The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on May 17, 1999, at the request of the claimant. The claimant was appealing a decision of the Review Office of the Workers Compensation Board (WCB) which determined that responsibility could not be accepted for his right wrist problems. The Panel discussed the appeal on May 17, 1999.

Issue

Whether responsibility can be accepted for the claimant's right wrist problems.

Decision

That responsibility cannot be accepted for the claimant's right wrist problems.

Background

On November 15, 1979, the claimant sustained a compensable left knee injury while employed as an equipment mechanic. As a result of the accident, the claimant had been in receipt of a permanent partial impairment award and long term wage loss benefits from the Workers Compensation Board of Manitoba (WCB). It is also noted that the claimant has other compensable claims with the WCB in relation to his neck and shoulders and had underwent arthrodesis of the left knee and arthroscopic surgery to the left shoulder.

In July 1997, the claimant contacted the WCB indicating that he was having right wrist difficulties from using a cane for his left knee injury. In a report dated August 19, 1997, the attending physician reported that the claimant had to compensate for his loss of function on the left side by his right upper and lower extremities. As a result, the physician stated the claimant was getting more strain to his right wrist and knee and felt this may become worse as time went by.

Subsequent information contained x-ray reports of the right wrist dated December 27, 1995, July 16, 1997, August 13, 1997, and a bone scan dated October 9, 1997.

On October 28, 1997, the treating orthopaedic specialist expressed his opinion that the claimant's wrist symptomatology was most likely related to "over strain and use of crutches when he had the fusion which had reasonably subsided. ...It appears that the use of the cane is not of any specific significance in relation to his complaint." The orthopaedic specialist suggested that the claimant should be treated symptomatically and would probably benefit by non-steroidal anti-inflammatory drugs if any real flare-up of swelling occurred.

On November 26, 1997, the case was reviewed by a WCB medical advisor at the request of primary adjudication. Following review of the file documents, the medical advisor believed that on a balance of probabilities, given the claimant's age and bilateral findings, that his right wrist complaints were due to age related osteoarthritic changes. On December 1, 1997, another WCB medical advisor reviewed the file and stated the following:

"This man had a knee fused for pain with no evidence of pathology in the knee to warrant such a procedure. It was not authorized and as clearly stated by previous MAs (medical advisors) and Medical Director (name) would not have been authorized.

He now complains of R (right) wrist pain and again there is no good organic evidence on x-ray or clinical exam to indicate any significant pathology other than some early degenerative changes - bilaterally.

There is no evidence to indicate:

1. Need for splint.

2. No indication that WCB has any responsibility in this request."

In a decision letter dated December 9, 1997, the claimant was advised by primary adjudication of the medical advisor's opinion of December 1, 1997. Based on this opinion, primary adjudication concluded that no responsibility would be accepted for the claimant's right wrist problems and any related expenses.

On December 10, 1997, the claimant appealed the WCB's decision not to accept responsibility for his right wrist problem. The claimant was of the opinion that the WCB medical advisor provided his opinion without the benefit of an examination and that board policy 42.10 and 42.20.10 had not been applied. The case was referred to Review Office for consideration.

On January 16, 1998, the Review Office considered two issues brought forward by the claimant. With respect to his right wrist difficulties, the Review Office confirmed that responsibility could not be accepted for the right wrist problems including the cost of a brace. When reaching its decision, the Review Office made note of the following:

• the attending physician's comments in August 1997 that the worker had to compensate for the loss of function on his left side by using his right upper and lower extremities. As a result the claimant was getting more strain to his right wrist and knee.
• the opinion expressed by the attending orthopaedic specialist in October 1997 - "It appears the use of the cane is not of any specific significance in relation to his complaint."
• the opinion of WCB healthcare personnel who consistently stated they could not find a relationship between the worker's claimed right wrist difficulties and his compensable injuries, including the utilization of a cane in the right hand.

Based on the above, the Review Office concluded that the weight of medical evidence did not support the worker's contention that his right wrist difficulties were in fact related to either of his compensable injuries.

On February 10, 1998, the claimant was seen and examined by another orthopaedic specialist who submitted an examination report dated February 17, 1998. Following review of the report by healthcare personnel, primary adjudication wrote the claimant to advise that no change would be made to its earlier decision regarding his right wrist difficulties.

On June 30, 1998, the attending orthopaedic specialist reported that he was referring the claimant to another specialist for possible surgery related to the right wrist. Following a review by WCB healthcare personnel, the claimant was advised by primary adjudication on July 24, 1998, that no change would be made to its earlier decision regarding his right wrist difficulties.

On March 24, 1999, the claimant submitted an appeal application with regard to his right wrist difficulties and requested an oral hearing. On May 17, 1999, an oral hearing was held and the Appeal Panel took into consideration all file documentation including a report dated May 10, 1999, from the treating orthopaedic specialist along with the results of an MRI of the right wrist dated February 18, 1999.

Reasons

The Appeal Panel is unanimously of the opinion that responsibility cannot be accepted for the claimant's right wrist problems. This conclusion has been arrived at after reviewing all of the written and oral evidence relating to this matter the salient parts of which are outlined below.

The claimant provided evidence at the appeal hearing on this matter to the effect that he had been having difficulties with his right wrist for approximately 4 to 5 years. In particular, he indicated that depending on what he was doing, the pain would come and go and last from one to two days at a time. He believed that his condition had not gotten any worse but was "pretty bad" in 1993 when he was attending physiotherapy. He further indicated that it was his belief that the difficulties with his wrist arose as a result of having to use a cane since he underwent surgery on his left knee.

The Panel noted that it was not until July of 1997 that the claimant first mentioned his right wrist difficulties to his doctor. This was despite the claimant's assertion that his difficulties had been ongoing for several years prior to that. Nevertheless, the claimant's attending physician indicated in a report dated August 19, 1997, that the claimant was experiencing more strain to his right wrist and knee as a result of compensating for his loss of function on his left side. He was thus referred to an orthopaedic surgeon and underwent x-rays of the right wrist and a bone scan. No bone or joint abnormality was identified in the x-rays and it was noted by various doctors that these tests showed no specific injuries related to the use of a cane. The orthopaedic specialist also confirmed at this time that "the use of the cane is not of any specific significance in relation to his complaint."

Subsequent WCB medical specialists also reviewed the claimant's file and all were consistently of the opinion that there was no relationship between the claimant's expressed right wrist pain and his compensable injuries including the use of a cane in his right hand. In particular, a WCB specialist on November 26, 1997, was of the opinion that there was no established medical evidence that would relate the claimant's clinical findings or bone scan findings to cane use. Given this opinion, the specialist felt that the claimant's complaints, medical findings and x-ray findings were related to age related osteoarthritic changes.

On February 18, 1999, the claimant underwent an MRI on his right wrist. No detectable damage was noted and no bone abnormality was evident. In a subsequent examination by the orthopaedic surgeon on March 23, 1999, clinic examination showed no significant additional findings.

As a result of the preponderance of evidence indicating that the claimant's right wrist difficulties are not related to any compensable injury, the Appeal Panel is of the opinion that responsibility cannot be accepted for the claimant's right wrist problems.

Panel Members

K. Dunlop, Q.C., Presiding Officer
A. Finkel, Commissioner
B. Leake, Commissioner

Recording Secretary, B. Miller

K. Dunlop, Q.C. - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 8th day of July, 1999