Decision #113/04 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on July 21, 2004, at the request of the worker. The Panel discussed this appeal on the same day and again on August 30, 2004.Issue
Whether or not responsibility should be accepted for the worker's current difficulties and related treatment.Decision
That responsibility should be accepted for the worker's current difficulties and related treatment.Decision: Unanimous
Background
During the course of his employment as a laborer on December 14, 1970, the worker sustained an oblique fracture of the proximal phalanx of his right ring finger when he fell and slipped on "sub-girts". On December 17, 1970, the worker underwent surgery which consisted of "closed reduction insertion of Kirschner wires".In a follow-up report dated February 23, 1971, the treating orthopaedic specialist reported that the worker complained of pain and stiffness in his finger and was of the view that he was unfit to return to carpentry work. Examination findings were reported as follows: "Proximal I.P. joint flexion was up to 90 degrees, distal I.P. joint flexion was up to 45 degrees, extension was full." The orthopaedic specialist suggested to the worker that he return for treatment in two week's time and to continue to mobilize his finger with active exercises.
The worker was further assessed by a WCB medical officer on February 23, 1971. Examination revealed enlargement of the PIP joint of the right ring finger. There was limitation of flexion and some tendency to ulnar deviation and overlapping. The medical officer considered the worker fit to return to work.
In December 2001, the worker attended the WCB's offices to report numbness in his ring finger along with pain going up his right arm. The WCB then requested and obtained up-to-date medical information from the worker's treating physicians which revealed the following:
- March 24, 2002 - a sports medicine specialist reported that he saw the worker on March 19, 2002 for problems he was experiencing with his right hand, arm and shoulder which appeared to stem back to an injury he sustained in 1970. Following his assessment of the worker, the specialist said he was uncertain as to the exact cause of the worker's right arm pain. He noted that the physical findings associated with his shoulder were difficult to interpret due to his pain response and decreased effort when testing the muscles. A cortisone injection into the symptomatic area was recommended.
- March 28, 2002 - an orthopaedic specialist reported that the worker complained of pain in his right ring finger on the dorsal aspect extending to his forearm which he claimed had been present since he fractured his finger. The worker also complained of right shoulder pain which started from a fall some 20 years ago. After examining the left shoulder, the orthopaedic specialist suggested that the worker continue with gentle exercises to regain more range of motion. With regard to his right ring finger complaints, the fracture was noted to be united and the slight rotation did not seem to be too significant according to the specialist. He had no explanation for the pain in the worker's forearm, the dorsum of his hand or ring finger from a musculoskeletal perspective.
- April 8, 2002 - the family physician outlined his examination findings of the worker between May 28, 2001 and February 22, 2002. The clinical impression was "osteoarthritis and degenerative disc disease".
On June 17, 2002, the worker attended the WCB's offices and asked for assistance with writing a letter of appeal to the Review Office. The worker felt that the surgery he had done in the 1970's had not been done right as he was unable to feel parts of his finger since then. He stated that he had a lot of pain in his 4th right finger and that he wanted to follow through with the treatment recommendations that were prescribed by his physical medicine consultant.
On August 2, 2002, the case was considered by Review Office which now included a copy of a report from a neurologist dated April 24, 2002. The neurologist stated, in part, "I can't therefore in summary, ascribe his ongoing complaints of pain, right hand and forearm, shoulder and neck, to anything ominous neurologically."
The Review Office determined that no responsibility would be accepted for the worker's current difficulties or related treatment. Review Office noted that the claim was only accepted for an injury to the right ring finger that occurred at work on December 14, 1970. Review Office was unable to relate the worker's right shoulder, neck, right arm and low back problems to the 1970 work event/injury and would not accept responsibility for these complaints or for any related treatment. The Review Office also found no evidence to attribute the worker's current right ring finger problems to his compensable 1970 injury. Review Office felt that the evidence did support that the worker had a good result from his 1970 surgery and that his neurological assessment was normal.
On November 28, 2003, an orthopaedic surgeon wrote to the attending physician noting that the pain and tenderness in the worker's right ring finger may be related to a neuroma and that surgery would be arranged to explore the old incision under local anesthetic.
On July 21, 2004, an oral hearing was held at the Appeal Commission following receipt of an appeal from the worker who disagreed with Review Office's decision. Following the hearing and after discussing the case, the Appeal Panel requested and obtained a report from the treating orthopaedic surgeon along with a copy of the operative report dated January 29, 2004, which was shared with the worker for comment. On August 30, 2004, the Panel met further to discuss the case and to render its final decision with respect to the issue under appeal.
Reasons
The worker attended the hearing, answered questions and made a statement on his behalf.The issue before us was "whether or not the responsibility should be accepted for the worker's current difficulties and related treatment." In his appeal form the worker identified the issue as "whether responsibility should be accepted for my right ring finger". At the hearing the worker confirmed that he was not attributing symptoms affecting other body parts to the 1970 compensable injury and was dealing only with his right ring finger.
For the worker's appeal to be successful, we must find that the recent treatment to the worker's right ring finger is related to the worker's compensable injury of December 14, 1970. We were able to find, on a balance of probabilities, that the current treatment is related to 1970 compensable injury.
In considering the worker's appeal, we determined that further medical information was needed. Accordingly we asked the orthopedic surgeon who operated on the worker's hand for information on the treatment provided to the worker as well as the physician's opinion on the relationship of the current condition to the 1970 work injury. We also asked for a copy of the operative report.
The orthopedic specialist responded on August 5, 2004. With respect to the relationship between the recent surgery and the 1970 compensable injury the orthopedic surgeon provided the following comments:
We also received a report from an occupational health specialist who assessed the worker on August 5, 2004 and reviewed the operative report of the surgery. This physician provided the opinion that given that the abnormality (the globular mass) was located in the area of the previous incision and fracture, and the fact that the worker reported persistent pain from this location it is likely that the finger pain was related to the previous injury."X-rays showed an old healed fracture of the proximal phalanx of the right ring finger. I explained to him that there was a possibility that there was a neuroma in his ring finger. I explained to him also that it might be possible to improve his pain with excision of the neuroma, but I could not guarantee it. He stated that he wished to proceed with the surgery and on the 29th of January 2004, under local anesthesia, he underwent an exploration of the wound. A small globular mass was found and excised. This was sent to pathology and I have enclosed a copy of the pathology report which shows no evidence of a neuroma.
I saw him in follow-up on the 12th of February 2004. His wound was well healed and the sutures were removed. He thought his pain might be slightly improved. I have not seen him since that date.
Given that his pain was in the exact location of his previous injury and related to the incision in his ring finger and given his story, it would be my opinion that there is a relationship between his present right ring finger condition and the injury sustained to his ring finger in the 1970 work-related accident. It would be my opinion that a period of temporary disability from the date of his surgery, the 29th of January 2004 until mid February 2004 should be considered."
The orthopedic surgeon's report provides useful new information on the presence of a globular mass at the site of 1970 fracture of the right ring finger. We note that this information was not available to Review Office when it considered this matter in 2002.
We agree with the opinion expressed by the orthopedic surgeon and find on a balance of probability that the current surgery is related to the 1970 compensable injury. We also note the orthopedic surgeon's observation that the period of temporary disability commenced on the date of the surgery, January 29, 2004 and continued until mid February 2004.
The worker's appeal is allowed and responsibility is accepted for the recent surgery and related treatment to the worker's right ring finger.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
A. Scramstad - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 8th day of September, 2004