Decision #77/04 - Type: Workers Compensation

Preamble

A non-oral file review was held on May 27, 2004, at the worker’s request.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable as a temporary aggravation of a pre-existing condition.

Decision: Unanimous

Background

In July 2002, the worker contacted the call centre at the Workers Compensation Board (WCB) to report difficulties that she was experiencing with both hands which she related to her work duties as a deli clerk/supervisor. The worker noted that her difficulties with her hands started in early January, 2001.

Initial medical information consisted of a Doctor’s First Report dated July 14, 2002, in which it was noted that the worker complained of painful hands which turned her skin red, white and blue. The diagnosis rendered was Raynaud’s phenomenon.

Another medical report was received dated August 2, 2002, which indicated that the worker was first seen on May 30, 2002 for complaints of right hand swelling and stiffness, especially painful in the 4th finger. The worker had this condition for the last two years. The physician’s diagnosis was Raynaud’s phenomenon. The physician did not believe that her condition was caused by her work environment but did feel that her symptoms worsened due to the cold environment that she worked in.

On July 25, 2002, the worker filled out a WCB questionnaire detailing the symptomatology in both of her hands.

The worker also provided details with respect to her work activities. She used a deli slicer, which had a light vibration, about 2 to 3 hours each day.

On September 9, 2002, a WCB internal medicine consultant reviewed the file information at the request of primary adjudication and made the following comments:

  • the diagnosis, from the brief history on file, appeared to be Raynaud’s phenomenon. The cause of the condition was unknown at this time.

  • the attending physician ruled out collagen vascular disease but thoracic outlet syndrome or systemic sclerosis which is part of collagen vascular disease has yet to be considered.

  • vibration from a meat slicer seemed to be an unlikely cause of the worker’s problem.

  • the diagnosis of Raynaud’s disease, which is more common in women, may be aggravated by exposure to cold. Cigarette smoking may also be contributing.

  • if the final diagnosis was proven to be Raynaud’s disease rather than secondary Raynaud’s phenomenon, the duties at work, such as exposure to cold, water, etc. may precipitate an episode of color changes and pain.

  • further investigations needed to be carried out to rule out thoracic outlet syndrome and peripheral nerve disorders.

Subsequent medical information consisted of a report from the Director of the Arthritis Centre dated August 11, 2003 along with x-ray reports dated October 21, 2002 and December 13, 2002. The results of various laboratory investigations were also received. A diagnosis of Raynaud’s phenomena was provided.

On November 26, 2003, the WCB’s internal medicine consultant reviewed the new medical information on file and provided the following responses to questions that were posed by primary adjudication:

  1. “The diagnosis of primary Raynaud’s phenomena has been confirmed.

  1. The worker’s work is unrelated to the disease process.

  1. The symptoms of primary Raynaud’s phenomena can be precipitated by exposure to cold, cigarette smoking, etc. The symptoms such as pain and colour changes may last up to a few hours. Primary Raynaud’s phenomena is a pre-existing condition.

  1. On some occasion the Raynaud’s phenomena may precede the development of scleroderma or systemic sclerosis by years. This is a collagen vascular disease and unrelated to her present occupation. Her own family physician would have to watch for the developments.”

In a decision letter dated December 5, 2003, the worker was advised by primary adjudication that her claim was not acceptable. Primary adjudication relied on Section 4(4) of The Workers Compensation Act (the Act) in its decision and was of the opinion that the dominant cause of the worker’s condition was not work related. On January 2, 2004, the worker appealed this decision to Review Office.

On February 13, 2004, Review Office confirmed that the claim was not acceptable. Review Office accepted the opinions expressed by both the worker’s attending physician, through his report dated August 2, 2002, and by the WCB’s internal medicine consultant, that the worker’s employment did not cause her Raynaud’s phenomenon. Review Office further stated, “…that as the dominant cause of the disease is not the workplace, then Section 4(4) of the Workers Compensation Act of Manitoba has not been met and therefore the claim is not acceptable.

On March 16, 2004, the worker disagreed with Review Office’s decision and a non-oral file review was arranged.

Reasons

In arriving at our decision in this matter, we have reviewed the full claim file and considered the worker’s written submission.

In her written submission the worker states that her condition is caused by the “…intense amount of cold-related work…” She notes that before working in this cold environment she had no symptoms. She also notes that her condition has improved since she found other employment away from the cold environment.

For the worker to be successful on this appeal, we must find that the dominant cause for the development of her bilateral hand complaints was her employment duties, or alternatively that she had a pre-existing condition in her hands that was aggravated by her employment duties. We were not able to find that her employment duties were the dominant cause of her condition. However; we did find that the nature of her employment duties resulted in a temporary aggravation of her pre-existing hand condition.

Medical evidence on the file confirms the worker’s condition as Raynaud’s phenomenon. There is no dispute as to this diagnosis. We note that the worker’s physician, rheumatologist and WCB internal medicine consultant all agree with this diagnosis.

The Review Office found that the claim was not acceptable. The claim was adjudicated under section 4(4) of the Act. Review Office found that employment was not the dominant cause of the worker’s condition.

We agree with the Review Office’s position that work is not the dominant cause of the worker’s condition and accordingly, the worker’s Raynaud’s phenomenon is not compensable as an occupational disease.

In arriving at this position, we accept the opinion of the worker’s own physician who advised on Aug 2, 2002 that “I do not believe that this condition is caused by her work environment…” We also rely upon the opinion of the WCB’s internal medicine consultant who advised on November 26, 2003 that “The worker’s work is unrelated to the disease process.”

However, in our view this does not end the matter. Although the worker’s condition does not meet the requirements for acceptance as an occupational disease claim, we find that it is a pre-existing condition and was aggravated by her employment working with cold products. The evidence on file establishes that the worker experienced symptoms when she worked with cold products. The evidence includes:


  • The Worker’s Accident Report notes “The pain increases with cold contact…” It also notes that “Had a week of vacation and had some improvement while off work, but after a few days back, worse again.”

  • The worker’s reply to a questionnaire dated July 23, 2002. The worker was asked “What are you doing when each of these symptoms appears? How do they progress?” She responded in part: “handling cold products at work”

  • The worker’s letter dated January 2, 2004 states “Now that I am not working in an environment that exposes my hands to cold on a regular basis, I am sleeping at night and have regained the mobility in my hands.”

  • The worker’s letter of May 10, 2004 states “At the present my hands have improved. Please consider how well my condition is now compared to when I was working with cold products daily.”

  • The worker’s Appeal of Claims Decision form notes “Since changing jobs symptoms are gone.”

We note that the following medical evidence also supports a finding that the worker suffered a temporary aggravation of her pre-existing Raynaud’s phenomenon:

  • Report from treating physician dated August 2, 2002 that “I do not believe that her condition is caused by her work environment, but I do believe that her symptoms are worsened due to the cold environment that she works in…”

  • WCB internal medicine consultant report of November 26, 2003. In reply to a question about whether the worker’s Raynaud’s phenomenon can be considered a pre-existing condition which was aggravated, the consultant replied:

“The symptoms of primary Raynaud’s phenomena can be precipitated by exposure to cold, cigarette smoking, etc. The symptoms such as pain and colour changes may last up to a few hours. Primary Raynaud’s phenomena is a pre-existing condition.”

Based upon the above evidence and on a balance of probabilities, we find that the worker experienced a temporary aggravation of her pre-existing Raynaud’s phenomenon, which we note typically resolves when she is away from the workplace.


The WCB Policy on Pre-Existing Conditions (44.10.20.10) is applicable to this case. It provides that WCB will accept responsibility where a pre-existing condition has been aggravated by a compensable accident. The WCB’s responsibility is limited to the period of the aggravation.

We find that the worker’s appeal is allowed. Determination of the length of the aggravation and associated benefits will be referred back to the WCB for consideration.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 3rd day of June, 2004

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