The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel review was held on June 4, 1999, following receipt of an appeal from the claimant.

Issue

Whether there is basis on which to extend compensation beyond June 24, 1993.

Decision

That there is no basis to extend compensation beyond June 24, 1993.

Background

For a complete background concerning the details of this case, please refer to Appeal Panel Decision No. 178/98, dated December 7, 1998.

Briefly, the claimant has two compensable claims with the Workers Compensation Board (WCB) involving carpal tunnel syndrome in both wrists. Following bilateral carpal tunnel releases, the claimant continued to complain of pain in her left hand/forearm as well as in the upper arm. She was subsequently diagnosed with sympathetic dystrophy, however, this diagnosis was not supported by WCB healthcare personnel, the treating rehabilitation medicine specialist or a neurologist.

Following examination by a WCB medical advisor on June 10, 1993, the claimant was notified by primary adjudication that wage loss compensation would be paid to June 24, 1993, inclusive and final. This decision was based on the medical advisor's opinion that the claimant's ongoing subjective complaints were not supported either on an organic or pathological basis and that the claimant had recovered from the effects of her compensable left carpal tunnel syndrome.

The case was next considered by the Review Office on September 3, 1993, following receipt of an appeal from the claimant. File documentation at this time contained the results of bilateral nerve conduction studies, dated July 23, 1993, as well as reports from an orthopaedic specialist and the attending physician. The claimant was diagnosed with bilateral rotator cuff syndrome, cervical spondylitis and myofascial neck pain.

On September 3, 1993, the Review Office found no basis on which to extend compensation benefits beyond June 24, 1993. The Review Office commented that by March of 1993, there was no clinical evidence of any ongoing and related trouble with the claimant's left upper extremity. The claimant's behavior was strongly suggestive of a non-organic disorder. The Review Office stated that the claimant's bilateral rotator cuff syndrome, cervical spondylitis, and myofascial neck pain were not related to her compensable wrist conditions.

Subsequent to September 3, 1993, the claimant's solicitor submitted new medical information to the Review Office from a rehabilitation medicine specialist, dated May 5, 1994. The specialist was of the opinion that the claimant suffered from fibromyalgia and myofascial pain. As this opinion was considered to be different than that of a medical officer of the WCB, the Review Office granted the request to convene a Medical Review Panel (MRP) in accordance with Section 67(4) of the Workers Compensation Act (the Act). Following examination by the MRP which was held on April 19, 1995, the Review Office made the following decision:

"A MRP has since offered that the claimant's current symptoms are generalized pain and weakness involving both upper extremities. There are no signs of carpal tunnel syndrome. The complaints result in a mild to moderate disability. The findings are, according to the MRP, based on historical data and are on the main subjective since there is little in the way of objective findings.

Review Office noting the onset and progression of the claimant's symptoms and the lack of objective clinical findings, remains unable to relate the claimant's trouble to an accident at work. There is, therefore, no basis on which to extend compensation beyond June 24, 1993."

On October 15, 1996, legal counsel for the claimant wrote to the Review Office indicating that new and significant medical evidence had recently come to light. Legal counsel stated that in addition to the already diagnosed conditions of myofascial pain and fibromyalgia, the claimant was diagnosed with a recurrence of right carpal tunnel syndrome necessitating surgery on February 2, 1996. Legal counsel stated that this was significant in as much as the MRP had failed to find any current evidence of carpal tunnel syndrome. The submission included several medical reports, dated November 3, 1994, May 23, 1996, June 25, 1996, and August 21, 1996 respectively.

A WCB neurology consultant reviewed the file documentation at the request of Review Office in June 1997. Following his review the neurology consultant concluded that "given the multiple changes in diagnosis and the continued lack of any consistent neurological examination findings I would be of the opinion that the Medical Review Panel was indeed quite accurate in their assessment. Any change in findings and any surgery carried out by Dr. [surgeon] would not be related to the compensable condition and initial surgery."

On July 23, 1997, the Review Office determined that the claimant's September 1995, symptoms were not related to her compensable injury. The Review Office stated there would be no change to its previous decision and that there was no basis to convene a second MRP.

On October 22, 1998, an Appeal Panel hearing took place to determine whether there was basis to extend compensation beyond June 24, 1993. On December 7, 1998, the Appeal Panel determined that it lacked the necessary jurisdiction to entertain the claimant's appeal and provided the following reasons for its decision:

"The claimant has two separate and distinct claims before the WCB. A 1990 claim involving right carpal tunnel syndrome and a 1991 claim involving left carpal tunnel syndrome. After entertaining an appeal hearing on the 1991 file, it became apparent that the two claims had inadvertently been intermingled. Medical evidence and correspondence dealing with the 1990 claim were mistakenly placed on the 1991 file and the WCB proceeded to adjudicate the 1991 claim on the basis of this evidence. We note that there has not been any secondary adjudicative decision made with respect to the 1990 claim by the WCB. The two files overlap with regard to possible ongoing difficulties and related time loss.

Inasmuch as the two claims have not been completely adjudicated by the prior levels of the WCB, we have no jurisdiction to entertain the issue under appeal relating to the 1991 claim. Accordingly, we are forwarding both files back to the WCB with the direction that the evidence be separated and placed on the appropriate file. Once this function has been completed these claims should be re-adjudicated by the WCB. Should either the employer or the claimant not be in agreement with the decisions rendered by the WCB, then each party may, of course, pursue its right of appeal."

The case was forwarded to primary adjudication and then to the Review Office to consider the Panel's request. On March 10, 1999, the Acting Director of Review Office indicated that he reviewed both claims and in particular the decision rendered by the Review Officer on September 10, 1993. The Acting Director stated that the Review Officer made reference to both claims, however the decision was not cross-referenced on the 1990 file, which should have been done as the decision was addressing both claims. The Acting Director of Review Office therefore confirmed the previous Review Office decisions that the claimant's conditions and current symptoms were not related to either of the compensable wrist injuries or were her problems considered to be related to an accident at work. The case was then referred back to the Appeal Commission to consider the claimant's appeal regarding benefits beyond June 24, 1993.

Reasons

The claimant developed right and left carpal tunnel syndrome while in the course of her employment as a meat cutter. The right condition was treated surgically in May 1990 and the left in May of 1992. Both of these surgeries were authorized by the WCB.

In approximately March of 1993, the claimant attended her treating physician and presented with complaints of soreness in the right shoulder and elbow area. Further investigation and examination eventually led to the following diagnoses: bilateral rotator cuff syndrome, cervical spondylitis and myofascial neck pain.

The preponderance of evidence confirms that the claimant's carpal tunnel syndrome both left and right has long since resolved. In this regard, we attached

considerable weight to the findings reached by the MRP in April 1995. "There are no signs to support carpal tunnel syndrome in either extremity."

In addition, we noted certain comments of the WCB's neurology consultant contained in a memorandum to the Review Office, dated June 30th, 1997. "The first documentation of any neck and shoulder problem is in March or February 1993. Subsequent to this she was referred to Dr. [orthopaedic specialist] who documented the right shoulder and arm pain. Dr. [neurologic specialist], who examined here for this problem in March 1993 felt that there was no organic basis for it. It seems quite clear then that the so called overload of muscles in the neck and shoulders occurred at a time when she was not working and could not possibly be related to any workplace injury. Further medical evidence also contradicts and disproves Dr. [treating physiatrist's] hypothesis. At the time of the Medical Review Panel Dr. [treating physiatrist] himself commented that the symptoms of carpal tunnel syndrome had disappeared entirely and that the symptoms in the right hand and wrist seemed to be more related to referred pain from the shoulder girdle. It was at this point that surgery originally proposed by Dr. [treating physiatrist] had been cancelled. Dr. [treating physiatrist] clearly states at this time that the myofascial pain and overlaid fibromyalgia were active at a time when the carpal tunnel syndrome had entirely disappeared. In a further letter from Dr. [hand surgeon] of February 12, 1997 he states that the symptoms of nerve irritation of carpal tunnel syndrome were completely relieved.
Given the multiple changes in diagnosis and the continued lack of any consistent neurological examination findings I would be of the opinion that the Medical Review Panel was indeed quite accurate in their assessment. Any change in findings and any surgery carried out by DR. [hand surgeon] would not be related to the compensable condition and initial surgery."

Based on the evidence and on a balance of probabilities, we find that there is no basis on which to extend compensation beyond June 24th, 1993. Accordingly, the appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

R. W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 5th day of July, 1999