The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on March 5, 2004, at the worker's request. The Appeal Panel subsequently discussed this case on several occasions, the last one being February 7, 2005.

Issue

Whether or not the worker is entitled to a permanent partial disability award for his inability to sweat.

Decision

That the worker is entitled to a permanent partial disability award for his inability to sweat.

Decision: Unanimous

Background

The worker sustained an injury to his right hand on December 1, 1968. The worker subsequently underwent revision amputations of the middle phalanges of the right middle and index fingers and was awarded a 6.6% Permanent Partial Disability (PPD) award by the Workers Compensation Board (WCB).

On March 16, 1971 the worker underwent a cervical dorsal sympathectomy which was accepted as a WCB responsibility. In 2003, the worker contended that this procedure caused him to lose his sweat gland and that he did not have the ability to sweat on the right side of his body. The worker claimed that it was difficult for him to grasp things with his right hand and he wanted to know if the WCB would increase his PPD percentage.

On June 4, 2003, a WCB impairment awards medial advisor reviewed the case. He noted that the worker had undergone a cervical dorsal sympathectomy on the right side because of causalgia and digital artery spasm affecting the fingers. Following re-evaluation of the worker's PPD award based on the current Manitoba WCB rating schedules, it was determined that the worker's PPD award would be increased to 8.3%. It was further noted that there was no PPD recommendation for the sympathectomy other than the cosmetic value which had already been considered at an additional 1.0%. This decision was communicated to the worker in a letter dated June 23, 2003. On July 14, 2003, the worker appealed the WCB's decision to deny responsibility for his ability to sweat to the Review Office.

On August 8, 2003, Review Office determined that there was no scheduled rating for the worker's inability to sweat in the WCB's Permanent Impairment Rating Schedule and that the worker would not be entitled to an PPD award in this regard. On January 2, 2004, the worker appealed Review Office's decision to the Appeal Commission and a non-oral file review took place on March 5, 2004.

Following the non-oral file review, the Appeal Panel requested and received additional information from the WCB's healthcare branch (dictated on April 8, 2004) concerning the etiology of the worker's condition along with information about the guidelines that were used by the WCB to calculate the worker's PPD.

On May 11, 2004, the Panel further met to discuss the case. At this time, the Panel asked the WCB's healthcare branch to follow-up on the suggestions that were made by the WCB medical advisor on April 14, 2004.

The worker was subsequently examined by a WCB impairment awards medical advisor and was also assessed by an independent dermatologist. In January 2005, the worker was provided with the additional information that was received by the Appeal Panel and was asked to provide comments. On February 7, 2005, the Panel met to render its final decision and considered a submission by the worker dated February 3, 2005.

Reasons

As the background notes indicate, the claimant is seeking an increase in his PPD award. In support of his request, the claimant advances the following argument:

“As a result of the cervical dorsal sympathectomy procedure I am unable to sweat in the right upper extremity. This disability has greatly restricted my ability to work. Specifically, I am unable to properly grip (sic) tools or other items with my right hand (hand is dry). Cracked skin on my right hand and the inability to sweat in hot weather on half my upper body has also been a disability.”

Review Office considered the worker’s request but determined that as there was no scheduled rating for the inability to sweat in the WCB’s Permanent Impairment Rating Schedule the worker would therefore not be entitled to a PPD award for his affliction.

Following our initial review of the worker’s file, we referred the file back to the WCB’s healthcare branch on March 9, 2004 for an updating and clarification of information respecting the worker’s condition. We also requested an assessment of the worker’s inability to sweat under the AMA Guides to Evaluation of Permanent Impairment.

A WCB impairment awards medical advisor examined the worker on July 30, 2004. We note the following comments contained in his examination report:

“While there is no rating for sympathectomy in the Manitoba Permanent Impairment Rating Schedule (sic). It is my opinion that the difficulties associated with his lack of sweating would equate to that associated with failure of tearing requiring artificial tears. This man reportedly requires extensive use of hand creams in order to maintain a grip on objects when using his right hand.

The recommended rating for dry eyes needing artificial tears on page 24 of the Permanent Impairment Rating Schedule, WCB of Manitoba is 2.0%.

I am therefore recommending that 2.0% be added to his previously awarded PPI (sic) to take into consideration the effects of the right sympathectomy.”

In addition, we further recommended that the WCB healthcare branch make arrangements for the issue of dry skin in the claimant’s right hand be assessed and that any recommendations with regard to a prognosis and treatment of this condition also be provided. The senior medical advisor of the WCB then referred the matter to a prominent local dermatologist for an independent medical examination.

The specialist provided the WCB with a comprehensive report dated January 12, 2005. In that report, he stated in part as follows:

“There appears to be little doubt that Mr. [the worker] lacks the ability to sweat on the right forearm and hand secondary to his previous sympathectomy as outlined by Dr. [WCB medical advisor].

Examination today confirms the fact that the right hand continues to be dry and that there is subsequent flaking of the skin. I can imagine that he would have difficulty in grasping equipment to work with due to the lack of moisture on his palms. I think he may well also be prone to an eczematous process with some cracking and fissuring. While the later (sic) could be treated with moisturizing creams and occasional use of topical steroids, I think the ability to hold equipment might not be helped by moisturizing with the use of moisturizing creams.

I have suggested the use of Lac Hydrin lotion in this regard.”

After having considered all of the evidence, we find that the worker is entitled to a PPD award for his inability to sweat. In this regard, we endorse the recommendation of the WCB’s impairment awards medical advisor that the claimant’s PPD rating be assigned an additional 2.0% for non sweating. Accordingly, the worker’s appeal is hereby allowed.

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 23rd day of March, 2005