Decision #28/06 - Type: Workers Compensation
Preamble
An appeal panel hearing was held on January 24, 2006 at the request of a worker advisor, acting on behalf of the worker. The panel discussed this appeal the same day.Issue
Whether or not responsibility should be accepted for the worker's right wrist problems as a consequence of the left wrist/forearm injury of May 1, 2001.Decision
That no responsibility should be accepted on the basis that the worker's right wrist problems are not related to her left wrist/forearm injury of May 1, 2001.Decision: Unanimous
Background
The worker is a long haul truck driver. She was injured at work on May 1, 2001 when a supporting pin on the back of a trailer broke causing the trailer handle to strike her left hand and wrist. Her injury was initially diagnosed as a fracture and later it was determined that she suffered a ligamentous tear for which she underwent surgery in October 2002. The Workers Compensation Board ("WCB") accepted responsibility for compensation related to the worker's left hand injury.The worker continues to suffer from chronic left wrist pain and she is permanently restricted from lifting greater than 10 pounds and from any repetitive use or forceful gripping with her left hand.
While receiving ongoing treatment for her left wrist difficulties, the worker returned to work performing clerical duties from July 2001 to November 2001 and again from May 2002 until November 2003, when her employer could no longer accommodate her work restrictions.
In a report dated January 7, 2004, the worker's surgeon noted that the worker presented with new symptoms in her right hand. The worker complained of numbness and tingling in all her fingers, with the right hand being worse than the left. On clinical examination, the surgeon noted a positive Tinel's sign over the carpal and cubital tunnel and a positive Phalen's test after 5 seconds in the right hand, with similar findings in the left hand but to a lesser degree. The surgeon concluded that there was evidence of bilateral carpal and cubital tunnel syndrome and recommended nerve conduction studies.
On February 2, 2004, a WCB case manager contacted the worker and discussed the worker's right hand difficulties. The worker stated that her right hand symptoms began in the office. She was unable to identify any specific activity or movement that caused her right hand to go numb. The worker stated that because she can't drive or lift anything with her left hand, she does everything with her right hand. The worker indicated that although she had been off work for over two months, the numbness in her right hand was more frequent now and happening all the time.
Nerve conduction studies were performed on March 1, 2004. Due to intolerance to testing, only the worker's right median nerve could be tested. The neurologist concluded that there was evidence of mild carpal tunnel syndrome on the right.
In a report dated March 15, 2004, the worker's surgeon indicated that the worker would benefit from carpal tunnel release on the right hand. On the left hand, the surgeon recommended a total wrist fusion although the worker may still have chronic pain following the surgery.
The WCB case manager requested an opinion from the WCB medical advisor regarding the relationship, if any, between the worker's compensable left wrist injury and her right wrist complaints. The WCB medical advisor was of the opinion that there was no relationship between the left and right wrist complaints.
In a decision dated March 29, 2004, the WCB case manager advised the worker that the WCB would not accept responsibility for her right wrist condition.
The worker appealed the decision. A worker advisor, acting on behalf of the worker, forwarded a submission that included a report dated December 10, 2004 from the worker's surgeon. The report states:
"On the balance of probabilities, the etiology of her right wrist difficulty is related to repetitive activity. I feel that her left wrist is playing a role and the fact that she has very limited activities with the left upper extremity, any form of repetitive activity she cannot do and these activities will be transferred to the right hand. Therefore as a result of her left wrist injury, there is a secondary exacerbation of symptoms in her right carpal tunnel syndrome due to the increased activities required on the right arm."The worker advisor argued that while the worker was employed doing office work she was forced to use her right hand due to the injury to her left hand. The worker advisor submitted that the work performed involved general office work, sorting trip envelopes and a substantial amount of data entry, which was highly repetitive, causing carpal tunnel syndrome in her right hand.
After consulting with a WCB medical advisor, the WCB case manager remained of the view that there was no relationship between the worker's right wrist and left wrist difficulties. The worker appealed this decision to the Review Office.
In its decision dated April 10, 2005, the Review Office held that no responsibility would be accepted for the worker's right wrist problems.
The Review Office was not satisfied that the worker's repetitive office duties involved substantial mechanical stress or force so as to be a significant factor in the development of carpal tunnel syndrome ("CTS") and that the worker had several non-work related factors such as gender, age, significant history of smoking, symptoms of menopause and diabetes, all of which are associated with increased risk of CTS. The Review Office also pointed to the evidence suggesting bilateral CTS, which suggests that the condition developed from non-work related factors. The Review Office concluded that on the balance of probabilities, the worker's right CTS was not related to her left wrist injury and the activities she was required to perform with her right hand.
On September 26, 2005 the worker appealed the Review Office's decision and an oral hearing was arranged.
Reasons
The issue before this Panel is whether there is a causal relationship between the worker's right wrist problems and the compensable injury to her left hand.To be successful in this appeal, the Panel must be satisfied that on a balance of probabilities the worker's right handed carpal tunnel syndrome was a result of the modified duties she performed. The panel was not able to make this finding.
Evidence at Hearing
At the hearing, the worker advisor argued that the worker's right handed carpal tunnel syndrome was caused by the repetitive typing, sorting and filing that she was required to do with her right hand when she undertook modified duties. The Panel questioned the worker in detail regarding the tasks she performed.
The worker testified that she first began modified duties in July 2001 that lasted approximately six weeks until September 2001. Her duties involved sorting logbooks, highlighting them, and arranging them alphabetically and by truck number. Her modified duties were interrupted and she did not return to office duties until May 2002.
She testified that in May 2002 her initial duties involved taking inventory of truck parts, moving parts for trucks with her right hand, counting the inventory and recording the information on paper. The worker testified that this is when she first noted problems with her right hand describing her hand as falling asleep from time to time. She testified that she did not have any symptoms in her right hand prior to this time. She testified that her right hand pain gradually got worse from the time she started doing inventory with increasing pain until she went to see her surgeon at the end of 2003.
The worker testified that after commencing modified duties in May 2002 she was off work for a period of time; however it was not clear when this break began and ended.
The worker testified that the jobs that she did over the last year of modified duties involved sorting, inventory, filing of trip jackets and entering data into the computer, all of which were done with her right hand. She explained that the amount of filing, sorting and data entry changed over the course of the year. For example, at one point the worker was responsible for the driver's logs, which required that she sort and file logs and give them to another person who entered information from the logs into the computer. Other times she did inventory that involved counting and moving parts and later on she was required to enter inventory data into the computer.
The worker testified that the job she did the most over the last year of modified duties involved the trip jackets. The worker testified that she was required to sort trip jackets, which are 9 by 12 inch envelopes containing truck records such as fuel and weigh scale receipts and logs and paperwork for each load. At first she was only sorting the trip jackets by colour or unit and later on she was also required to file the trip jackets. At a later point in time, her duties were expanded to include opening the trip jackets, sorting and removing the documents inside and entering data from the trip jackets into the computer.
The worker described the tasks that she would normally do in a given day when she was involved with the trip jackets. First, she would get a box of trip jackets and bring them to her desk. A box would contain approximately 350 trip jackets and the worker would begin sorting by taking the jackets out of the box and sorting them by driver name or by trip number. The worker would put the trip jackets into the appropriate file that was beside her desk in a box. She generally spent a few hours each day in the morning doing this sorting.
After she finished sorting, the worker would bring a box to her desk and pull out each envelope. She would enter the name or number of the trip jacket into the computer, colour code the envelope and then open the envelope using a slicer and take out the logs inside. She would record the trip number, the date and log information into the computer using one or two fingers on her right hand. She testified that she had to look through all of the logs, count the logs and flip through papers and receipts in the jacket to get the information she needed to input into the computer. She testified there were about 20 fields of information that might have to be entered for each trip jacket. She testified that she did not work steadily on the computer as she would have to flip through many papers, logs and receipts and sometimes consult maps to determine mileage or hunt for other information. She removed logs, customs papers and other documents and then she put each trip jacket back in the box before starting another one.
She testified that after spending a few hours each morning sorting and filing the trip jackets, she would move on to opening the jackets, removing the papers and entering data as described in the above paragraph. She would often spend an hour or two each day helping another worker put colour coded stickers on envelopes and placing them in boxes. She testified that while performing her tasks she would be interrupted many times each day to help her co-workers locate jackets or find papers.
Analysis:
This case focuses on whether the worker's office duties had sufficient risk factors associated with the development of carpal tunnel syndrome.
Carpal tunnel syndrome is a condition characterized by an abnormality of median nerve function in the wrist due to compression of the nerve within the carpal canal. The condition occurs in the non-working population as well as the working population and the cause is often unknown.
Medical and scientific research suggests that there are both non-work related and work-related risk factors associated with carpal tunnel syndrome. Non-work related factors include hypothyroidism, diabetes, obesity/high body mass index, gender (female), age at menopause, hysterectomy and smoking amongst others.
Where work duties are suggested to be the source of the problem, there is considerable medical literature focusing on the specific types and frequencies of body mechanics that could lead to the development of CTS. The condition has not been shown to arise simply from general physical work or routine daily hand use. The work activities commonly cited as leading to the development of CTS are activities utilizing the hand/wrist that involve high repetition associated with high force, prolonged flexed postures of the wrist, forceful pinching and gripping or direct pressure on the carpal tunnel area of the palm or wrist. Scientific literature suggests that the prevalence of CTS is lowest in workers performing low-force, low-repetitive jobs.
After considering all of the evidence on file and the worker's testimony, the panel has concluded that the worker's job duties were not, on a balance of probabilities, related to the development of her right hand carpal tunnel syndrome. We have arrived at this conclusion for the following reasons:
- The worker testified that her right hand symptoms started in May 2002 when her job tasks involved taking inventory of truck parts. This task would not be considered a high force or highly repetitive job nor did it involve any sustained keyboarding. She was also unable to associate the beginning of her problems with any particular task she was performing at that time. This inability to associate the onset of her symptoms to any specific task or duration of performing certain activities does not support a causal relationship with her work activities;
- The worker testified that when her symptoms started, her right hand would go numb periodically and that the frequency of tingling, numbness and pain increased from May 2002 until she saw her surgeon on January 7, 2004. The fact that her symptoms did not improve with rest or during the periods that she stopped working or stopped certain activities, but continued to progress and worsen suggests a non-work related cause;
- The work activities that the worker described over the last year of her modified duties were considered very carefully by the panel. Her duties of sorting, filing, lifting trip jackets and boxes, opening trip jackets, pulling out and replacing documents and data entry involved a variety of different hand and wrist movements that allowed the worker to control her pace, get up and move around and assist other workers with other tasks. The amount of keyboarding was not for sustained periods of time. The trip jackets were not heavy and the worker's wrist was not in a prolonged awkward position that would place significant force on her wrist. The panel does not consider these work activities to be of the type associated with the development of CTS as they were not highly forceful or highly repetitive;
- There are a number of non-work related factors associated with CTS present in this case. The worker was diagnosed with diabetes, a condition that is associated with CTS. Other risk factors present include the fact that the worker is female, that she has a high body mass as well as the evidence that she has been a long-time smoker and has undergone a hysterectomy.
The panel concludes, after weighing all of the evidence, that the worker's development of carpal tunnel syndrome was not related to the performance of her modified job duties and therefore, her right wrist condition is not related to her left wrist injury. We find that the claim for compensation in this case is not accepted.
Panel Members
M. Thow, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
M. Thow - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 3rd day of March, 2006