Decision #87/04 - Type: Workers Compensation

Preamble

A file review was held on May 6, 2004 at the request of a worker advisor representing the claimant. At that time, the Appeal Panel decided that the appeal should be heard by way of an oral hearing. At the Appeal Panel's request, the oral hearing was convened on June 8, 2004 and the Panel discussed this appeal on the same day.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable as an enhancement of a right carpal tunnel syndrome condition.

Decision: Unanimous

Background

In March 2003, the worker submitted a Worker's Accident Report to the Workers Compensation Board (WCB) for bilateral wrist difficulties that she attributed to her work duties which included the repetitive use of a computer along with paper work. The worker noted that she advised her employer of her difficulties on February 24, 2003.

In a memo on file dated April 1, 2003, a WCB adjudicator documented the following information that he obtained from the worker:
  • the worker had been employed with the accident employer in the same position for the past 2 years. She is right hand dominant.

  • the worker began to experience occasional pain and stiffness in her hands for about 4 months. As time went on, the frequency of her problems increased and her hands started to wake her up at night. The right hand was worse than her left hand and all of her fingers are numb.

  • job duties include data entry, record keeping, filing and issuing hunting/fishing licenses. Four hours a day was spent on the computer. The longest continuous period would be 1 to 1 ½ hours. The rest would be made up with occasional use through the day or doing books, filing, etc.

  • the worker stated that she did not have thyroid, diabetes or high blood pressure and was not on any medications. She was not involved with any hobbies and her involvement with sports was limited to a couple of baseball games per year.
On April 9, 2003, the employer was contacted and the job duties described by the worker were confirmed. The employer said the worker did mention that she was having trouble with her wrists last summer so they purchased a new chair and a wrist support for her keyboard.

On April 22, 2003, a WCB medical advisor reviewed the medical information on file and a diagnosis of bilateral carpal tunnel syndrome was confirmed. The medical advisor commented, however, that he was unable to relate the CTS condition to the worker's job duties which he outlined as being "no prolonged, forced position or heavy job required."

In a decision dated April 23, 2003, the worker was advised by the WCB that responsibility for her claim had been denied. The WCB was unable to establish that the worker had been exposed to significant work related factors in the development of her CTS condition or that she suffered a personal injury due to an accident arising 'out of and in the course of' her employment.

On July 16, 2003, a worker advisor, acting on behalf of the worker, appealed the above decision to Review Office.

On August 8, 2003, Review Office confirmed that the claim was not acceptable. In reaching its decision, Review Office considered the information that was supplied by the worker, the employer, the treating neurologist and the opinion expressed by the WCB medical advisor. Review Office concluded that "…while the worker's job duties may be some what repetitive, the weight of evidence has not led Review Office to conclude that the performance of these duties, has on a balance or probabilities, resulted in the worker developing carpal tunnel syndrome. Therefore there has been no accident as defined by the Act and the claim is not acceptable."

In February 2004, the worker advisor disagreed with Review Office's decision and a non-oral file review was requested. On April 7, 2004, the Appeal Commission received additional information from the worker advisor which included a report from an occupational health physician dated January 8, 2004 along with medical literature concerning carpal tunnel syndrome and a list of job duties that the worker performed throughout her working career.

On May 6, 2004, a non-oral file review took place. Following discussion of the case, the Appeal Panel requested the convening of an oral hearing to obtain more information about the worker's job duties. On June 8, 2004, an oral hearing took place at the Appeal Commission.

Reasons

This appeal initially came before us as a written review dealing with claim acceptability. We asked the parties to attend an oral hearing so that we could obtain a better understanding of the worker's job duties at her current and prior jobs, and its relationship to the worker's right carpal tunnel syndrome.

The worker attended the hearing with a worker advisor. At the hearing she provided extensive information regarding her duties at jobs she had worked in recent years. The worker's current employer was represented at the hearing by two staff persons. The employer representatives did not take a position on acceptance of the worker's claim but answered questions and provided general comments about the worker's job duties.

The issue before us was whether the worker's claim was acceptable. For the worker's appeal to succeed we must find that the worker's duties at her current employment caused, aggravated, or enhanced her medical condition. We find that the worker's duties at her current employment enhanced the pre-existing carpal tunnel syndrome of her right wrist and that her claim is acceptable.

The worker's position, as expressed in a written submission, was that "…working conditions in ALL her workplaces would be the sole dominant cause of her carpal tunnel condition in her right wrist." At the hearing the worker advisor confirmed that the worker's position was that carpal tunnel syndrome was a pre-existing condition and that her duties caused an enhancement of the pre-existing condition. The worker provided a report from an occupational health physician which supported this position. This report was not on file when Review Office considered this file.

We do not agree with the worker's initial position that her work duties caused her carpal tunnel syndrome. We find that the worker's employment duties were not the dominant cause of her condition. Rather we find, on a balance of probabilities, that the worker had pre-existing carpal tunnel syndrome in her right wrist and that duties at her current employment enhanced this condition to the point that surgery was necessary. We find that the enhancement of her pre-existing condition satisfies the definition of accident under Section 1(1) of The Worker's Compensation Act (the Act).

We note that Policy 44.10.20.10 dealing with pre-existing conditions is applicable to this case. Paragraph 1 (a) of this policy provides:
"Where a worker's earning capacity is caused in part by a compensable accident and in part by a non compensable pre-existing condition, or the relationship between them, the Worker's Compensation Board will accept responsibility for the full injurious result of the accident."
In arriving at this conclusion, we rely upon the evidence of the worker's occupational health physician who concluded: "The fact that [the worker] has symptoms and NCT abnormalities on both sides and no major occupational risk factors on the left side would argue that she may have a predisposition to CTS. The increased intensity of the symptoms on the right, her young age coupled with the occupational risk factors make me feel that the symptoms in her right hand were exacerbated by her work." This physician goes on to state that her work has led to an enhancement of her condition.

As noted above we find that the worker's duties, on a balance of probabilities, enhanced her pre-existing carpal tunnel syndrome in her right wrist.

Evidence was provided on the worker's job duties at her previous jobs, especially the duties and working conditions at a funeral home where she worked in an administrative position. The worker indicated that her carpal tunnel syndrome first became symptomatic during her employment at the funeral home. She described the duties which she believed contributed to her condition. Her evidence, however, was that when she started her current employment she was symptom free.

We note that when the worker commenced her current employment there was a 14 month backlog in data entry and filing. To eliminate this backlog the worker spent a large portion of her time entering data on a spreadsheet. This involved significant use of a mouse and keyboard. Initially she used the main keyboard rather than the number keypad. The worker indicated that the filing cabinets were full and that force was required to fit the documents into the files. A significant portion of her work time involved the hand written completion of forms with carbon copies. This required heavy pressure in writing on the forms. The evidence also established that her work station was not ergonomically correct, which caused the worker to perform her duties (data entering, using a computer mouse and writing) in an awkward position. During this job, the worker's symptoms increased to the point where she sought medical attention and, finally, surgery to relieve the carpal tunnel. We find that these job duties involve forceful gripping and pinching of the right hand and awkward positioning of the wrist, all of which are known factors in the enhancement of a pre-existing carpal tunnel syndrome.

We agree that the duties at her previous employment may have aggravated her carpal tunnel syndrome and accept the worker's evidence that her condition was not symptomatic when she started her current employment.

The worker's appeal is therefore allowed with respect to her right wrist carpal tunnel syndrome.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 25th day of June, 2004

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