The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on June 16, 2005, at the request of the 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.

Background

On April 15, 2004, the worker contacted the Workers Compensation Board (WCB) to report an injury involving both her wrists which occurred on July 2, 2003. The worker stated that repetitive keyboarding had caused the symptoms of numbness in her fingers and pain in the palm of both hands. She stated that she first noticed symptoms in the summer of 2003 while cleaning her sun room windows. She went on holidays for 3 weeks in late August, early September. Her symptoms didn’t seem to be bothering her until she returned to work. She wasn’t sure what was causing her symptoms and thought maybe she just slept funny. The worker noted that she had been in her current position for the past 7 years but over the last couple of years, there had been less writing and more keyboarding required.

The employer’s accident report confirmed an accident date of July 2003. The report stated that the worker’s symptoms had begun after she was required to type more and that she was experiencing these symptoms at all times of the day and night.

On February 5, 2004, the worker was seen by a neurologist who reported that she had been symptomatic for the past six months. He stated that it was much worse on the right side although the worker was left handed. Nerve conduction studies confirmed a diagnosis of moderate carpal tunnel syndrome on the right and mild on the left.

On July 20, 2004, primary adjudication contacted the worker to gather more information. The worker advised that she worked full time at her current employment but also worked casually as a nurse, 2 shifts per month. It was noted that the worker had no problems with her wrists while nursing for 22 years previously and that the problems with her wrists started after her current job required her to type more. The worker indicated that in her role as a nurse, she was not required to perform any physical work.

In a decision letter dated July 20, 2004, primary adjudication advised that the WCB was unable to accept responsibility for the worker’s wrist injury. After considering the employment activities and after reviewing an ergonomic assessment report, it was felt that a relationship between the development of her bilateral wrist difficulties and an accident arising out of and in the course of her employment could not be established.

In January 2005, the WCB received an appeal submission from the worker’s union representative asking that Review Office reverse the decision to deny this claim. The union representative provided the WCB with a letter from the worker’s team leader indicating that over the past year and a half, the worker’s job had changed. The letter stated that the job now requires 50 – 60% keyboarding as there had been a decrease in the amount of documents that had to be hand written.

In a decision dated January 21, 2005, Review Office determined that the claim was not acceptable. They stated that following their review of all information, the worker had not sustained personal injury by an accident arising out of and in the course of her employment.

On April 4, 2005, the worker’s union representative appealed Review Office’s decision and an oral hearing was convened before an Appeal Panel on June 16, 2005.

Reasons

Chairperson Walsh and Commissioner Day:

The worker has been diagnosed as suffering from carpal tunnel syndrome in both wrists. She testified at the hearing of this appeal that although symptoms showed up in both hands at about the same time, in the summer of 2003, the symptoms in her right hand were much more severe. In May of 2004 the worker had carpal tunnel surgery performed on her right hand. She has since returned to work. She testified that subsequent to the surgery, the problem in her right hand has been corrected. She continues to have symptoms in her left hand which are gradually worsening but because her left hand is her dominant hand she is holding off having surgery on that wrist although such treatment has, she testified, been recommended by the surgeon who performed the operation on her right hand.

In her appeal before this Panel, the worker submitted that the bilateral carpal tunnel syndrome she experienced was directly related to her employment. Specifically, her position was that keyboarding overuse, along with an awkward wrist position caused injuries she sustained during the course of her employment.

In describing her employment duties at the time her symptoms began, the worker testified that almost her whole day was spent doing typing and correspondence. She testified that even phone conversations with clients, which could take 15 - 20 minutes had to be recorded by typing contemporaneously in order to comply with the computer template supplied by her employer.

The worker also testified that during the course of the work day she used her right hand to answer the phone and to operate the mouse. Her job duties required a significant amount of scrolling up and down using the mouse.

Of further significance was the worker's evidence regarding an ergonomic assessment that was carried out in her department in October of 2001. Prior to that ergonomic assessment the worker testified that she had not had any problems with her wrists. As a result of that ergonomic assessment, the arms on the worker's chair were removed. Although the written report which was produced as a result of that ergonomic assessment suggested that adjustable arm rests ought to have been reinstalled, no arm rests were ever attached during the period in which the worker developed the symptoms of carpal tunnel syndrome. The arm rests were only reattached on the advice of the worker's family physician. This occurred in October of 2003, after the worker began experiencing the symptoms which were ultimately diagnosed as being carpal tunnel syndrome.

The worker testified that the removal of the arm rests resulted in an abnormal flexion or extension position of her wrists. Prior to the removal of the arm rests the worker testified that her wrists were fairly flat when she was working because she had something to rest her arm on. Once the arm rests came off, however, she testified that she was in a position where her elbow dropped down and her wrist position was such that her hand was actually hyper-extended.

The worker testified that she experienced symptoms at work particularly when she was on the phone. She would find that her fingers and palm were sore. Depending on how much time she spent typing and on the phone she would find she would have to stop and shake her hands to give them a rest.

The worker also testified that in the spring of 2003 her job duties changed such that the amount of typing she was required to do significantly increased. The worker's employer confirmed in a letter dated August 27, 2004 that over the past 1.5 years co-workers having the same job description as the worker had been required to substantially increase the amount of keyboarding performed during the course of their work. This included the elimination of any handwritten summary assessments and the typing of all documentation pertaining to client conversations. In that letter, the employer went on to advise that the worker's job description involved 50-60% of time spent keyboarding. For the worker in particular this represented a significant increase because she had previously been in the habit of handwriting summaries of her client's applications and telephone conversations.

The worker also testified that she worked over 20% additional hours throughout the period from 1999 to 2003. The reason for this overtime was to deal with the backlog situation which occurred as the result of the changes made to the job description by her employer. The worker testified that her employer's requirements meant that there was additional work without additional resources. Her record of employment confirmed that from 2001 through 2003 the worker worked a considerable amount of overtime. She believed that the increase in keyboarding and significant overtime spent at work, all of which occurred after the arm rests were removed from her chair, caused the carpal tunnel syndrome to develop, bilaterally.

With respect to non-work related potential causes of carpal tunnel syndrome, upon being questioned by the Panel, the worker testified that she has never had a home computer and has therefore not done any typing outside of her work requirements. She further testified that she has never been pregnant. She does not suffer from diabetes, hyperthyroidism, arthritis or skeletal injury. She does not smoke and is not obese. She has worked as a nurse for 20-25 years and has never had a problem with her wrists. She does not knit or crochet.

As part of her submission, the worker relied on information provided by the MFL Occupational Health Centre Inc. which provides, among other services, information regarding occupational injury and disease. According to a publication of that organization dated September 2003, risk factors of repetitive strain injury include: high repetition – doing the same type of work for the duration of the day; continually using the same limbs or muscle groups; and working in awkward positions where wrists are bent in order to use tools.

The worker's representative at the hearing submitted that all of these risk factors took place during the period leading up to the diagnosis of the worker's repetitive strain injury.

The worker's submission also cited Bulletin No. 200 produced by Workplace Safety and Health Division, Manitoba Labour and Immigration. That bulletin, dated February 2003, described the following risk factors for repetitive strain injury "As the repetition rate increases, muscle contractions become more rapid and frequent. Tasks with high repetition can be damaging even if the required forces are minimal and normally safe." The publication goes on to discuss working in awkward positions: "rotating the wrist, and bending the wrist forward, backward or to the side" as significant factors in increasing the risk of an injury. It was submitted on behalf of the worker that her job duties required a high number of repetitions performed while her wrists were placed in an awkward position and that this led to the development of carpal tunnel syndrome.

The angle at which the worker's wrists were placed once the arm rests were removed from her chair was confirmed by the photographs the worker tendered as exhibits during the course of her hearing. These photographs showed the worker seated at her workstation with her wrists placed at an angle to her keyboard.

As a federal government employee, the worker's claim for compensation falls under the requirements of the Government Employees Compensation Act R.S.C. G-8 ("GECA").

GECA determines eligibility for compensation benefits for employees falling within its jurisdiction. Under an agreement with the Federal Government, GECA is administered in Manitoba by the Manitoba Workers Compensation Board ("WCB").

Subsection 4(1) of GECA states that compensation shall be paid to an employee who is caused personal injury by an accident arising out of and in the course of his employment.

"Accident" is defined in section 2 of GECA as including "a willful and intentional act, not being the act of the employee, and a fortuitous event occasioned by a physical or natural cause."

According to WCB policy 44.05.10, the definition of "accident" in the Act will be given a broad interpretation to include "the gradual onset of a personal injury, including an injury resulting from a gradual process or repetitive injurious motion …".

The evidence disclosed that the worker's symptoms arose after a period of time during which her employment demands required a substantial increase of keyboarding and use of the computer mouse. Coincidental with this increase in computer workload, the arm rests from the worker's chair were removed causing her wrists to be placed in an awkward position.

We are satisfied, based on the totality of the evidence that these employment related factors combined to cause the worker to develop bilateral carpal tunnel syndrome. We find, therefore, that the claim is acceptable.

Panel Members

S. Walsh, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

S. Walsh - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 29th day of July, 2005