 shoulder surgery.

  • The WCB medical advisor noted the comments made by the attending surgeon that he felt the cuff tear was recent.
On February 18, 2002, the worker advisor appealed Review Office's decision and a non-oral file review was arranged.

Reasons

As the background notes indicate, the claimant sustained his compensable injury in November 1974 when his right hand got caught between belt and a pulley on a rock crusher. According to the claimant this event resulted in "a crushed hand and a pulled shoulder." The claimant's shoulder condition did not improve over time and he was eventually referred for a period of therapy at the Health Sciences Centre, Rehabilitation Centre. The treating consultant reported, in part, as follows:
    "Very likely this patient sustained a brachial plexus injury on the right side involving the upper trunk. Now he has residual weakness of the biceps, deltoid, brachioradialis group of muscles. I am arranging for him to have therapy here to strengthen the muscles and carry out EMG and Nerve Conduction Tests. The tests should indicate whether we can expect recovery of muscle power soon or if it will take a longer time."
The term brachial plexus is medically defined as a network of the last four cervical and the first thoracic spinal nerves supplying the arm, forearm and hand.

Throughout the history of this file, WCB medical consultants examined the claimant on three separate occasions and as well there were two examinations by treating rehabilitation medicine specialists. We note, however, that not one of these doctors found any of the claimant's symptoms to be related to a rotator cuff problem.

The claimant recently underwent an arthrogram of his right shoulder on May 1st, 2001. The results of this procedure revealed a full thickness right rotator cuff tear, but according to the physician performing the arthrogram, "the tore (sic) margins of the supraspinatus tendon still appear to be of normal thickness, indicating that this is likely not a longstanding tear". (Emphasis ours) In addition to the foregoing comment, the consulting orthopaedic surgeon reported, in his June 26th, 2001 letter to the claimant's treating physician, as follows: "This is likely an acute on chronic event with an acute tear of about 6-7 months ago with a history of chronic impingement syndrome for many years." (Again our emphasis)

We find the preponderance of evidence does not support the claimant's contention that his right rotator cuff tear is related to the 1974 compensable injury. 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 12th day of April, 2002

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