The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on June 7, 2005, at the request of a union representative, 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

On November 5, 2002, the worker contacted the call centre at the Workers Compensation Board (WCB) to report difficulties that she was experiencing with both arms and hands that she related to her work activities as a healthcare aide/paramedic. In May 2001, the worker stated that she began to drop things and experienced a constant throbbing pain in both wrists. She sought medical treatment in August 2001. The worker noted that she was right hand dominant and that she continued to perform her regular duties despite her ongoing difficulties. She said that her doctor related her bilateral carpal tunnel syndrome (CTS) and ganglion to 27 years of employment.

In a memo to file dated November 20, 2002, a WCB adjudicator II outlined the work duties of a healthcare aide and a casual paramedic as described by the worker. The adjudicator also obtained information regarding the worker's past/current medical history/treatment, extra-curricular activities, etc.

On December 9, 2002, primary adjudication referred the case to a WCB medical advisor to review the file and to comment on a diagnosis and whether it was related to the worker's employment activities. In a response dated December 11, 2002, the medical advisor diagnosed the worker with bilateral CTS which he felt was unrelated to her employment activities. He stated, "…on a balance of probabilities, other factors have been identified - - smoking, obesity, bilateral and diffuse musculoskeletal problems…"

In a December 18, 2002 decision, the worker was advised that her claim for compensation was denied. Based on a review of the worker's job duties together with her pre-existing, non-work related risk factors associated with CTS and the opinion expressed by the WCB medical advisor, the adjudicator stated he was unable to establish a relationship between the worker's current condition and her employment activities.

On September 22, 2004, a union representative appealed the adjudicator's decision to Review Office on behalf of the worker. The union representative asked Review Office to consider the job duties that the worker performed which included awkward positioning of the hands and wrists along with lifting, pushing, pulling, gripping, etc. The union representative stated that he had reviewed the medical section of the claim and failed to identify a pre-existing factor. The union representative believed that the worker suffered a workplace incident/accident that arose out of the course of her employment and that the claim should be accepted.

In a decision dated January 20, 2005, Review Office confirmed that the claim for compensation was not acceptable. Review Office noted that the worker had numerous risk factors that could lead to CTS, i.e. bilateral adhesive capsulitis of both shoulders, bilateral patellofemoral pain in her knees, a possible sleep apnea, diagnosis of fibromyalgia and bilateral CTS. There were other risk factors such as obesity, smoking, gender and age. Review Office believed that the non-work related risk factors outweighed the possible work-related risk factors. In February 2005, the worker's union representative disagreed with Review Office's decision and an oral hearing was arranged.

Reasons

The Panel was asked to determine whether the worker's claim is acceptable. For the appeal to succeed we must find that the worker's medical condition, bilateral CTS, was caused by the worker's employment duties. We did find on a balance of probabilities that the worker's medical condition was caused by her duties.

Argument and Evidence at Hearing

The worker attended the hearing with her union representative who made a presentation on her behalf. The worker answered questions posed by her representative and the Panel. The employer was represented at the hearing by an advocate who made a presentation on behalf of the employer.

The worker advised that she has been employed as a healthcare aide for 29 years. At the time of the injury she was working in the acute hospital wing of a healthcare facility which accommodates 10 to 12 patients. She described her duties which are performed over a 12 hour shift and include turning bedridden and sleeping patients, assisting patients with self care and toileting, changing incontinent patients, feeding and dressing patients. She described the arm, hand and wrist actions involved in these duties. She also described the duties she performed as a paramedic and the aspect of the duties which she thought contributed to her CTS.

The worker's union representative reviewed the medical evidence which confirmed that the worker has CTS. He submitted that the worker's job duties involve repetitive gripping, pinching, and wrist movements with flexion and extension. The union representative disagreed with the Review Office decision that the worker has other risk factors which are more likely the cause of her medical condition.

The employer's representative noted that a WCB healthcare advisor provided the opinion that the worker's condition was not work related and that the worker has many non work-related and pre-existing factors which could be contributing factors to the worker's condition. He noted the WCB has found that the worker's duties were not sufficiently repetitive to cause the condition. He advised that the employer does not disagree with the Review Office decision.

Analysis

Having considered all the evidence we find on a balance of probabilities that the worker's claim is acceptable. In doing so, we have determined that the worker sustained a personal injury by accident as provided in subsection 4(1) of The Workers Compensation Act (the Act).

We find that the worker's CTS was caused by her employment duties. At the hearing the worker provided a detailed description of her job duties. She indicated that she is the only healthcare aide on the floor at any given time dealing with up to 12 patients, many of whom are incontinent and unable to move without assistance. The worker must turn the patients on their sides, dress the patients, change those who are incontinent and remove wet soaker pads. The evidence confirmed that these duties involve awkward positioning of the wrist and hands and the use of high force. There is significant use of wrists in lifting, pulling, pushing, twisting and use of the hands in forceful gripping and pinching. There is also mechanical stress and force in changing the soaker pads, bathing, moving and turning patients. While the worker's condition is bilateral, we note that her employment duties are performed with both hands.

We acknowledge that the worker may have other risk factors for the development of CTS which are not work related, but find, on a balance of probabilities, that the worker's employment duties are more likely the cause of her condition.

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 21st day of July, 2005