Decision #158/03 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on November 13, 2003, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on November 13, 2003

Issue

Whether or not the claimant was fit to return to work on a graduated basis.

Decision

That the claimant was fit to return to work on a graduated basis.

Decision: Unanimous

Background

The claimant contacted the call centre at the Workers Compensation Board (WCB) to report bilateral tendonitis in her shoulder and arms which she related to assisting a resident on June 5, 2001 during the course of her employment as a home care attendant.

Initial medical information provided by the attending physician confirmed that the claimant was diagnosed with bilateral shoulder tendonitis, right lateral epicondylitis and probable carpal tunnel syndrome. The claimant was also noted to have type I diabetes. The WCB had accepted the claim and wage loss benefits were paid to the claimant commencing June 13, 2001.

A neurophysiological report dated August 30, 2001, revealed that the claimant had evidence of a bilateral median neuropathy in the carpal tunnels, moderate in degree.

In a February 5, 2002 report, an orthopaedic surgeon indicated that he first saw the claimant at the hand clinic on November 6, 2001. At an examination on January 8, 2002, the claimant had been wearing splints for the past two months with significant improvement. He felt that the claimant should continue with conservative management and would be reviewed again in two month's time.

The claimant was assessed by a WCB physical medicine and rehabilitation consultant (physiatrist) on March 7, 2002. Based on his clinical examination, the physiatrist indicated there were limited findings. There was some minor irritability of the supraspinatus portion of the rotator cuff bilaterally, but negative impingement tests. There was minor irritability of the right AC joint with improvement.

On March 12, 2002, the treating orthopaedic surgeon reported that the claimant had virtual full resolution of her bilateral carpal tunnel syndrome and that she could leave off her splints.

In a memo dated May 1, 2002, a WCB adjudicator documented that he had discussed a graduated return to work program for the claimant with the WCB physiatrist. The physiatrist felt that the claimant could gradually increase her hours over a 4 - 6 week period and then she could return to work full time. No restrictions were outlined.

In a progress report dated May 17, 2002, the attending physician commented that the claimant had full elevation in her shoulder with mild impingement. Treatment plans included an injection, a gradual return to work, physiotherapy and a repeat call in at the WCB's offices.

In a memo dated May 16, 2002, the WCB physiatrist expressed the following opinion with respect to the claimant's degree of recovery from her compensable accident of June 5, 2001:
"I expected that she would recover from her reported work injury and would anticipate and (sic) that she would be able to progress to return to work to her prior work duties. I expect that the risk of further musculoskeletal injury (not necessarily in the same area as past injuries) would be expected to be high as per the prior discussion."
On May 31, 2002, primary adjudication determined that the claimant was fit to participate in a graduated return to work program starting at 2 hour shifts and gradually increasing her hours over a 4-6 week period. On June 2, 2002, the claimant disagreed with the decision, being of the view that she was still suffering from her right shoulder injury.

On August 22, 2002, primary adjudication reiterated its position that the claimant had recovered from the effects of her compensable injury and that wage loss benefits would be paid to August 28, 2002 inclusive and final. The claimant was advised that her case would be referred to Preventive Rehabilitation Committee to determine if she was eligible for preventive vocational rehabilitation services.

On October 11, 2002, Review Office confirmed that the claimant was fit to return to her full regular duties on a graduated basis. In reaching its decision, Review Office noted that the claimant had experienced problems with her shoulders, right arm and wrists as a result of a non-specific injury. It was the opinion of both her treating physician and the WCB physiatrist that she could return to work and there was no evidence to contradict this conclusion.

In a memo dated November 20, 2002, a member of the Preventive Vocational Rehabilitation (PVR) Committee indicated, after investigating the claimant's WCB claims history, that she did not have an established pattern of injury. She was therefore not eligible for benefits under the PVR policy. On December 10, 2002, the claimant was informed of this decision.

In early May 2003, the claimant's union representative asked Review Office to reconsider its decision of October 11, 2002 based on a report prepared by the claimant's treating physician dated April 22, 2003. The treating physician outlined his view that the claimant was not capable of working due in part to her compensable injury and, in part, due to her pre-existing condition.

On June 13, 2003, Review Office determined there would be no change to its previous decision. Review Office stated, in part, that the claimant did not have 'any appreciable change' with the cortisone injection into the subacromial space, which would lead one to believe that her symptoms were likely related to a structural predisposition rather than an injury. Review Office also felt that the WCB's policy on pre-existing conditions (44.20.20.10) was not applicable in this case. On July 22, 2003, the claimant's union representative appealed Review Office's decision and an oral hearing was arranged.

Reasons

As the background notes indicate, the claimant's attending physician's first report outlined a diagnostic impression, which included bilateral shoulder tendonitis, right lateral epicondylitis and probable carpal tunnel syndrome. It should also be noted that the claimant has type I diabetes.

On March 7th, 2002, the claimant was examined by a WCB medical advisor specializing in physical medicine and rehabilitation. His clinical examination revealed very limited findings. "Findings suggested some minor irritability of the supraspinatus portion of the rotator cuff bilaterally, but negative impingement tests. There was some minor irritability of the right AC joint as well, with improvement, as expected off the potentially AC joint irritating activities."

The consultant advised the claimant to continue to exercise the internal and external rotators of her shoulders and shoulder stabilizers as well as "to progress to some regular general fitness activities on a regular basis". But more importantly, the medical advisor commented that the claimant "should be able to progress to return to work her prior work duties as symptoms continue to improve and resolve".

The evidence is clear that by March 12th, 2002 the claimant had virtually full resolution of her bilateral carpal tunnel syndrome symptoms. With respect to the claimant's gradual return to work, the treating physician confirmed in his May 17th, 2002 progress report that the claimant was certainly capable of alternate or modified work duties. The claimant's capability to continue a graduated return to work program was again affirmed by the treating physician in his July 10th, 2002 progress report. Ongoing treatment involved home exercises and self care on the part of the claimant.

On April 22nd, 2003, the treating physician, after reviewing the claimant's file together with other documentation provided to him by the claimant's union representative, commented as follows:
"As a home care worker, she [the claimant] has physical demands related to client care that can provoke chronic tendonosis. Her small stature requires that she works at the higher end of her physical demands, therefore, she is more predisposed to strain. At the same time, she may not have any strain if the specific physical demands of her job were not present or were lighter.
I think if she remains within the aforementioned restrictions, she will be able to control her shoulder symptoms. Chronic tendonosis [degeneration of a tendon from repetitive microtrauma] tends to flare with increased demand and she may require intervention if the situation arises."

After having thoroughly considered all of the evidence, we find that the claimant was, on a balance of probabilities, fit to return to work on a graduated basis. Accordingly, the claimant's appeal is hereby dismissed.

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 16th day of December, 2003

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