The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An appeal panel hearing was held on February 3, 2006, at the worker's request. The panel discussed this appeal on the same day.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

In March 2005, the worker filed a claim with the Workers Compensation Board (WCB) for difficulties that she was experiencing with her wrists which she attributed to the repetitive nature of her job duties. The date of accident was recorded as being March 2, 2005 and was reported to the employer on March 15, 2005.

On March 2, 2005, the worker underwent nerve conduction studies which revealed bilateral carpal tunnel syndrome (CTS), mild to moderate on the left and moderately severe on the right.

On March 22, 2005, the employer's representative opposed the acceptance of the claim given that the diagnosis was bilateral CTS and that the worker's job duties were performed with her right hand. The representative noted that non-occupational risk factors may be the cause of the worker's bilateral wrist condition.

On April 13, 2005, a WCB adjudicator spoke with the worker to gather additional information concerning her work duties, outside activities, medical history, etc. On April 18, 2005, the adjudicator obtained further information from an employer representative regarding the worker's job duties and her knowledge of the worker's wrist complaints.

In a decision dated April 28, 2005, the worker was advised "In the opinion of Rehabilitation and Compensation Services, a relationship between the development of your bilateral wrist difficulties and an accident arising out of and in the course of your employment has not been established. It is noted that although your duties may be repetitious, they do not involve high repetition and force for long durations and there are no mechanical stresses or altered wrist flexion/extensions involved in your duties as a part-time [name] clerk. Therefore your claim for compensation has been denied."

On May 13, 2005, the worker wrote to her adjudicator and asked that she reconsider the decision of April 28, 2005. The worker contended that her last 14 years of working with her employer was a direct cause of her CTS condition and that her job duties did involve high repetition and force in addition to stress and altered wrist extensions.

In a report to the WCB dated March 31, 2005, the attending physician reported that the worker had been treated conservatively for several months with little or no relief. He felt that the worker was a candidate for decompression of both median nerves.

In a letter dated May 20, 2005, the adjudicator informed the worker that no change would be made to the original decision to deny the claim. The adjudicator remained of the view that an accident arising out of and in the course of the worker's employment had not been established.

On June 5, 2005, the worker appealed the adjudicator's decision of May 20, 2005 and provided Review Office with a letter from her attending physician dated June 7, 2005. The physician outlined his position that there was no obvious cause/source for the worker's CTS condition other than her work activities.

On July 26, 2005, Review Office considered the worker's appeal along with a rebuttal submission by the employer dated July 25, 2005. Review Office agreed with primary adjudication that the claim was not acceptable. Review Office found that the worker had some non-work related risk factors that were known to cause CTS which included gender, age, obesity and a history of smoking. With regard to the worker's job duties, Review Office found that her duties did not involve high force repetitive activity or extreme full wrist flexion/extension involving force in a repetitive motion of the left wrist.

On September 2, 2005, the worker appealed Review Office's decision and an oral hearing was arranged. On December 30, 2005, the employer provided the Appeal Commission with further information to consider in support of its position that the claim was not acceptable.

Reasons

This is a worker's appeal of a WCB decision to deny the worker's claim for bilateral CTS. The stated issue is whether or not the claim is acceptable. For the appeal to be successful, the Panel must find there is a causal relationship between the worker's condition and her employment duties. The Panel finds, on a balance of probabilities, that a relationship does not exist. Specifically the Panel finds that the worker's duties did not cause the worker's bilateral CTS and as such the claim is not acceptable under the Government Employees Compensation Act and applicable WCB policies.

Evidence and Argument at Hearing

The worker attended the hearing with her family physician who made a presentation on the worker's behalf. The worker read a prepared statement and answered questions posed by the panel.

The employer was represented by its WCB specialist who made a submission on behalf of the employer and called a witness to provide evidence in support of the submission.

On behalf of the worker, the physician submitted that the claim ought to be accepted. He commented that "…the repetitiveness of 4000 items on average, five days a week over 14 years has at least have to be considered as a causal factor in the development of carpal tunnel which is work-related in the absence of any other personal activities….that promote carpal tunnel development…" The physician disagreed with the reasons provided by the WCB for denying the worker's claim. The physician advised that the worker has undergone CTS surgery on both wrists.

The worker advised that she has worked at the jobsite for 14 years. The worker provided information on the number of items which are dealt with at the worksite on a daily and weekly basis. The worker provided information on her job duties. She works five days per week, approximately 30 hours per week and picks up extra hours when available. On Mondays she starts earlier, may help out on the loading dock and may be required to move a full mail cart. Other duties include dealing with pre-sorted items, dispatch work, and placing mail in lock boxes. From Tuesday to Friday her primary duties are to sort metered material and flyers into lock boxes. She also covers the counter during lunch break.

The worker noted that the employer representative and physiotherapist attended at the jobsite on a Tuesday morning after all the mail wagons were pushed out of the loading dock and the mail dumped. She advised that Tuesdays are the slowest days at the jobsite. She stated that this day was "…a poor picture of actually what happens on a daily routine."

The employer representative submitted that the worker's condition was not caused by her work. The employer representative reviewed the evidence on the claim file and referred to literature which supported the employer's position.

The employer called as a witness, a physiotherapist with training in the areas of ergonomics, anatomical biomechanics and biostatistics. The physiotherapist performed a job site analysis of the worker's duties. The physiotherapist described her methodology, using standardized objective measurements to measure the forces required to perform the tasks. She advised that the worker demonstrated the elements of her job and that she recorded this on a video which was provided to the Appeal Commission. Copies of the video had been provided earlier to the panel and to the worker. The worker advised that she hadn't viewed the video.

The physiotherapist testified that the critical job demands that were assessed fall into the light to medium category which is between 20 and 50 pounds. The physiotherapist was asked whether the worker's job duties were causative of bilateral CTS. The physiotherapist replied:

"Well, as I stated in the report, the job duties were not, in my opinion, in the range that would, in and of themselves, cause bilateral carpal tunnel syndrome. And I've indicated here that there's as likely to be non-occupational factors."

The worker expressed concern regarding the measurements taken by the physiotherapist, especially in regards to the mail cart that is on the loading dock. The physiotherapist advised that she measured the cart movement with a load of approximately 300 pounds. At the hearing it was noted that the weight of the loaded cart can be up to 600 pounds. The physiotherapist acknowledged that this increased weight would be putting more force on the upper extremity and the body. She noted it would put more strain on the worker than any other part of the job but would not in her opinion be enough to cause carpal tunnel.

Analysis

This case involves a worker who was diagnosed with bilateral CTS. The panel is aware that this condition may be caused by work related factors and non-work related factors. The condition can also be idiopathic, of unknown origin. As well, CTS which is not initially work related can be aggravated by work factors.

The issue in this case is whether there is a relationship between the worker's CTS and her employment. If there is a relationship, the claim is acceptable and the worker is entitled to receive benefits from the WCB. The WCB, at both the primary level and the reconsideration level (Review Office) denied a relationship between the worker's CTS and her job duties. In reviewing this case, the panel has also found the worker's job duties did not cause or aggravate the worker's CTS.

The panel's responsibility in this case is to determine, on a balance of probabilities, whether the worker's job duties have caused the worker's bilateral CTS. The panel has carefully considered the worker's job duties both as described by the worker at the hearing and as demonstrated by the worker on the video recorded by the physiotherapist. The panel has also noted the physiotherapist's analysis and observations of the job duties.

The panel acknowledges that the worker's job is repetitive but finds that in performing her duties the worker's wrists and hands are not held in the extreme end range of flexion and extension. Nor is there direct pressure on the worker's wrists and no sustained maximal gripping force is required. The panel also finds that the worker has variety in her duties. Regarding the movement of the full mail cart from the loading dock, the panel finds that this duty is not a risk factor as it is not performed on a frequent basis by the worker. Finally the panel notes that the worker's CTS is bilateral which is frequently an indication of a non-work related condition. The panel finds that the worker's job duties have not caused her bilateral CTS and that the claim is not acceptable.

The appeal is denied.

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 22nd day of March, 2006