The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on December 9, 2004, 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 the claim is acceptable.

Decision

That the claim is acceptable.

Decision: Unanimous

Background

In February 2002, the worker filed a claim with the Workers Compensation Board (WCB) for right arm and hand difficulties that she related to the nature of her employment activities as an accounts payable clerk which included daily computer, mouse and calculator usage along with stamping. The date of accident was reported as being December 15, 2001 and was reported to the accident employer on January 25, 2002.

Medical information on file diagnosed the worker with bilateral carpal tunnel syndrome (CTS) which was confirmed by nerve conduction studies.

On April 4, 2002, a WCB adjudicator spoke with the worker and gathered additional information concerning the onset of her symptoms, a complete description of her job duties along with information regarding her general health and medical treatment that she received.

On April 11, 2002, the employer confirmed the worker's job duties and desk set up to a WCB adjudicator. The employer noted that the worker's computer desk was approximately 2-3 inches lower than her desk. He felt that the worker used her calculator more than one hour per day and he confirmed the change in her job duties, i.e. increased stamping starting in August/September 2000.

The case was reviewed by a WCB medical advisor on April 11, 2002. The medical advisor was of the opinion that the worker's employment activities would not be the cause of her CTS condition.

In a decision dated April 12, 2002, the WCB denied the claim for compensation as it was unable to establish a relationship between the worker's right arm and hand difficulties and an accident arising out of and in the course of her employment.

On May 29, 2002, a worker advisor asked the WCB to reconsider its decision of April 12, 2002. The worker advisor contended that the worker's current diagnosis was directly related to her work duties and therefore her claim should be accepted. In support of her position, reference was made to the following commentary contained in a report by the treating physician dated May 10, 2002:

"In my medical opinion, the current diagnosis of Ms. [the worker's] right hand and arm condition is mainly carpal tunnel syndrome as well as flexor tendonitis."

"However she does have to stamp invoices more than 100 times a day and this involves forceful gripping of the stamper. I think this could cause carpal tunnel syndrome in her right hand. The repetitive work would also cause the tendonitis. …I am not aware of any pre-existing condition effecting (sic) her right arm and hand."

On July 10, 2002, a WCB medical advisor reviewed the above medical information and stated, "I don't think gripping the stamper involves a lot of force."

In a further decision dated August 14, 2002, the WCB confirmed that it was unable to establish a relationship between the worker's work duties and the development of her right arm and hand difficulties.

The case was again reviewed by a WCB medical advisor on September 17, 2002. The medical advisor noted there was no mention of flexor tendonitis until a physiotherapist reported it on March 4, 2002. The medical advisor believed that the worker's keyboarding may be repetitive but it was done without any resistance and her wrist was in a neutral position. He felt that this type of activity had not been shown to cause wrist tendonitis. With regard to stamping, i.e. 100 times per day, the medical advisor said it was less than 20 times per hour and this would not be repetitive in his opinion.

On October 17, 2002, a WCB rehabilitation specialist completed a work site assessment to review the physical demands of an accounts payable clerk. The results of the work site visit are contained in a memo dated November 22, 2002.

Following consultation with a WCB medical advisor on December 5, 2002, the WCB informed the worker advisor that no change would be made to the earlier decision of April 12, 2002. After reviewing all the file information including the work site assessment, the medical advisor's opinion remained the same.

In a submission to Review Office dated January 2, 2003, the worker advisor appealed the WCB's decisions of April 12, 2002 and December 17, 2002.

On February 21, 2003, Review Office determined that the claim was not acceptable. Review Office found that the worker's job was reasonably repetitive, with moderate volumes of typing on a keyboard and a variety of tasks that take her away from computer use. Review Office was of the opinion that there was no evidence of sustained abnormal posturing of the wrist, and there was good positioning of the worker's wrists when carrying out tasks. There was minimum mechanical stress and force on her hands/wrists. On a balance of probabilities, Review Office concluded that the worker's CTS condition was not work related and did not meet the tests required by subsection 4(1) of The Workers Compensation Act (the Act). On October 12, 2004, the worker advisor appealed Review Office's decision and an oral hearing was arranged.

Reasons

The issue before us was whether the worker's claim is acceptable. For this appeal to be successful we must find a relationship between the worker's right arm and hand difficulties and her work duties. We did find that the worker's work duties aggravated her pre-existing right CTS and that accordingly her claim is acceptable.

Evidence at the Hearing

The worker was represented by a worker advisor who made a presentation on behalf of the worker. The worker also answered questions posed by her representative and the Panel. The employer was represented by its human resource manager.

The worker outlined her past and current jobs with the employer. She noted that prior to July 2000, her duties were primarily supervisory, but after this date she became the sole staff person in the accounts payable department and her duties became more clerical.

She stated that she first noticed symptoms in her right arm and hand after the change in job duties in July 2000. She identified the duties which she considered to have caused her condition.

Although surgery had been considered, the worker advised that she has not had surgery and that her condition may have improved. She is hopeful that with physiotherapy treatments her condition will improve more and surgery will not be necessary. She also advised that in October 2001 another staff person joined the department and shares the duties. This has reduced the physical demands on the worker. As well, there have been some minor ergonomic adjustments to her work station.

The worker advised that although she had been diagnosed with bilateral CTS, she has not had any problems with her left arm and hand. She advised that she is right handed and performs most duties with her right hand.

The worker's representative reviewed the evidence and offered the opinion that the weight of evidence, including medical opinions, supported the view that the worker's right CTS was caused by her work activities. She noted that a WCB rehabilitation specialist conducted a worksite assessment and identified a number of risk factors in the worker's duties which can lead to the development of CTS, including repetitive motion, excessive grasping forces, exposure to compressive forces and awkward constrained postures. The representative noted that the worker has not missed work and is seeking medical aid expenses.

Analysis

The worker has been diagnosed with bilateral CTS while the evidence at the hearing was that the worker is right handed and performs most duties with her right hand. The evidence does not establish that the work duties caused the worker's bilateral CTS. In assessing the evidence we find, on a balance of probabilities, that the worker's bilateral CTS is not caused by the worker's work duties but rather is a pre-existing condition. We do not make any determination as to the cause of the pre-existing condition. However, this does not conclude the matter. We note the worker first experienced symptoms after her job duties changed in July 2000. We find that the duties performed after this date aggravated the worker's pre-existing right CTS, and that the claim is acceptable as an aggravation of a pre-existing condition in accordance with WCB Policy 44.10.20.10, Pre-Existing Conditions.

The nerve conduction studies performed on February 25, 2002 confirm the worker suffers from bilateral CTS, mild on the left and moderate on the right. The difference between the two wrists is consistent with our finding that the right wrist condition has been aggravated by work duties.

We note the opinion of the WCB medical advisor in a memo dated April 11, 2002 that the worker's work activities would not cause CTS. While we agree the work activities would not cause the worker's CTS, we find, on a balance of probabilities, that the activities aggravated the pre-existing CTS.

We also note the worksite assessment prepared by the WCB rehabilitation specialist which identified several elements of the worker's duties which are risk factors for the development of CTS. While we did not find that the work duties caused the worker's CTS, we believe the risk factors noted in the worksite assessment aggravated the worker's right CTS. The risk factors identified by the rehabilitation specialist included repetitive motion, excessive grasping forces, exposure to compressive forces to the palm structures and awkward/constrained postures that in some instances were prolonged. The worksite assessment also found that the worker's workstation was not conducive to neutral postures or limiting exposures to muscle loading of upper limbs. We find there was sufficient forceful gripping, pinching, along with awkward wrist movements to aggravate the right CTS. We also find that the worker's left wrist was not subject to these risk factors.

In arriving at the conclusion that the worker's condition has been aggravated we note:

• The worker's symptoms first arose in 2000 and she has continued to work at the same duties without need for extended absence from work or wage loss.
  
  
• Surgery was recommended but has not been performed and the worker has continued to work without a worsening of symptoms. The worker advised that with physiotherapy her condition appears to have improved.
  
  
• The worker is no longer taking medication for the condition and has reduced the use of splints both at work and at home.

The worker's appeal is allowed.

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 11th day of January, 2005