Decision #139/04 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on September 15, 2004, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on the same day.Issue
Whether or not there is entitlement to wage loss benefits after November 12, 2003.Decision
That there is entitlement to wage loss benefits after November 12, 2003.Decision: Unanimous
Background
On July 31, 2003, the claimant caught his right arm in the knives of a rotor during the course of his employment as a farm equipment mechanic. The claimant clarified that his arm was cut but the glove he was wearing wasn't. The diagnosis rendered by a sports medicine physician on August 2, 2003 was a crush injury/strain and a possible nerve injury. The claim was accepted by the Workers Compensation Board (WCB) and benefits were paid to the claimant commencing on August 1, 2003.In a letter dated September 5, 2003, the attending physician asked the WCB to expedite a consultation with a neurologist as it was felt that the claimant may have post injury neuropraxia.
On October 17, 2003, the treating neurologist confirmed that the claimant's clinical picture was consistent with a radial sensory nerve injury along with right carpal tunnel and a right cubital tunnel syndrome. With regard to the radial sensory nerve lesion, the neurologist commented that the prognosis for improvement was favorable and that no further treatment was warranted at the moment.
In a decision to the claimant dated November 6, 2003, a WCB case manager outlined his opinion that there was no longer a loss of earning capacity and that the claimant was capable of returning to work. The case manager stated, "I came to this conclusion because the tests completed confirm your diagnosis as noted above and medical opinion on file indicates that this injury should not affect your ability to complete your job duties. Wage loss benefits will be paid to November 12, 2003 or a date that you return to work, if sooner."
In November 2003, Review Office received an appeal submission from the claimant regarding the WCB's decision to terminate his benefits effective November 12, 2003. The claimant noted that his occupation was very strenuous and he was right hand dominant. He pointed out that it was his personal physician's opinion that he should not return to work.
Prior to considering the claimant's appeal, Review Office sought the medical advice of a WCB orthopaedic consultant. On January 19, 2004, the consultant advised Review Office that the diagnoses of superficial abrasion to the right/forearm and neuropraxia sensory branch radial nerve were consistent with the mechanics of the work accident. He was also of the view that the diagnoses of carpal tunnel syndrome and cubital tunnel syndrome did not arise out of the July 2003 compensable event.
In a decision dated January 23, 2004, Review Office agreed with the WCB's orthopaedic consultant that no responsibility could be accepted for the right carpal tunnel syndrome or cubital tunnel syndrome as these conditions did not arise out of the compensable event. Review Office considered the neurologist's opinion that the prognosis for improvement was favorable with respect to the radial sensory nerve lesion and that no treatment was suggested. Review Office also considered the opinion of a WCB medical advisor who reported that the injury to the radial sensory nerve would have 'no effect on function or muscle strength, and …he should be fit for regular duties." Review Office concluded that the claimant was not entitled to benefits beyond November 12, 2003 as there was no information to substantiate that his loss of earning capacity after that date was related to the compensable radial sensory nerve injury.
In July 2004, a worker advisor, acting on behalf of the claimant, appealed Review Office's decision of January 23, 2004 and submitted a report from the treating physician dated July 7, 2004. In his report, the physician outlined his view that the claimant was unable to return to his previous job and work site and that the claimant was fit for alternative work which did not require use of his right upper limb in a forceful and repetitive pattern. On September 15, 2004, an oral hearing was held to consider the claimant's appeal.
Reasons
As the background notes indicate, the claimant caught his hand in a piece of machinery that resulted in a knife cut across the volar aspect of his right wrist. According to the treating neurologist, the claimant "continues to experience numbness over the dorsal radial aspect of the right wrist and hand as well as the dorsal aspect of the thumb. This is associated with pain which radiates from the thumb up to the elbow on the lateral aspect of his forearm. These symptoms are increased with the use of the arm."At the hearing, we were provided with considerable evidence and detail with respect to the claimant's job duties. In particular, we took special notice of the claimant's inability to use impact tools, his difficulties with using ratchets, screwdrivers and hammers together with the loss of his fine motor skills in the first three fingers of his dominant right hand. According to the claimant's oral evidence, these residual difficulties severely impacted on his ability to work in visually concealed areas, which required him to reach and stretch in awkward positions.
The WCB's decision to terminate the entitlement to benefits was primarily based on a medical advisor's opinion that the claimant's neuropraxia (i.e., radial sensory nerve lesion) would not preclude his returning to regular duties as a farm equipment mechanic. In arriving at our decision, however, we preferred to attach more weight to the medical opinions expressed by the claimant's treating neurologist and attending physician.
- April 19, 2004 letter to the attending physician from the treating neurologist - "The clinical picture remains most consistent with a right radial sensory nerve lesion and a right carpal tunnel syndrome. I strongly believe that the aforementioned radial sensory nerve lesion is work related and secondary to the incident of July 2003. I do not believe that the majority of his symptoms are necessarily related to the identified carpal and cubital tunnel syndrome."
- July 7, 2004 letter to the claimant's worker advisor from the attending physician - "The bottom line is that this gentleman sustained a work-related injury to his wrist which was diagnosed as a neuropraxia (sensory and motor dysfunction of the nerve). Unfortunately, the injury has not resolved. What this means is that he is not fit to return to his previous job and work site, however, he is fit for alternative work in which he does not use his right upper limb in a forceful and repetitive pattern."
Panel Members
R. W. MacNeil, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
R. W. MacNeil - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 19th day of October, 2004