The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on May 19, 2005, at the request of a worker advisor, acting on behalf of the worker. The Panel discussed this appeal on the same day.

Issue

Whether or not responsibility should be accepted for the worker's recurrence of symptoms occurring in June 2004, the proposed treatment and time loss from work and the suggested graduated return to work program.

Decision

That responsibility should not be accepted for the worker's recurrence of symptoms occurring in June 2004, the proposed treatment and time loss from work and the suggested graduated return to work program.

Decision: Unanimous

Background

In May 2000, the worker submitted a claim to the Workers Compensation Board (WCB) for injuries to both forearms which she related to the repetitive nature of her employment activities as a telephone operator. The initial diagnosis rendered was "extensor tendonitis bilat. forearms". The claim was accepted by the WCB and wage loss benefits were paid to the worker commencing October 12, 2000.

On January 12, 2001, the worker underwent a hand grip evaluation at the WCB to determine her capabilities. The report indicated that the worker passed 1 of 3 validity checks.

On January 12, 2001, the worker was assessed by a WCB medical advisor. He concluded that there were insufficient objective findings to establish a diagnosis of tendonitis involving the forearms or wrists, including the extensor, flexor or de Quervain's tendonitis. It was suggested that the worker undergo nerve conduction studies to evaluate median nerve conduction across the carpal tunnels.

A report was received from an independent medical consultant dated January 29, 2001. The consultant stated, "I have not found evidence of an autoimmune nor inflammatory nor arthritic disorder. Historically, her description fits with the so called repetitive strain injury, which at this time appears substantially improved."

On February 6, 2001, the WCB advised the worker that wage loss benefits would be paid to February 9, 2001 inclusive as there was no medical evidence to support total disability from her work activities.

On February 19, 2001, a neurologist advised the treating physician that nerve conduction studies were completely normal as was his neurological examination of the worker.

In August 2003, the worker advised the WCB that she had been experiencing ongoing difficulties with her arms and hands that started approximately three months ago. Effective September 10, 2003, the WCB paid the worker full wage loss benefits on the basis of a recurrence.

On October 27, 2003, a physical medicine and rehabilitation specialist examined the worker and reported that she had "very minimal findings...". The specialist recommended "functional restoration" rather than interferential treatments.

Progress reports were received from the worker's treating physiotherapist.

In October 2003, the worker returned to alternate duties, but had to stop due to ongoing difficulties. In December 2003, the worker began another graduated return to work program (GRTW) commencing one hour per day.

On February 20, 2004, a WCB medical advisor reviewed the file information and concluded that the current compensable diagnosis was "probable repetitive strain extensor tendonitis both forearms."

On April 29, 2004, the worker was examined by a WCB physical medicine and rehabilitation consultant. There were no abnormal findings noted on the examination and he recommended that the worker continue her return to work program with a view to returning to full regular work duties. He also recommended that the worker continue to take her regular scheduled breaks and that no physical restrictions were required. There was no indication for any further specific investigations or treatment.

In a report dated May 4, 2004, a specialist stated that acupuncture treatment had improved the worker's symptoms and that she should work as little as possible while receiving this treatment.

The worker's graduated return to work program ended on May 14, 2004 and she returned to full regular duties. On June 2, 2004, the WCB confirmed that wage loss benefits were paid up to and including May 14, 2004 inclusive and final.

On June 8, 2004, the family physician advised the WCB that the worker's subjective complaints resurfaced since she returned to her full regular duties. The physician recommended that the worker remain off work for the next six weeks and then return to a graduated return to work not exceeding four hours per day. On June 18, 2004, primary adjudication determined that the family physician's report contained no findings to change the WCB's opinion that the worker was fit to complete the GRTW program and that no further investigations, treatment, or restrictions were required. Accordingly, primary adjudication refused to extend further wage loss benefits or services.

On June 22, 2004, a worker advisor requested reconsideration of the WCB's June 18, 2004 decision. The worker advisor referred to the medical reports on file dated May 4, 2004 and June 8, 2004. The worker suggested that she had a recurrence of her compensable hand, wrist and forearm symptoms and that the WCB should provide coverage for time loss and medical expenses during her treatment, recovery and gradual return to work.

On October 28, 2004, primary adjudication clarified that the June 8, 2004 medical report had been reviewed to determine if a recurrence of her prior difficulties had occurred. As the report contained no medical findings that would support a recurrence, no change would be made to the WCB's decision that the worker was not entitled to further wage loss benefits or services.

On October 29, 2004, the case, including a submission from the accident employer's advocate, was considered by Review Office. Review Office determined that no responsibility would be accepted for the worker's recurrence of symptoms, for any proposed treatment or time loss, or the suggested graduated return to work program. Review Office made reference to a number of medical reports on file and concluded that the worker's subjective complaints did not constitute evidence of disability.

Subsequent to the above decision, a report was received from an occupational health physician dated October 20, 2004. On December 14, 2004, the worker advisor asked Review Office to consider this report and to accept responsibility for the worker's recurring forearm and hand symptoms and provide coverage for time loss and recommended treatment.

On February 25, 2005, Review Office considered the report from the occupational health physician as well as a submission from the employer's advocate dated February 14, 2005. Review Office determined that no change would be made to its earlier decision of October 29, 2004. In Review Office's opinion, the worker's symptoms were subjective and were not supported by objective evidence. In March 2005, the worker advisor appealed Review Office's decision and an oral hearing was arranged.

Reasons

As outlined in the background notes, the claimant was examined by her treating physical medicine and rehabilitation specialist on October 27, 2003 because of persisting pain and numbness in both of her hands. The specialist reported the following examination findings to the attending physician:

“She had slight tenderness on the forearm over the supinator and the brachioradialis but with no referred pain. She did not have any tenderness over the wrist tendons on the dorsal or the volar aspect. Resisted supination and pronation of her forearm did not cause her any pain. Resisted extension of her wrist did not cause her any pain. The roll-up test was negative. Stressing extensor tendons did cause her any (sic) discomfort. She had good strength of her hand muscle as well (sic) her forearm and upper limb muscles. She did not have any evidence of any atrophy of her muscles. There was no evidence of carpal tunnel syndrome or ulnar neuropathy. Impression is that she has very minimal findings but seems to have much more impairments.”

Minimal objective medical findings prompted the WCB to arrange a call-in examination of the worker in order to obtain a history from her as well as to examine her forearms/elbows. The worker was examined by the WCB’s physical medicine and rehabilitation consultant on April 29, 2004. We note in particular the following findings recorded by the consultant.

“The file suggests no evidence on any investigations including neurologic, and no electrophysiologic evidence of any evidence of carpal tunnel syndrome. On the current clinical examination there was no evidence of any neurologic involvement. This was entirely within normal limits. There has also been a rheumatologic review with no evidence of any rheumatologic condition or inflammatory arthritis identified.

On the current clinical examination there were no objective findings identified on the current screening musculoskeletal examination.

There was no pathoanatomic diagnosis identified to explain the subjective sensitivity to pressure diffusely present in the soft tissues.

There does not appear to be any contraindication for her continuing on a return to work process back to her full regular duties. There does not appear to be any indication for any further specific investigations or treatment. There does not appear to be any rationale for maintaining any further restrictions.”

The file evidence confirms that the worker’s undiagnosed or non-specific complaints have not prevented her from working full time at her regular duties. She has not incurred any time loss or received specific medical treatment over the past eleven months. Based on the weight of evidence we find that the worker had, on a balance of probabilities, recovered from the effects of her compensable injury as of May 14, 2004. With respect to the worker’s particular absence from work on June 18, 2004, we note that there had been no change in her clinical findings to suggest a recurrence. In addition, the worker did in fact return to work on a continuous basis the next working day.

After having considered all of the evidence, we find that responsibility should not be accepted for the worker’s recurrence of symptoms occurring in June 2004, the proposed treatment and time loss from work and the suggested graduated return to work program. Accordingly, the worker’s appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

R.W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 5th day of July, 2005