Decision #12/04 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on December 16, 2003, at the request of the claimant. The Panel discussed this appeal on the same day.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable.

Decision: Unanimous

Background

The claimant advised her employer on May 9, 2002 that she injured her left shoulder region while performing repetitive lifting and checking maneuvers during the course of her employment as a cashier.

On May 9, 2002, the claimant attended a hospital emergency facility with complaints of left arm pain. The diagnosis rendered was rotator cuff tendonitis and calcification. This diagnosis was also confirmed in a left shoulder x-ray taken on April 17, 2002.

A physiotherapy report dated May 25, 2002 noted that the claimant required 6 to 8 treatments per week for two weeks. The therapist assessed the claimant with "left bicipital tendon, rotator cuff strain, ? pec strain, sterno-clavicular joint subluxation."

On May 29, 2002, an adjudicator with the Workers Compensation Board (WCB) contacted the claimant to obtain additional information concerning her work history, details regarding the onset of her left shoulder symptoms and the medical treatment that she received.

On June 4, 2002, the attending physician reported that the claimant suffered from a repetitive strain injury to her left shoulder region.

In a decision dated June 19, 2002, primary adjudication informed the claimant that her claim for compensation had been denied as it had been unable to support a relationship between her chronic shoulder condition and her workplace activities. Primary adjudication also stated, in part, the following:
"…According to you and your employer there were no changes or increases to your work duties or workload around April 2002. Without a specific incident or an increase in your work duties or workload to account for the onset of your symptoms, the WCB cannot establish that your condition is related to your work activities. Therefore, your claim has been denied."
On September 3, 2002, a union representative, acting on behalf of the claimant, submitted a report from the attending physician dated July 31, 2002. The union representative contended that this report "…clearly indicates her clinical findings are consistent with the repetitive nature of her work. Even if she had a pre-existing condition, the work she did could certainly cause an aggravation. Any and all of these scenarios support a relationship between her work and her shoulder condition. On this basis, the claim for compensation should be accepted."

Prior to considering the above submission, primary adjudication obtained additional information from a specialist who had seen the claimant on May 21, 2002. A WCB medical advisor discussed the medical information with a WCB adjudicator on October 24, 2002.

On October 25, 2002, the adjudicator wrote to the union representative to state that it was the WCB's opinion that the claimant's shoulder was degenerative in nature and could be symptomatic with or without provocation. It was felt that the claimant's work duties did not involve work at above shoulder level to any significant degree. In view of this opinion, no change would be made to the previous decision to deny the claim. On October 31, 2002, the union representative appealed this decision and the case was referred to Review Office.

Prior to considering the appeal, Review Office arranged for a WCB rehabilitation specialist to attend the claimant's work site in order to assess the physical demands of the work that the claimant had been involved with at the time of making this claim. The rehabilitation specialist's findings are contained in a memo dated February 14, 2003. Review Office also sought the medical advice of a WCB orthopaedic consultant and his response to Review Office is dated February 20, 2003.

On February 21, 2003, Review Office determined the claim was not acceptable. Review Office was of the opinion that the diagnosis for the claimant's left shoulder condition was "degenerative rotator cuff calcification." Significant weight of evidence was placed on the opinion expressed by the WCB orthopaedic consultant that the diagnosis was not a repetitive strain injury and may be symptomatic inside and outside of work. It also may give rise to acute and/or chronic symptoms.

Review Office felt there was no evidence that the claimant's work duties caused an aggravation to the existing condition of degenerative rotator cuff calcification. The worker initially advised that she did not know what part of her job caused her shoulder problem. As the condition of degeneration can be symptomatic with or without provocation, Review Office said it was unable to establish between the onset of her left shoulder symptoms and her job duties. On September 16, 2003, the union representative appealed Review Office's decision and an oral hearing was arranged.

Reasons

This case involves a person, who suffered injury to her left shoulder, which she alleges was caused by her employment in a large grocery store. Her claim for compensation was denied, which decision was upheld upon reconsideration by Review Office.

She has appealed that decision to the Appeal Commission. For her appeal to be successful, the Appeal Panel would have to determine that her left shoulder injury arose out of and in the course of her employment. We have made that determination.

In coming to our decision, we conducted a thorough review of the claim file, as well as holding a hearing, at which we heard testimony from the claimant, her union representative and the employer's representative.

Her initial treatment was in the emergency room of the local hospital. The diagnosis, at that time, was rotator cuff tendonitis and calcification.

She was subsequently treated by her family doctor who, in a letter dated July 31, 2002, wrote:
  • [The claimant's] "left shoulder x-rays does (sic) indeed reveal rotator cuff calcification. This can be a finding that occurs as a joint has experienced repetitive strain injuries and associated swelling of tendons. … the sports medicine specialist, who assessed her, felt that her history and examination were consistent with repetitive strain injuries."

  • "… a reasonable case could be made that certainly her injury and examination findings are consistent with the repetitive nature of her work."

  • "… her work as a cashier/checker could certainly have at least contributed to her shoulder condition."

  • "… if she had a pre-existing condition her work could certainly have aggravated or exacerbated it."
The sports medicine specialist reported, in a letter dated May 23, 2002:
  • [The claimant's] "history and examination findings are consistent with repetitive strain injury associated with the left distal rotator cuff common tendon and the pectoralis minor tendon at its origin. Chronic shoulder girdle postural deficits also are present. … The noted calcium deposits typically are not a significant source of symptoms."
In a letter, dated October 5, 2002, the same specialist described the working diagnosis as "left rotator cuff tendonopathy and associated pectoralis minor tendon involvement." She also noted that the claimant was showing continued improvement, from physiotherapeutic treatment, as well as a graduated return to work program, which involved alternate duties.

Subsequent to this, a board medical advisor described the probable diagnosis as "calcific tendonitis." He expressed the opinion that, as the claimant's work duties did not involve much work at or above the shoulder level, the relationship between this diagnosis and the work duties was "very weak."

The orthopaedic consultant to Review Office, later, wrote that the diagnosis was "degenerative rotator cuff calcification", which is "not a repetitive strain injury", and which may be symptomatic inside and outside of work.

From our review of some of the literature about calcific tendonitis, we have noted that the general consensus is that that condition is most likely to come on suddenly and cause severe pain. This is not consistent with the description of the onset described by the claimant, who spoke of gradual onset, which would cause some pain for a day or two and then subside for a few days.

We are more inclined to accept the more general diagnosis of her treating specialist, that being tendonopathy, resulting from repetitive strain injury.

We also note the February 2003 report of the Rehabilitation Specialist, who conducted a workplace assessment, which stated the following findings:
  • "Repetitive arm, shoulder work bilaterally with forces, given the nature of her job duties over the past 20 years."

  • "Due to her small stature, reaches and lifts were from floor level to above shoulder level while working in the bulk foods area."

  • "Cashing involves weights that vary from ounces to 26 pounds. Repetitive shoulder movements are observed while dealing with the cashing of items, scanning and placement into bags and then the shopping cart."

  • "… it is clear to the writer that this claimant has been carrying out repetitive work for the past 20 years, particularly for the hands, arms and shoulders."
Our consideration of the foregoing evidence has led us to conclude - on a balance of probabilities - that the claimant's shoulder problems did arise out of her employment.

Therefore, the appeal is allowed. The claim is acceptable.

Panel Members

T. Sargeant, Presiding Officer
B. Popowich, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

T. Sargeant - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 16th day of January, 2004

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