Decision #11/06 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on October 12, 2005, at the worker’s request. The Panel discussed this appeal on the same day and again on December 8, 2005.Issue
Whether or not responsibility should be accepted for the proposed wrist surgery.Decision
That responsibility should be accepted for the proposed wrist surgery.Decision: Unanimous
Background
On September 13, 1999, the worker submitted a claim to the Workers Compensation Board (WCB) indicating that he injured his right wrist by pushing a meter into its meter socket base on August 12, 1999. The Employer’s Report of Injury confirmed that an accident occurred on August 12, 1999 and that the worker lost 1 day and 6 hours as a result of the injury.
A Doctor’s First Report dated August 26, 1999 indicated that the worker was treated on the same day for pain and swelling to the dorsum area of his right wrist. The worker was unable to fully flex, extend, pronate or supinate his right wrist. The history of injury was “August 12, 1999, while attempting to put back a meter into position, slammed meter with flexed right wrist…” The worker was diagnosed with a right wrist soft tissue injury and a referral was made for physiotherapy treatment.
An x-ray report of the right wrist dated August 26, 1999 revealed post-traumatic osteoarthritic changes within the scapholunate ligament disruption. An acute fracture or dislocation was not identified.
The WCB accepted the claim and wage loss benefits were paid.
A Chiropractor’s First Report dated May 30, 2000 revealed that the worker was treated for right wrist pain and a right ganglion cyst over the right radial head. The history of injury was “constant use of Rt [right] hand to install a meter (by hammering with palm) caused Rt wrist articular radiographic changes as per Dr. [radiologist] report.” The diagnosis rendered was “traumatic Rt wrist arthritis due to the nature of job - pounding meter with right hand (palm).” Treatment plan included a referral to a plastic surgeon for the ganglion cyst and to an orthopaedic specialist.
On July 5, 2000, the worker filed a Workers Report of Injury stating that his right wrist was still injured from his September 1999 injury and that physiotherapy treatment was ineffective.
On August 29, 2000, the worker advised a WCB adjudicator that his injury never really healed properly but was not terribly problematic. Over time, the bump on his right wrist grew bigger and seemed to move towards the inside of his wrist. He stated that he eventually saw his chiropractor who suggested that he see a specialist as he may require surgery. The worker did not make any appointments to see the specialist as he never had the time and did not want to have surgery performed. The worker noted that there had been no change to his job duties and that he continued to install/remove meters but used his left hand now instead of his right. The worker said he was not claiming anything from WCB and that he would continue to work.
On October 15, 2002, the worker underwent an x-ray to his right wrist and left clavicle. The x-ray report stated “There is evidence of a previous scapholunate dislocation. Severe degenerative change is present at the radiocarpal joint resulting from this and several small well corticated ossific densities are noted posteriorly related to remote trauma. There has been further degenerative change since 1999 but the findings were present at this time as well.” The clavicle revealed “…a fracture through the mid shaft of the clavicle with overriding of the bony fragments approximately the width of the shaft. No other injury is seen.”
In a referral letter to a hand specialist dated October 15, 2002, the treating physician noted that the worker had a full thickened area on his right wrist for a number of months and that it worsened when he hammered things with his hand.
On December 2, 2002, the hand specialist advised the treating physician that the worker would benefit from a titanium scaphoid replacement together with a three corner limited wrist fusion. On January 8, 2003, the hand specialist asked the WCB’s approval to proceed with the recommended surgery as he noted that the worker had an accepted claim for a right wrist injury that occurred four years ago.
In a written response dated January 9, 2004, a WCB senior medical advisor advised the hand specialist that “…none of the pathology of which you mentioned in your report relates to any compensable injury as these changes were present on an x-ray taken immediately following the date of the injury itself and the changes noted at that time were old and remote. Accordingly, the WCB cannot accept any financial responsibility for the proposed surgery.” In September 2004, the worker disagreed with this decision and the case was forwarded to Review Office for consideration.
On February 3, 2005, Review Office determined that no responsibility would be accepted for the proposed surgery. Review Office noted that the 1999 x-rays already showed old post-traumatic osteoarthritic changes within the wrist. It was felt that these changes would not have been caused by the specific trauma that occurred in the workplace on August 12, 1999. In making its decision, Review Office consulted with a WCB orthopaedic consultant.
With respect to the worker’s contention that the progressive pounding of his wrist on meters over a number of years may have caused his condition, Review Office agreed with the WCB orthopaedic consultant that the worker’s primary problem was a pre-existing osteoarthritic condition along with scapholunate disruption. Review Office noted that the medical advisor was unable to relate either of these conditions to the worker’s employment or to the specific incident of August 12, 1999. Review Office concluded that there was no evidence to indicate that the work in general or the accident in particular caused or enhanced the worker’s pre-existing condition. On August 16, 2005, the worker appealed Review Office’s decision and an oral hearing was arranged.
Following the hearing and after discussion of the case, the Appeal Panel requested additional medical information from the worker’s treating surgeon. A report from the specialist dated November 14, 2005 was forwarded to the interested parties for comment. On December 8, 2005, the Panel met to further discuss the case and to render its final decision.
Reasons
The issue before the Panel is whether responsibility should be accepted for the proposed wrist surgery. At the hearing, the worker advised that he had the surgery on August 24, 2005 so the issue is amended accordingly. For the appeal to succeed, the Panel must find that the medical condition leading to the surgery was due to the worker’s compensable injury. The Panel did find a relationship between the surgery and the compensable injury and accordingly the WCB is responsible for the surgery.
Evidence and Argument at Hearing
The worker attended the hearing with his wife. Since 1995 his duties involved disconnecting and reconnecting meters. He averaged approximately 15 disconnections and reinstallations per day. He brought a meter and related equipment to explain and demonstrate the actions required to perform his duties. He advised that it is necessary to hit the meter with his hand to force it into position during the reconnection process.
The worker stated that he had been continually hitting meters since 1995 and considers that this damaged his right wrist. The worker described the 1999 accident and resulting injury. After the injury, the worker began using his left hand to hit meters. The worker did not recall any other injury to his wrist.
The worker advised that his injury worsened so he agreed to have the surgery which took place in August 2005. He stated that his condition has improved since surgery, but he still wears a cast and requires physiotherapy.
Analysis
The Panel has considered all the evidence on the file and obtained additional evidence from the worker’s treating surgeon. The Panel finds, on a balance of probabilities, that the surgery was required as a result of the worker’s compensable injury and is the responsibility of the WCB. The Panel finds it probable that the worker’s wrist condition is the result of many years of trauma caused by hitting meters to fix them into position.
In arriving at this conclusion, the Panel places significant weight on the opinion of the worker’s treating surgeon provided in a report dated November 14, 2005. The surgeon commented:
“This man presented with increasingly severe radial wrist pain and swelling with increasing weakness of grip and x-ray showed evidence of an old tear and disruption of his scapho-lunate ligament with a subsequent osteoarthritis of the radio-scaphoid joint. Osteoarthritis of the wrist is extremely rare to arise de nouveau. It almost always is a result of previous trauma to the wrist. In addition, disruption of the scapholunate ligament does not happen as part of any degenerative process, but again due to definite trauma to the wrist.
On discussion with the patient, there is no evidence of any other trauma to his wrist during his life, apart from that encountered in his occupation when he constantly had to slam the meter back into position using the heel of his hand over a significant period of time. Accordingly, I feel that this is almost certainly the cause of the ligament disruption with the subsequent post-traumatic osteoarthritis as there is lack of any other evidence or any other trauma mechanism.”
The Panel finds that the worker’s medical condition – the ligament disruption – was caused by his work duties and that the surgery is the responsibility of the WCB. The appeal is accordingly allowed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
A. Scramstad - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 11th day of January, 2006