Decision #172/99 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on September 29, 1999, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed the case on September 29, 1999, and November 30, 1999.

Issue

Whether or not the claim is acceptable.

Decision

The claim is acceptable.

Background

On December 29, 1998, the claimant submitted a claim for compensation benefits with respect to left carpal tunnel syndrome (CTS) that he related to his employment as a mechanic.

Initial medical information revealed that the claimant underwent a left carpal tunnel release on September 21, 1998. The operative report documented that the claimant's main symptoms occurred while driving at work. It was noted that the claimant's job involved repairing buses and that he found increasing weakness and difficulty while performing these tasks. The surgeon indicated that, "He will be pursuing a Workers Compensation claim and therefore this is being forwarded to them".

In a letter dated April 26, 1999, the attending physician stated that the claimant presented in his office on August 12, 1997, complaining of paraesthesia in both hands. This came on primarily when driving vehicles and rarely awakened him at night. The claimant's symptoms were confined to the radial digits with no ulnar symptomatology. The claimant had undergone a right carpal tunnel release on April 6, 1998, and a left carpal tunnel release on September 21, 1998.

The attending physician went on to state that his diagnosis was that of bilateral carpal tunnel syndrome and due to a previous right median nerve injury, this side was corrected first. The claimant later underwent a left carpal tunnel release. Conservative management was not indicated and his symptoms were not nighttime related and they appeared to occur with use of the wrist. The claimant had complete recovery following his bilateral carpal tunnel releases, which confirmed the correct diagnosis and proper management. At last follow up on November 3, 1998, six weeks post left carpal tunnel release, the paraesthesias had resolved and his strength was 70% of normal.

Initial information from the employer revealed that the claimant started employment with their company on July 6, 1976. The claimant then completed a four-year apprenticeship as an auto mechanic apprentice and from July 6, 1980, he worked as a journeyman mechanic until the present. The employer stated that the function of a journeyman mechanic was the removal, rebuild and replacement of mechanical components. Other functions were tow truck duties such as servicing vehicles on the street with minor mechanical repairs. The tasks performed by the claimant were accomplished by the use of both wrists but one hand would be used predominantly when attaching and tightening fasteners such as nuts and bolts. The duties were not repetitious. There were a diverse number of tasks performed when carrying out these duties. There were forces exerted when performing the duties but it would be questionable as to whether they were excessive. There was pushing, pulling and lifting involved with daily activities. Maximum angles would be performed infrequently.

The employer stated that the claimant had performed outside duties, which may contribute to his condition. It was noted that the claimant had an outside business, which was the supply and installation of television satellite dishes. He was also very involved with boat racing and had a keen interest in snow mobiling and automobiles.

On March 16, 1999, the claimant provided a sworn statement to a WCB Field Representative. Briefly, the claimant stated that 8 years ago he began to have problems in both hands, the left being worse than the right. He stated he was left hand dominant. The claimant advised that in the spring of 1998 his right wrist was operated on and he was off work for 6 weeks. He did not file any claim for this and used his sick leave. He said he did not file a claim at that time as he did not want the hassle dealing with WCB. With respect to the surgery on his left wrist, the claimant advised that his doctor recommended that he file this claim.

The claimant stated that he was involved in a boating accident in the summer of 1996 and his right elbow was badly injured due to being cut by a boat propeller. He was off work for 11 months due to this.

On May 11, 1999, the claimant was advised that the WCB would accept financial responsibility for his left wrist complaint. "While there is evidence of non-employment related, pre-existing factors in the development of this condition, it is felt that your employment activities as a mechanic with the [employer's name] would have been a major precipitating factor to the onset of your wrist complaints." This decision was appealed by the employer on May 19, 1999.

In a submission to Review Office dated July 12, 1999, the employer asked for an explanation as to why it took so long for the claimant's symptoms to appear. The employer's representative stated, in part, "Specifically, Mr. [the claimant] has been doing similar work for approximately twenty-two years and the physical requirements would not have changed appreciably during this time. The logical answer, and we suggest the only answer, is that they are not the cause of Mr. [the claimant's] bilateral wrist problems. There are numerous non-work related factors which can lead to the development of carpal tunnel syndrome and we believe these to be the more likely explanation for Mr. [the claimant's] problems. In addition to the known non-work related factors, it has also been established that approximately 50% of all diagnosed carpal tunnel syndrome conditions are idiopathic in nature. We believe that this is where the standard of proof, historically employed by the Board, come into play. We suggest the weight of evidence, on balance of probabilities, does not support a work relationship."

On July 23, 1999, Review Office rendered the following decisions:

    That, on a balance of probability, the claimant's occupation as mechanic and his regular job activities contributed something significant to the cause of his carpal tunnel injury; and

    That this type of causal connection was sufficient to provide for entitlement to benefits under the provisions of the Workers Compensation Act, and the WCB's current practices for adjudication of carpal tunnel claims; and

    That acceptance of the claim, and payment of benefits, is confirmed.

Review Office stated that the information in this case did not provide evidence of a primary systemic cause for the claimant's carpal tunnel injury. The information did, however, reveal that the claimant probably had exposure to both occupational and personal risks which would reasonably contribute to the cause of his carpal tunnel syndrome. Given the overall information and the fact that the claimant's main symptoms seemed to occur at work, Review Office believed there was sufficient evidence to indicate that work related hazards likely contributed to the cause of the worker's carpal tunnel injury.

On July 28, 1999, the employer's representative appealed the Review Office's decision and a non-oral file review was held on October 22, 1999. At that time, the Appeal Panel determined that an oral hearing should be convened as opposed to a non-oral file review. An oral hearing was then convened on December 1, 1999.

Reasons

The issue in this case is whether or not the claim is acceptable. The relevant subsections of The Workers Compensation Act (the Act) are subsections 1(1) and 4(1).

In this appeal we reviewed all the evidence on file and received during the hearing process and find that the evidence supports a finding on a balance of probabilities that the claim is acceptable.

In this appeal the claimant alleges that his left carpal tunnel syndrome for which he required surgery should be compensable as related to his work activity as a mechanic.

In considering this appeal we concur with the Review Office that the evidence on file reveals that the claimant has no systemic medical conditions that would be considered material risk factors for the development of the left carpal tunnel syndrome and that there is evidence on file that the claimant engaged in some outside recreational activities which the employer has contended could have been causal in the development of the claimant's left carpal tunnel syndrome.

At the hearing the employer argued that the claimant did not file a WCB claim until after his left wrist surgery and contested the claimant's prior knowledge of the diagnosis, as the evidence revealed that the claimant had prior right carpal tunnel surgery for which he had not claimed with WCB.

We note in this regard that the claimant was diagnosed with bilateral carpal tunnel syndrome with more severe symptoms on the left. The right wrist carpal tunnel was operated on first electively as the claimant had had a non-compensable median nerve transplant at the right elbow and there appeared to be a desire to operate on the right wrist first to avoid any possible compromise of the claimant's right median nerve transplant.

The claimant's response to the employer's argument was that he did not wish to pursue a WCB claim for the right side due to perceived "hassles"/difficulties associated with WCB claims of which he had become aware. Although we find this perception to have little basis, nevertheless, we do not perceive this to be a bar to the subsequent filing of a claim for the left carpal tunnel syndrome.

The evidence reveals that the claimant has been employed as an auto or journeyman mechanic since 1976 and that from about 1997 to the present time the claimant has been working in the field on a service van doing less intensive repairs of buses as compared to those performed in the shop. However, in the 3 to 4 years prior to 1997 the claimant had been working nights doing heavier mechanical repairs in the shop and had been also been regularly performing heavier mechanic duties prior to that time.

In a sworn statement dated March 16, 1999 the claimant has indicated that he first felt symptoms and had problems with his hands 8 years before which we accept as from approximately 1991. The claimant further indicated that the symptoms in the left were more severe than those on the right and we note in this regard that the claimant is left hand dominant.

The claimant has indicated that his surgeon informed him that he felt the condition was work related and this impression is confirmed in the surgeon's operating report dated September 21, 1998 and his narrative report of April 26, 1999. In the operative report for release of the left carpal tunnel dated September 21, 1998 the claimant's attending surgeon documents that the claimant's main symptoms occurred while driving at work and that the claimant in performing his job repairing buses found " increasing weakness and difficulty doing his tasks." and the surgeon also indicates, respectively, "He will be pursuing a Workers Compensation claim and therefore this is being forwarded to them" and; " Conservative management was not indicated, as his symptoms were not nighttime related and they appeared to occur with a use of the wrist."

At surgery the median nerve was found to be "markedly compressed within the tunnel and with an hour glass deformity and obvious hyperemia on release."

In order to accept responsibility for a claim such as this it must be determined, on a balance of probabilities, that the employment activities contributed to the development of the condition. To establish a causal relationship between the onset of carpal tunnel syndrome and the employment activities it must be determined that the job functions require repetitive flexion/extension of the wrists against resistance, direct pressure against the hands/wrists or gripping or positioning of the wrists at maximum angles.

In light of the nature of the claimant's employment duties as a mechanic now and in particular at the time of the onset of symptoms we find that the claimant's wrists would have been exposed to the above. Although we recognize the claimant's extra curricular activities may have contributed to his complaints, on a balance of probabilities, the employment duties and, specifically the extent to which these are performed on a regular basis, would suggest a predominant causal relationship to the employment. Therefore we find that the claim is acceptable and the employer's appeal is denied.

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 9th day of December, 1999

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