The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on September 20, 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 the condition of carpal tunnel syndrome is related to the 1999 workplace injury and/or to the more recent employment duties.

Decision

The worker's carpal tunnel syndrome is not related to the 1999 workplace injury and/or to the more recent employment duties.

Decision: Unanimous

Background

On February 10, 1999, the worker filed a claim with the Workers Compensation Board (WCB) for right wrist difficulties that she attributed to her work activities.

The Employer's Report of Injury dated February 10, 1999 indicated that the worker advised her supervisor that she injured her hand but did not know from what. She stated that her hand was sore and she was going to see a doctor. This was on February 2, 1999.

Initial medical reports showed that the worker was treated on January 31, 1999 and again on February 2, 1999. The first physician diagnosed the worker with soft tissue inflammation R wrist possibly due to overuse. The second physician's diagnosis was "soft tissue injury R hand".

On February 16, 1999, x-rays of the right wrist and thumb revealed no fracture or other abnormality of the right wrist. The right thumb revealed tiny osteophytes at the IP joint consistent with minimal degenerative changes.

A WCB medical advisor examined the worker on May 19, 1999 to establish the worker's current medical status and functional capabilities. The medical advisor reported that the worker was struck by a piece of metal on January 30, 1999 while performing her work duties. She began to experience swelling and pain in the area of the dorsal right thumb and first metacarpal area. Based on his examination findings and the worker's history, the medical advisor felt that the worker likely contused the base of her right thumb in the area of the first MCP joint at the time of her workplace incident. She may have had a De Quervain's tenosynovitis at that time. The medical advisor concluded that the worker could return to work with restrictions with a further review in 4 to 6 weeks time.

In a decision dated August 6, 1999, the worker was advised of the WCB's opinion that she was fit to return to her regular part-time job and that wage loss benefits would be paid to July 28, 1999 inclusive and final.

In December 2001, the worker contacted the WCB to indicate that she was having further difficulties with her right hand. The WCB then contacted the worker's treating physician to obtain additional medical information.

In a report to the family physician dated January 8, 2002, a sports medicine specialist noted that the worker's right hand had been worse for the last 5 months and that the worker was currently unemployed. Examination revealed evidence of De Quervain's tenosynovitis of the right wrist. Treatment suggestions included wrist splint, physiotherapy and medication.

On February 25, 2002, the WCB informed the worker that the WCB could find no causal connection between her current wrist difficulties (De Quervains tenosynovitis) and her compensable right wrist injury (a contusion) of January 30, 1999. The adjudicator indicated that the worker did not seek treatment for her De Quervain's tenosynovitis until December 17, 2001 which was four months after she terminated her employment with the accident employer.

On April 25, 2003, the worker filed a claim with the WCB for a right wrist injury that occurred during the course of her employment as a customer service representative on November 1, 2002 (reported to the employer on April 22, 2003). The worker indicated that the delay for reporting was because she felt the pain would go away but the pain became worse. The worker described the accident as follows:

"Constantly doing repetitive work. The work involves: taking in the dry cleaning, document information on paper and keying info in the computer. I also ticket the clothing with a danison gun. The clothing at times have to be pinned with pins. I also take the full bags (20 lbs each bag) and tie them up and move them to the side. I started working for this firm in about 1999. I worked for two years and then I took a break for one year. I did not work from about July 17, 2001 to my return to work date of July 17, 2002. I did not work for full year, I collected EI. Total years worked with this firm are 3 years doing same duties."

The Employer's Accident Report dated April 29, 2003 indicated that there was no specific accident reported by the worker, only that she had carpal tunnel syndrome in her right wrist. It was unknown whether this was work related.

In a telephone conversation on May 1, 2003, the worker advised a WCB adjudicator that she was a diabetic for 12 years and smoked for 20 years (.5 pack). The worker provided a detailed explanation with regard to her daily activities as a customer service representative. On May 13, 2003, the adjudicator spoke with the accident employer and obtained further information concerning the number of invoices processed in a day on average, the size of shipments and the amount of repetition that was involved in the worker's job activities.

Medical information that was submitted by an internal medicine resident dated November 28, 2002 showed that the worker was treated in the rheumatology clinic regarding arthritis in her hands. The worker was diagnosed with undifferentiated arthritis and carpal tunnel syndrome, worse on the right.

On June 9, 2003, primary adjudication asked a WCB medical advisor to review the file information and to comment on the current diagnosis and whether or not there was a cause and effect relationship between the diagnosis and the work duties performed by the worker.

In a decision dated June 10, 2003, the worker was advised of the WCB's position that it was unable to establish that an accident, in accordance with the WCB's definition of an accident, had taken place or that the worker's right wrist symptoms were caused by her employment activities. This decision was based on the following factors:

• the employer was not aware that the worker was having problems with her wrist until April 23, 2003;
• the worker had pre-existing medical conditions of diabetes and arthritis;
• the work duties performed by the worker were not considered to be highly repetitive in nature;
• the opinion expressed by the WCB medical advisor on June 9, 2003 that the worker's symptoms were more probably due to underlying medical and non-work related risk factors other than her employment.

On November 28, 2003, a worker advisor appealed the above decision to Review Office. The worker advisor argued that the weight of evidence confirmed a causal relationship between the worker's right wrist CTS to the 1999 workplace injury and her more recent work duties. It was felt that the worker's right CTS was enhanced, as defined by WCB policy, and that the WCB must accept full responsibility.

In a decision dated February 27, 2004, Review Office confirmed that the worker's right CTS was not related to her 1999 workplace injury or to the more recent work activities. Review Office based its decision on the following factors:

• the worker's job duties were part-time and she was working at slower locations;
• the job duties involved occasional movements of the wrist but did not require high force repetitive activity;
• the worker had diabetes, hypothyroidism and was a smoker;
• the worker may have sustained a blow to the right wrist but there was no skeletal injury;
• medical testing confirmed a diagnosis of bilateral CTS;
• rheumatology reports indicated significant increase in blood tests confirming an active arthritic condition.

On December 14, 2004, the worker advisor asked Review Office to obtain new information from a rheumatologist which proved that the worker was injured at the time of her 1999 workplace injury. Review Office subsequently obtained a report from a rheumatologist dated January 18, 2005. This report was forwarded to the worker advisor for comment.

On March 18, 2005, Review Office confirmed that the worker's right wrist difficulties were not related to the 1999 workplace injury and/or the worker's more recent work duties. In Review Office's opinion the worker's part-time work duties from September 1998, including two weeks of full time duties, were insignificant when compared with the significant difficulties she was having related to her insulin-dependent diabetes which caused episodes of falling while in a hypoglycemic state. Review Office also noted that the worker reported to the rheumatologist that her left wrist symptoms commenced two months prior to December even though she had been off work since July. Based on the weight of evidence, Review Office was of the view that on a balance of probabilities, the worker's CTS was not caused, aggravated or enhanced by her workplace injury of 1999 or her more recent work activities. In June 2005, the worker advisor appealed Review Office's decision and a hearing was arranged.

Reasons

The issue before the Panel was whether the worker's CTS is related to her 1999 workplace injury and/or her more recent job duties. For the appeal to be successful, the Panel must find a relationship between the worker's CTS and workplace injuries. In other words, the Panel must find that the worker's job duties caused, aggravated or enhanced her CTS. After considering all the evidence, including the worker's evidence at the hearing, the Panel could not find that the worker's CTS is related to her employment.

Argument and Evidence at Hearing

The worker attended the hearing with a worker advisor who made a presentation on her behalf. The worker answered questions posed by her representative and the Panel. The employer did not participate in the hearing.

The worker provided a detailed description of her job duties which involved bagging, ticketing and tagging, labeling, packing and moving customer's clothing. The worker had to organize the items on racks in proper order. The worker used several tools in performing her duties including computer, pen, stapler and danison gun. The worker described the volume of activity. She noted that the volume of transactions varied during the week. She also noted that some locations where she worked as a floater after her surgery were busier than locations where she worked before the surgery. The worker noted that prior to commencing this job she did not have any problems with her wrists.

The worker's representative asked the Panel to consider that every time the worker returned to work her right hand symptoms increased. He stated the worker's position that the timing of the accident and the timing of the onset of symptoms, were all linked to the worker's work activities. The representative also stated that he looked at the case as involving more of an aggravation of the right wrist CTS by the job than the blow to the right wrist causing the CTS in the wrist. The representative noted that the treating rheumatologist's opinion supported the worker's position.

Analysis

The Panel was not able to find a relationship between the worker's CTS and her job duties.

The Panel finds that the worker's job duties do not involve high force repetitive activity generally associated with the development of CTS. While some of the duties required activities involving movements of the wrist, these activities were performed on a limited basis. The Panel finds the worker's job duties are varied, involving many actions including, entering names and numbers on a key board, hand writing on certain forms, attaching tickets and tags and bagging items. The Panel also finds that, in general, the workplace was not busy although on certain special days there was more activity. The Panel notes the worker's observation that "Monday and Tuesday, I'll be honest, was dead."

The Panel notes that the worker has been diagnosed with bilateral CTS. The Panel also notes that the worker is right hand dominant and performs most activities with her right hand. The Panel finds that the bilateral nature of the worker's condition is consistent with a non-work related cause.

The evidence shows that the worker stopped work for a one year period from July 2001 to July 2002. The Panel notes that the worker did not seek medical attention for her wrist after leaving her employment in July 2001 until December 17, 2001 when she sought medical attention from her treating physician for swelling on the right radial side of the wrist. A February 19, 2004 report from the treating physician notes that "She began to complain in late 2001 of now a shooting pain going up her right hand into the wrist along with some tingling." She was diagnosed with tenosynovitis of the right wrist. The Panel finds that the onset of these symptoms during a period when the worker was not working is consistent with the conclusion that the worker's condition is not work related.

The Panel notes, as referenced in the background, that the worker suffers from several conditions which have been associated with the development of CTS. On June 9, 2003, a WCB healthcare advisor commented that "On balance CTS not likely related to job but to the underlying conditions." The Panel agrees with this opinion and finds, after considering all the evidence that the worker's condition is not on a balance of probabilities, related to or caused by her work duties.

Accordingly, the appeal is declined.

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 20th day of October, 2005