Decision #14/99 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on September 16, 1998, following receipt of an appeal from a union representative, acting on behalf of the claimant. The Panel discussed this case on September 16, 1998, and January 7, 1999.

Issue

  1. Whether the worker is entitled to payment of wage loss benefits beyond October 8, 1997; and
  2. Whether responsibility can be accepted for the worker's right shoulder and neck complaints.

Decision

  1. That the claimant is entitled to payment of wage loss benefits from October 6, 1997, to March 12, 1998; and
  2. That responsibility should not be accepted for the worker's right shoulder and neck condition.

Background

During the course of his employment as a painter in early May 1997, the claimant accidentally struck his right forearm/hand against an electric paint shaker that was malfunctioning. The claimant stated that he did not miss time from work following the incident and continued working his regular duties.

On August 27, 1997, the claimant stated he was painting a wall using a roller when the roller became caught on a receptacle and plug in cord. When he pulled up on the roller, the roller suddenly came free causing his right hand to strike the underside edge of a cabinet.

Medical information was received from a general practitioner who treated the claimant on August 28, 1997 who diagnosed contusion of the right hand. Physiotherapy and a home exercise program was the recommended form of treatment. In a progress report dated September 26, 1997, the general practitioner stated that a chronic pain situation may be developing and that the claimant would be seeing a chiropractor for another opinion.

When treated on September 26, 1997, the attending chiropractor reported the worker's history as "worker injured his right arm, hand and shoulder when he got caught in a paint shaker. The diagnosis was a cervical radiculitis and C7 dermatomal pain.

In a letter dated September 30, 1997, a neurologist reported that soreness in the dorsal aspect of the right hand was noted on the flexor tendon of the right middle finger. There were pain symptoms on either side of the metacarpophalangeal joint of the right middle finger and pain on the medial and lateral aspects of the right middle finger. The neurologist could find no evidence of an organic neurological disorder causing the patient's symptoms.

The case was reviewed by a WCB medical advisor on October 23, 1997, and November 12, 1997, at the request of primary adjudication. On October 23rd the medical advisor's opinion was that on a balance of probabilities, there was no cause and effect relationship between the accident as described in May 1997 and the diagnosis of a contusion of the right hand as reported by the physician on May 13, 1997. Based on the first medical report dated August 25, 1997, the claimant had already recovered from the contusion at that time. On November 12, 1997, the medical advisor stated that the diagnosis following the August 27, 1997, incident was a contusion to the right hand and that the claimant would of been disabled a maximum of 1-2 weeks. There was no relationship between the chiropractor's diagnosis of cervical radiculitis and the August 27, 1997, accident.

A progress report from the attending chiropractor dated November 20, 1997, indicated a change of diagnosis to carpal tunnel syndrome right wrist.

On December 19, 1997, Claims Services determined that the August 27, 1997 accident was acceptable based on a complete review of the file. Given the description of the accident and the initial diagnosis of contusion to the right hand, Claims Services was of the opinion that recovery would have taken place within a two week time frame. Claims Services was unable to accept the diagnosis of cervical radiculitis, provided by the attending chiropractor, as being related to the August 27, 1997, incident or the incident occurring on May 2, 1997.

Following the above decision additional medical information was received from a second neurologist dated December 16, 1997. The neurologist reported his examination findings and concluded "...this is not carpal tunnel syndrome or C7 root compression. I think he has an extensor tendonitis of the forearm and perhaps some muscular pains in the trapezius on the right." The specialist noted that the claimant related his history that the pain into the forearm and all the way up to the shoulder came on after attending physiotherapy.

An x-ray report of the cervical spine dated February 4, 1998, noted slight reversal of the normal curvature in the mid cervical region consistent with muscle spasm. The C4-5 and C5-6 disc spaces were most likely reduced. The right shoulder revealed no bone or joint abnormality.

A sports medicine specialist's report dated March 6, 1998, indicated the patient presented with symptoms of forearm extensor tendonitis with a complication of right arm and neck regional myofascial pain. The specialist reported that this was a difficult problem to improve because of the myofascial pain. An attempt was made to perform exercise through reconditioning but the claimant was unable to tolerate the exercise and was referred back to physiotherapy.

Additional x-rays were taken of the cervical spine on February 19, 1998. There was no significant change when compared with the films of February 4, 1998. The impression was cervical spondylosis associated with muscle spasm. The narrowing of the exit foramen at C4-5 level on the right was probably significant. A bone scan dated March 2, 1998, revealed "no scintigraphic evidence of reflex sympathetic dystrophy."

The claimant was examined at the WCB offices on March 12, 1998. Based on his examination findings, the medical advisor believed that the claimant may have a mild form of extensor tendonitis and some myofascial pain in the right trapezius muscle. The medical advisor further believed that the claimant's presentation was more of abnormal illness behavior. He stated that as a result of the compensable injury the claimant could have developed contusion to the dorsum of his hand and may have injured the extensor tendon, which may lead to some tendonitis. With respect to the right shoulder and neck problems, the medical advisor only found one significant tender muscle, namely the right trapezius, which was not in keeping with the claimant's magnified limitation.

The case was seen by the Review Office on April 3, 1998, based on an appeal received from the claimant. Prior to rendering its decision, the Review Office obtained an opinion from a WCB orthopaedic consultant on March 31, 1998.

On April 3, 1998, the Review Office determined that the claimant was entitled to wage loss benefits for a period of six weeks following the injury of August 27, 1997. No responsibility could be accepted for the worker's right shoulder and neck complaints as the Review Office considered that these were not related to the compensable injury.

The Review Office stated that based on the weight of medical evidence the worker suffered a blunt injury to his hand which could have resulted in extensor tendonitis, however, this condition would have resolved within a period of six weeks. There was no indication that a prolonged course of physiotherapy was necessary to resolve the problem. The Review Office's opinion was that the worker's neck and shoulder problems were not considered related to the May or August 1997 compensable injuries which were blunt type traumas to the back of the right hand.

On July 16, 1998, a union representative appealed the above decision to the Appeal Commission and an Appeal Panel hearing took place on September 16, 1998. Following the hearing and discussion of the case, the Appeal Panel requested additional medical information from two of the claimant 's treating physicians. On November 5, 1998, all parties were provided with copies of the medical reports which were obtained by the Panel and were asked to provide comment.

On January 7, 1999, the Panel met to render its final decision and took into consideration submissions from the employer's representative dated November 12th and December 17, 1998, and from the union representative dated November 27th, and December 10, 1998.

Reasons

The issues in this appeal are whether the claimant is entitled to the payment of wage loss benefits beyond October 8, 1997; and whether responsibility can be accepted for the worker's right shoulder and neck complaints.

The relevant subsections of the Worker's Compensation Act (the Act) are 39(1) and (2) which provide respectively for wage loss benefits for a loss of earning capacity as a result of a work-related injury and for the duration of those benefits.

Subsection 39(1) states:

Wage loss benefits for loss of earning capacity

39(1) Where an injury to a worker results in a loss of earning capacity after the day of the accident, wage loss benefits shall be payable to the worker calculated in accordance with section 40 and equal to

a) 90% of the loss of earning capacity for a maximum of 24 months; and

b) 80% of the loss of earning capacity after the 24 months.

Subsection 39(2) states:

Duration of wage loss benefits

39(2) Subsequent to subsection (3), wage loss benefits are payable until

a) the loss of earning capacity ends, as determined by the board; or

b) the worker attains the age of 65 years.

We reviewed all of the evidence on file and received during the hearing and decision process. We find that the weight of the evidence on a balance of probabilities supports a finding that the claimant is entitled to the payment of wage loss benefits from October 8, 1997 to March 12, 1998 as a result of his work related injuries of May 2, 1997 and August 27, 1997 which were both blunt injuries to the back of the claimant's right hand. We further find that responsibility should not be accepted for the claimant's right shoulder and neck complaints as we find no relationship between these symptoms and the injuries to the right hand of May 2, 1997 and August 27, 1997. In arriving at these conclusions we placed weight on the following evidence:

  • In reports dated May 12, 1997 and September 18 and 26, 1997 an attending physician diagnoses a contusion of the right hand and notes numbness on minimal activity, after physiotherapy, and suggests that chronic pain may be developing but finds no evidence of a neurological problem;
  • In a report dated September 30, 1997 an attending neurologist confirms no evidence of a neurological deficit and reports findings of pain on the dorsal aspect of the right hand in a circular area centered on the flexor tendon of the right middle finger as well as pain involving the right middle finger. The neurologist makes no reference to any neck or shoulder symptoms;
  • In response to an adjudicator a WCB medical advisor indicates on November 7, 1997 that in his opinion there was no relationship between the chiropractic diagnosis of cervical radiculitis and the compensable injury of August 27, 1997;
  • On December 16, 1997 a second neurologist reported a history of pain involving the dorsum of the right hand with subsequent symptoms involving the extensor aspect of the forearm all the way up to the shoulder with complaints of numbness but no neck pain. The neurologist diagnosed an extensor tendonitis of the forearm with no evidence of carpal tunnel syndrome or a C7 root compression;
  • On December 30, 1997 an attending physician diagnoses tendonitis, indicates that the claimant continues to complain of pain as before, but finds nothing objective;
  • A cervical and upper extremity bone scan performed March 2, 1998 reveals early degenerative changes in the cervical spine and no evidence of reflex sympathetic dystrophy;
  • In a report dated March 6, 1998 a sports medicine specialist diagnoses a forearm extensor tendonitis with some evidence of a regional myofascial pain syndrome;
  • A WCB medical advisor examined the claimant on March 12, 1998 and concurred with the diagnosis of extensor tendonitis, likely related to the compensable injury, and notes tenderness in only the right trapezius muscle which in his opinion was not in keeping with the claimant's magnified limitations. The WCB medical advisor was of the opinion that the claimant's condition was quite benign and that much of the claimant's limitations were self imposed;
  • On March 31, 1998 the file was reviewed by a WCB orthopaedic specialist who indicated that the type of blunt injuries sustained by the claimant would result in a soft tissue contusion and local bruising which in turn may give rise to a tenosynovitis of the extensor tendon on the dorsum of the hand. He further expressed his opinion that the claimant's upper arm and shoulder symptoms did not equate with the compensable injuries.

We note that following the initial injury to the back of his right hand, the claimant returned to work on or about May 11, 1998 and continued to work until August 1997 when he injured the back of his right hand again. We note from the evidence that medical providers and WCB consultants concluded a diagnosis of tendonitis resulting from the claimant's hand injuries. It was not until seen by a chiropractor on September 26, 1997, approximately one month after the claimant stopped working following the August 27, 1997 injury, that a diagnosis of cervical radiculitis was suggested. We also note however when seen by the neurologist in December 1997 the neurologist specifically notes the absence of neck pain.

Based on the evidence available we find that the shoulder and neck symptoms are not related to the compensable injuries of May and August 1997. In further support of this position we have considered the mechanism of injuries involving the right hand, the delayed onset of the shoulder and neck symptoms from the dates of accident, and the existence of early degenerative changes found on diagnostic testing. Therefore, on a balance of probabilities, we find there is no cause and effect relationship between the two blunt trauma injuries to the hand and the subsequently reported condition in the neck and shoulder. We feel, however, due to the development of the claimant's shoulder and neck symptoms, appropriate treatment for the extensor tendonitis became complicated by the introduction of this secondary diagnosis and may have extended recovery time from the compensable conditions.

We find that it was not until March 12, 1998 that the WCB came into possession of comprehensive medical information suggesting a resolution of the right hand tendonitis condition. In light of the above the claimant is entitled to payment of wage loss benefits to March 12, 1998 inclusive and final. We also find that responsibility should not be accepted for the claimant's right shoulder and neck complaints with respect to the compensable incidents of May 2, 1997 and August 27, 1997. Therefore the claimant's appeal is allowed in part.

Panel Members

D. A. Vivian, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

D. A. Vivian - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 18th day of January, 1999

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