The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on May 29, 2002, at the request of an advocate, acting on behalf of the claimant. The advocate was appealing a decision of the Review Office of the Workers Compensation Board (WCB) which determined that responsibility could not be accepted for the claimant's right carpal tunnel syndrome. The Panel discussed the appeal on May 29, 2002 and again on July 2, 2002.

Issue

Whether or not responsibility should be accepted for the worker's right carpal tunnel syndrome.

Decision

That responsibility should be accepted for the worker's right carpal tunnel syndrome.

Decision: Unanimous

Background

In January 2000, the claimant submitted an application for compensation benefits with respect to left shoulder, hand and arm difficulties which she related to her employment activities as a sewing machine/iron operator. Subsequent file records showed that the claimant was diagnosed with severe bilateral carpal tunnel syndrome (CTS), worse on the left side.

On February 16, 2001, primary adjudication denied the claim for compensation as it was determined that the evidence did not establish a relationship between the development of CTS and the claimant's work duties. This decision was overturned by Review Office on November 2, 2001, when it was determined that, based on a balance of probabilities, the claimant's left CTS was attributable to her employment activities as a sewing machine operator.

In December 2001, an advocate for the claimant contacted the Workers Compensation Board (WCB) advising that he wished to pursue a claim for the claimant's right CTS condition.

On December 28, 2001, primary adjudication wrote to the claimant and her representative, stating that a WCB medical advisor was consulted with respect to the claimant's right CTS condition. The medical advisor noted that the right CTS symptoms did not appear until after the claimant was off work and that prior to this she was asymptomatic on the right side. The medical advisor was of the opinion that the claimant's work duties involving her right hand were non-repetitive and did not require repetitive flexion of the hand. Primary adjudication therefore concluded that a causal relationship between the claimant's right sided CTS condition and an accident arising out of and in the course of her employment had not been established. On January 4, 2002, the claimant appealed this decision to Review Office.

In a decision dated February 22, 2002, Review Office determined that no responsibility should be accepted for the claimant's right CTS as being related to her employment as a sewing machine operator. Review Office noted that the claimant's right sided symptoms were asymptomatic until the latter part of the year 2000. As the claimant had not been employed as a sewing machine operator since March 10, 2001, it could not associate the onset of symptomatology many months later with her employment activities. On March 4, 2002, the claimant appealed Review Office's decision and an oral hearing was arranged.

On May 29, 2002, an oral hearing was held at the Appeal Commission, after which the Panel requested that additional information be obtained prior to discussing the case further. Specifically, the Panel requested a copy of the March 20, 2002, operative report which related to the decompression surgery which was performed on the claimant's right hand. The operative report was later received and was forwarded to the interested parties for comment. On July 2, 2002, the Panel met to render its final decision on the issue under appeal.

Reasons

The Appeal Panel is unanimously of the opinion that responsibility should be accepted by the WCB for the claimant's right carpal tunnel syndrome. This decision has been made after a thorough review of the evidence on the claimant's file and after hearing the claimant's oral recitation of her work history and job duties. The claimant also physically demonstrated the motion involved in the completion of tasks related to her job duties which was helpful in understanding the repetitive nature of her job.

The claimant began working for the employer in 1985 as a sewing machine operator. She last worked in February of 2001. Initially her job primarily involved operating a sewing machine which of necessity involved a great deal of repetitive pushing and pulling of fabric through the sewing machine with her hands. Some steam ironing was involved which necessitated the repetitive use of her right hand and thumb.

In 1996, the work process at her place of employment became "modular" and the claimant's duties changed significantly to involve steam ironing for almost 80% of her time at work. For this work, the right thumb constantly presses the steam button on the iron handle while pressing the cloth. The claimant estimated that she would iron about 200 pairs of pants per day with eight presses on the steam button per pair of paints. She worked eight hours per day, five days per week.

Since 1996, the claimant has made ongoing complaints related to both her left and right shoulder. In a report from an occupational health doctor on November 4, 1996, the claimant reported "two months of right shoulder pain" which was diagnosed as "early impingement syndrome of the right shoulder." For three years prior to 1996, the claimant recalled having tingling in the radial aspect of the right hand involving the thumb, index and middle finger.

The claimant's representative argues that the claimant's right wrist problems were not initially diagnosed correctly as it was considered to be arthritis. There was also more concentration by the claimant's treating physicians on her left wrist problems which were initially more symptomatic. Nerve conduction studies were completed in June 2000 and revealed severe bilateral carpal tunnel syndrome. The left wrist was worse than the right. The right median nerve velocity was 20.1 m/s and the left median nerve velocity was 30.08 m/s. According to the claimant's treating physician in his report dated April 3, 2002, normal nerve velocity is 50-70 m/s.

The claimant discontinued working in March 2000 particularly due to her left hand and arm symptoms at that time. A left carpal tunnel decompression surgery was completed on December 6, 2000, at which time it was noted that the median nerve was "certainly compressed." The WCB accepted responsibility for this claim.

Once the left wrist nerves were decompressed, the claimant's treating physicians began to focus more on her right wrist symptoms. Following surgery, the claimant returned to work in March 2001 but lasted only a week because of a recurrence of pain in both hands and shoulders. She has not worked with the employer since that time.

On March 20, 2002, a right carpal tunnel syndrome decompression surgery was performed. The operative report noted that the right median nerve was compressed by the transverse carpal ligament.

The Appeal Panel is in agreement with the claimant's representative that until the nerve conduction studies in January of 2002, there was poor medical documentation over the claimant's right wrist problems, probably because her left wrist problems were initially more severe and over shadowed her right wrist problems. We agree with the claimant's treating physician's comments in his report dated April 3, 2002 that "the findings in 2000 of right carpal tunnel syndrome are consistent with her reporting numbness in her thumbs, index and middle finger which dates back to approximately 1992 and worsened in 1996 when her operating the steam iron increased."

The Panel is also of the view that the claimant's job duties as described by her from 1996 onward were repetitive in nature and on a balance of probabilities, likely contributed to her right carpal tunnel syndrome.

Panel Members

K. Dunlop, Q.C., Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

K. Dunlop, Q.C. - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 14th day of August, 2002