The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on August 11, 2004 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 not acceptable.

Decision: Unanimous

Background

The claimant is 47 years of age and has been employed for 24 years with the same employer. On February 28, 2003, she completed an accident report indicating that she had been diagnosed with carpal tunnel syndrome in her right wrist.

The claimant filed a claim with the Workers Compensation Board ("WCB") attributing her right wrist difficulties to the amount of time she spent typing and using a computer in the performance of her duties. In the Worker's Accident Report the claimant indicated that she experienced symptoms of numbness in her fingers that had been progressing since September 2002 and that she would wake up at night with numbness in her fingers on both hands. The claimant also indicated in the Report that there had not been any change in her job duties or workload around the time her symptoms started.

A nerve conduction study report dated February 6, 2003 indicated mild left and severe right carpal tunnel syndrome as well as evidence of a mild left cubital (elbow) tunnel syndrome.

On October 30, 2003, a WCB adjudicator contacted the claimant to gather additional information. According to the memorandum of their conversation on file, the adjudicator noted the following:

• For the past three years the claimant has been responsible for all billing and paperwork for cell phones and pagers used in the employer's facility. Prior to this the claimant was a secretary. In her current position, the claimant uses a computer all day, mainly on a spreadsheet, entering numbers using the mouse with her right hand. The preparation of the spreadsheets involves cutting and pasting using the mouse. There is not a lot of typing in the position, mostly entering numbers.
  
  
• There had not been sufficient secretarial work in her previous position and she gradually took on the duties of her new position.
  
  
• The claimant had experienced problems in both her wrists, right worse than left, prior to her new position, however, it was worse in her new job. She is right hand dominant.
  
  
• The claimant felt that her symptoms were work related because they flared up at work and there was no other cause. The claimant can go days at work without a problem and then her symptoms would flare up for several days in a row but she could not pinpoint the cause of the flare up.
  
  
• The claimant is not diabetic; she does not smoke and has not had any prior wrist injuries.

A medical report was received from the treating physician dated December 1, 2003. The physician indicated that the claimant first attended at his office on September 21, 2001 reporting symptoms localized to her right elbow, which the physician attributed to right tendonitis or epicondylitis and prescribed anti-inflammatory medication. When seen again on March 8, 2002, the claimant presented with right arm and wrist numbness in an ulnar distribution pattern. As symptoms progressed the claimant was referred for a nerve conduction study in February 2003 and to a plastic surgeon for possible right carpal tunnel release. The physician was not aware of any underlying or pre-existing conditions that would be contributing to the claimant's symptoms.

In a decision dated December 10, 2003, the WCB adjudicator determined that the claimant's duties had not contributed to the development of carpal tunnel syndrome and denied the claim. The adjudicator stated as follows:

"In the opinion of Rehabilitation and Compensations Services carpal tunnel syndrome is a condition that can develop from both work related as well as non-work related risk factors. Accepted work related factors would include highly forceful and repetitive motions of the wrists involving twisting, gripping, pulling, flexion/extension or vibration. Non-work related risk factors can include, but are not limited to gender, obesity, diabetes, menopause and hypothyroidism, skeletal injury to the wrist, age, smoking, caffeine intake, as well as idiopathic etiology [i.e. unknown cause or origin].

While your job description does include repetitive work, it is noted that your wrists or hands are not in constant exposure to potential CTS inducing risk factors. The fact that the carpal tunnel is bilateral and you are right hand dominant suggests that the cause is related to the systemic and non-work related risk factors rather than to overuse in the work place."

The claimant wrote to the WCB on December 29, 2003, requesting a review of her claim. In her letter the claimant advised that she had been performing the same type of work for the past 23 years and was only placed in a somewhat ergonomically correct workstation since April/May of 2003.

The case was considered by the Review Office. The Review Office denied the claim. The Review Office noted that carpal tunnel syndrome was known to develop from work related risk factors which involved high force repetitive activity such as twisting, gripping, pulling, pinch pressure and wrist flexion/extension. After reviewing the claimant's job description, Review Office was unable to identify any duties that required repetitive flexion/extension of the wrist against significant resistance and concluded that on the balance of probabilities, the performance of these duties had not resulted in her developing carpal tunnel syndrome.

In May 2004, the claimant appealed Review Office's decision and an oral hearing was held before this panel on August 11, 2004.

The Claimant's Evidence at the Hearing

The claimant gave evidence at the hearing respecting her employment history and job duties. She advised the panel that for the past 7 years she has worked in the Communications and Information Systems Department, first as an administrative assistant for 4 years and since 2001 to the present, as a telephone service coordinator. As an administrative assistant, the claimant typed correspondence, answered phones, opened and sorted mail. She indicated for the last one and a half years in this position her duties were light as she was sharing the position with another employee and there was not enough work for her to do on a full-time basis. In approximately 2001 her job function was changed and she became responsible for the ordering and distribution of pagers and cell phones and related billing. Since that time she is no longer responsible for typing letters or sorting mail.

The claimant testified that she first experienced wrist problems and numbness in her fingers when she was in her previous position as an administrative assistant, prior to changing functions. Her evidence was that she experienced numbness in the fingers of both hands, but that she did not relate her problems to her work at that time.

The claimant was questioned in detail regarding her duties as a telephone service coordinator. She confirmed that she worked 7.5 hours per day, 5 days a week, with no overtime. Her duties involved receiving email or phone messages from other departments requesting cell phones and pagers. Upon receipt of a request, the claimant filled in a one page form by hand noting such details as date, pager or phone number, location and problem. In the case of pagers, the claimant is able to retrieve the unit from her work area, and in the case of cell phones, she calls the supplier to deliver the phones to her. She was responsible for activating and programming the units prior to delivery and arranging for the units to be sent to the appropriate location. The claimant would file the paperwork and enter key information regarding each unit on a computer spreadsheet.

On average the claimant distributed between eight and nine pagers and three to four cell phones each day. She estimated that she spent approximately one hour each morning dealing with messages, paperwork, filing, activating and labeling units and arranging delivery prior to entering data on computer spreadsheets. She would also be required to do these tasks throughout her day depending on when requests and phone deliveries were received.

The claimant described her spreadsheet duties as requiring her to pull up the relevant folder, file and column primarily using the arrow key with her right index finger. She was required to enter the date, the seven digit phone number or pager code and a brief reason for replacement.

The claimant is also responsible for maintaining and updating information necessary for local phone line billings. This function involves manually retrieving written work orders from a colleague, receiving and printing emails from Manitoba Telephone System, keying in line changes into a database and filing work orders. The claimant testified that some days she will not do any data entry for this task and on other days she may do as much as one hour depending on the number of work orders. She is also responsible for keying simple entries for maintaining the long distance database with such entries averaging six or seven each week.

With respect to her billing function, the claimant generates invoices for pagers, cell phones and phone charges that require her to enter data onto computer spreadsheets. She explained that this work is carried out during the last 2 weeks of each month and is interspersed with the other duties she performs. She testified that this involves cutting and pasting as well as keying in other billing information. The claimant also described spending one and a half days per month doing journal coding involving the copying and editing of data on a spreadsheet and approximately 3 days each month generating reports for approximately 175 departments involving primarily cutting, pasting, reformatting and printing utilizing her right hand. The claimant estimated that she spends anywhere from 5 to 7 hours on her computer each day.

The claimant advised that her work station was ergonomically assessed by the Department of Occupational and Environmental Medicine (OEM) in February 2003. The claimant indicated that the OEM report was vague on recommendations. In September 2003, the claimant moved to a more comfortable work station and incorporated gel pads on her keyboard and mouse to rest her wrists. She has not noticed any difference in her symptoms with these changes.

With respect to her symptoms, the claimant confirmed that she continues to have numbness in the fingers in both hands, though it is worse on her right hand. She also experiences numbness in both elbows. She has braces for both hands, which she wears when her symptoms flare up. The claimant testified that she can go for periods of time where she has no hand problems and then her symptoms flare up. To date she has not missed any work due to this problem. She is considering carpal tunnel release surgery and is on a waiting list.

The claimant also advised the panel that she was diagnosed this year with hypothyroidism and is on medication for this condition. She is five foot 4 inches tall and weighs 185 pounds.

The Employer's Submission

The employer's representative submitted that there was no relationship between the claimant's computer work and her carpal tunnel syndrome. The representative argued that while some jobs involving repetitious activities using force have been linked to carpal tunnel syndrome, the scientific literature does not support such a link in computer users where little force is required.

The representative referred to a study provided to the panel, published in 2001, which estimated the frequency of carpal tunnel syndrome in computer users at a medical facility. The study indicated that the frequency of this syndrome among computer users was similar to that in the general population and suggests that using a computer in the setting studied does not enhance the risk of carpal tunnel syndrome.

The employer's representative further argued that the claimant's condition had developed in both hands, which suggests that it was not related to her work duties where she primarily used her right hand and that it started when she was doing general secretarial duties. She also pointed to the non-work related risk factors in this case such as the diagnosis of hypothyroidism, the claimant's body mass, gender and age, all of which are associated with increased risk of carpal tunnel syndrome.

Reasons

Section 4(1) of The Workers Compensation Act ("Act") provides that compensation will be payable to workers who have suffered a personal injury "arising out of and in the course of the employment". In order for this panel to accept the worker's claim, we must be satisfied, on a balance of probabilities, that the worker's carpal tunnel syndrome is causally related to her employment duties.

After considering all of the material on file and evidence at the hearing, the panel has concluded that the claimant's job duties were not, on a balance of probabilities, related to the development of her carpal tunnel syndrome. We have come to this conclusion for the following reasons:

• The temporal onset of the claimant's hand problems occurred at a time when she was doing light and varied duties as a secretary. At that time she did not associate her problems with any task she was performing. The claimant indicated she could go for days at work without problems and when her symptoms flared up, she was unable to pinpoint the cause. This lack of a clear temporal linkage between the claimant's computer usage and symptoms is an important criteria that does not support a causal relationship;
  
  
• From the onset, the claimant's numbness occurred in both hands. One would not expect to see problems developing at the same time in the claimant's left hand given that the majority of her computer use was done with the right hand. The fact that the problem developed simultaneously in both hands suggests systemic, non-work related factors may be at play;
  
  
• The claimant's job duties varied substantially and there were no long stretches of typing. Her keyboarding involved short bursts of typing with use of the mouse to drag, copy and print at a moderate pace. She was required to review messages, make phone calls, file papers, hand write forms and organize deliveries of phones and pagers throughout her day. The panel is of the view that the claimant's wrist movements using her computer were not highly repetitive in the circumstances and involved low force. The scientific literature suggests that the prevalence of carpal tunnel syndrome is lowest in workers performing low-force, low-repetitious jobs;
  
  
• There are a number of non-work related factors associated with the development of carpal tunnel syndrome present in this case. The claimant was diagnosed with hypothyroidism, a condition associated with carpal tunnel syndrome. Other known risk factors present in this case include the claimant's high body mass index, as well as the fact that she is middle aged and female.

The panel therefore concludes, after weighing all of the evidence, that the claimant's development of carpal tunnel syndrome was not related to the performance of her job duties and therefore, her condition did not arise out of and in the course of employment, as required by the Act. We find that the claim is not acceptable and deny the appeal.

Panel Members

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

Recording Secretary, B. Miller

M. Thow - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 24th day of September, 2004