The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

This appeal deals with the causal relationship between the worker's bilateral carpal tunnel and cubital tunnel syndrome and her work duties.

The worker began employment with the employer in May, 2004. She reports developing right and left carpal tunnel and cubital tunnel symptoms in late July or early August, 2004, for which she saw her doctor in October, 2004. She was then referred to a surgeon who diagnosed her with bilateral carpal and cubital tunnel syndrome.

The worker filed a claim with the Workers Compensation Board (the "WCB") on February 10, 2005. The WCB denied the worker's claim on February 16, 2005 on the grounds that although the worker's job duties comprised keyboarding and mouse work, there was no evidence of highly forceful repetitive activity involving motions of the wrist such as twisting, gripping, pulling, pinch pressure, vibration or repetitive wrist flexion/extension which would expose the worker to significant work related factors resulting in the development of carpal tunnel syndrome. This position was upheld by the Review Office in a decision dated August 12, 2005. It is this decision that the worker appealed to the Appeal Commission.

An appeal panel hearing was held on June 1, 2006. The worker appeared and was represented by a worker advisor. The employer did not appear.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

The worker began employment with her employer in May, 2004 as a payroll clerk and accounts payable. In the later summer and early fall of 2004 she began experiencing numbness in her hands and fingers and pain in her elbows. She says that the feeling first started in her right hand and elbow, and then in the left.

She continued to be symptomatic and she saw her doctor in October, 2004 who referred her on to a surgeon.

The worker was diagnosed with bilateral carpal tunnel and cubital tunnel syndrome. Surgery was performed on her right wrist and elbow on January 20, 2005.

Shortly after, and contrary to her doctor's advice, the worker returned to employment duties. She says that this early return to work aggravated her symptoms. Shortly thereafter, she was laid off by her employer.

Then on February 10, 2005, the worker called the WCB to report her injury. She took the position that her data entry job caused her condition. She said that she typed 150 words a minute on the computer all day. At that time, she also reported a pre-accident problem with bilateral wrist tendonitis which required surgery in 2001 and 2003. The worker also advised that her wrist symptoms first appeared in September/October 2004. She confirmed that there was no significant accident or incident at work to account for the onset of symptoms. Rather, she related her current problems to the repetitive nature of her work.

This position has been supported by her family physician and her surgeon:

- In a February 14, 2005 medical report, the surgeon stated that her carpal and cubital tunnel syndrome was exacerbated by her job duties.

- On February 18, 2005, the worker's physician stated "it is my professional opinion that her carpal tunnel is directly related to her job duties. She did repetitive typing and data entry on a daily basis".

- On May 15, 2006, in response to questions asked by the worker advisor, the surgeon stated:

"In my opinion if she performed repetitive activity prior to her initial surgery in 2005, this would have a direct relationship to exacerbation or the cause of her symptoms. It is well known that any form of repetitive work plays a significant roll in cubital and carpal tunnel syndrome…In my opinion carpal and cubital tunnel syndrome is commonly seen in patients who do a high volume of data entry. They do not need forceful or heavy activity to cause or exacerbate these symptoms…"

The worker's job duties were investigated by the WCB to determine whether they were consistent with the onset of carpal tunnel and cubital tunnel syndrome:

A job site assessment done by the WCB on July 20, 2005 revealed the following:

- there are increased work demands in the summer, due to increased construction - along with this it is noted that job demands are decreased in the winter
- the payroll clerk is responsible for entering new staff and removing staff from the system
- maintaining staff files both in the computer and paper files - primarily recording changes in status or completion of safety courses
- balancing and check hours (this data is entered by other staff) and involves visually checking information in the computer against paper data
- ensuring correct deductions are made - both for work and government deductions.
- software used included Microsoft Office and Streetsmarts, and accounting program
- computer use is primarily numeric, there is keyboard and mouse work and several of the functions can be completed with either key or mouse strokes. Alpha entry is for the most part filling in forms, short phrases and names. There may have been the occasional need to generate Word documents however this would not have been a regular occurrence.
- handwriting - maintaining file folders (completing information such as name address etc., and short notes.
- generate cheques every 2 weeks
- place payroll information in a binder in the vault every 2 weeks
- check information in vault, usually daily
- normal work hours are 8:30 to 4:30 with an hour for lunch - breaks are flexible. I was advised Ms. [the worker] had requested flex hours - coming in early to accommodate working at her home business - a driving range. It is my understanding she started earlier and left earlier, needing to be home by 4:30.

It was the assessor's opinion that:

- the worker's job duties were light with a variety of tasks.
- the workload had a seasonal variation
- the work station height allowed for positioning options and was generally accepted as a reasonable option for multi-task positions to promote neutral wrist posture;
- the job position appears to have a variety of daily tasks for example, data entry, data verification, access file cabinets, filing, access adjacent work areas. These tasks allow for changes in body position, wrist and hand postures.

The variety of the worker's tasks is echoed in a July 17, 2005 letter to her insurance company:

"I arrived at the office everyday…between 6:00 a.m. and 6:45 a.m. I was always the first girl in accounting to arrive so as soon as I got there I would have to open the vault where all the accounting files and books were kept. The vault door itself weighs approximately 200 to 300 pounds. Once I got the doors open, I would have to grab my metal tray and file holder. Together they weighted approximately 15 to 20 lbs.

I would spend the first two to three hours entering the worktime for the employees that worked into the computer. The other girls would arrive at 8:30 a.m. From 8:30 on I would also have to write any cheques that needed to be written right away.

I was not allowed to keep any computer books in my office, so if I had to look up an employees (sic) hours I would have to run to the vault…".

The worker confirmed the variety of her duties at the hearing. She also confirmed that she often had to get up from her desk and get the material needed to do her work. The material was located either in the office space she was working in, or in one of the eight other trailers on-site.

The worker also testified that in doing her work, she mainly used her right hand for numerical data entry. For some jobs she would use her left hand when she needed to, for example, enter a worker's name.

The data entry was also done subject to verification. In other words, she would either be prompted by the computer to enter data, or would enter information from paper material that would be located to her left. The worker would peruse the information, which was often numerical information, verify calculations on a calculator, and then enter them into the computer.

Further, the worker usually took a one hour lunch break as well as the occasional smoke break.

Reasons

To accept the worker's appeal the panel must find that the worker's bilateral carpal tunnel and cubital tunnel syndromes arose out of and in the course of her employment, or that they were aggravated by it. We are unable to make that finding.

Subsection 4(1) of the Act provides as follows:

"Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment is caused to a worker, compensation as provided by this Part shall be paid by the board out of the accident fund, subject to the following subsections."

Subsection 1(1) of the Act defines an accident:

"accident" means a chance event occasioned by a physical or natural cause; and includes

(a) a wilful and intentional act that is not the act of the worker,

(b) any

(i) event arising out of, and in the course of, employment, or

(ii) thing that is done and the doing of which arises out of, and in the course of, employment, and

(c) an occupational disease,

and as a result of which a worker is injured;

CTS has many causes. In the case where a worker develops bilateral CTS, there is a strong suggestion that the cause is found elsewhere than in her work duties. For this reason, it is extremely important to understand the nature of the worker's duties and the position both her wrists are in during the performance of these duties to determine whether it is the work duties that is causing stress on the worker's wrists. Indeed, as opined by the worker's own treating physicians, repetitive data entry work can cause strain on the wrists and lead to CTS.

Cubital tunnel syndrome also has multiple causes - habitual leaning on the elbow, repetitive flexion and extension of the elbow, congenital variations of the humeroulnar aponeurotic arcade, diabetes, hereditary neuropathy, rheumatoid arthritis, old fracture with joint deformity or habitual elbow flexion during sleep. Once again, it is important to examine the work duties to determine if there is a correlation.

The evidence before the panel is that the worker's duties were not highly repetitive in nature and that she often took breaks throughout the day, either for lunch, smoking or to retrieve materials. There is also very little cogent evidence of poor wrist or elbow positioning during the performance of her duties.

The panel did turn its mind as to whether the hours worked by the worker were sufficient to cause her symptoms. The worker's evidence was that she worked 12 hour days at least three times a week. This is not supported by the calendar of hours she provided to the WCB. Nor is it supported by her April 21, 2004 letter to her employer :

"…I would rather work from 7:30 a.m. to 4:00 p.m. with a half hour lunch. Because I have someone running the driving range for me, I have to be back there at 4:30 to take over for the night otherwise I would have to pay my sister overtime since she starts there at 8:30 a.m. every morning…"

In arriving at our decision the panel placed considerable weight on the findings of the WCB rehabilitation specialist who assessed the worker's job and workplace.

We further relied on the evidence that this worker has suffered from a bilateral wrist condition dating back to 1999. Considering that her current upper extremity conditions are also bilateral, combined with the worker's other risk factors, and that she primarily uses her right hand in her job duties, we could not conclude that the bilateral conditions of cubital and carpal tunnel syndrome result from her work duties.

The panel finds on a balance of probabilities that the worker's varied job duties are not causally related to the development of her bilateral cubital and carpal tunnel syndrome and that she did not suffer an aggravation of either of these conditions from her job tasks.

We further find that there was no medical evidence to support an aggravation of her right cubital and carpal tunnel decompressions when she returned to work following her January 2005 surgery.

On the basis of the foregoing, we find that the worker's claim is not acceptable.

Accordingly, her appeal is denied.

Panel Members

L. Martin, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

L. Martin - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 20th day of July, 2006