The Appeal CommissionThe Workers Compensation Act of Manitoba

According to the claimant’s evidence, he developed a high pitched tinnitus (ringing) in his right ear after he had been pointing meat hooks on a trip hammer for approximately 8 or 9 days. This event prompted the claimant to consult an Ear, Nose and Throat specialist and also eventually to file a workman’s claim for injury with the WCB. In a letter dated May 5^th, 1971, the specialist reported the following information to the WCB:

“This patient consulted me on April 6, 1971, stating that he had had high pitched tinnitus in the right ear for four days. There was no hearing loss. He said that he had been working with a trip hammer, which was very noisy, for the past two weeks. His previous work had also been noisy. He also complained of nasal obstruction, but this was a longstanding complaint and he had had unsuccessful surgery elsewhere. This disability was not related to any industrial injury. On examination the ears were normal but the Pure Tone Audiogram showed a moderately deep high tone notch, maximal at 4,000 cycles (copy enclosed).

Mr. [the claimant] is to undergo further nasal surgery but, as I indicated, this is not connected with industrial injury. The audiogram is, in my opinion, consistent with damage due to noise exposure. I do not believe, however, that two weeks at the trip hammer would be sufficient to cause a permanent loss - - more likely his previous record of noisy work is responsible.”

Two days later on April 8^th, 1971 the claimant presented himself at a local hospital for further examination. The hospital’s attending Otolaryngologist forwarded a report to the WCB in which he stated:

“This patient presented himself at the hospital on April 8, 1971, stating he had ringing in the right ears (sic) which had been of six days duration: the left ear was not troublesome; and that he related the onset of the hearing problem to the use of a trip hammer on a meat hook over a two week period prior to his complaint. He said that there was much noise in the environment where he works, that he wore ear plugs (sic). He stated he noticed no difference in hearing on either side, but when he left work he felt as though he was slightly deafened. His hearing seemed to be relatively normal later in the day when he was at home. He usually noted then that about three minutes after leaving work his hearing seemed to improve to some extent.

Audiometric studies were done, a copy of which is enclosed. This shows a high toned hearing loss between 4,000 cycles and is associated with acoustic trauma.

Examination of his ear, nose and throat was essentially normal apart from this.

The tinnitus could be related to the injury to the organ of Corti for which, of course, we have no relief. I am unable to provide any treatment for this patient.”

Sometime towards the latter part of April 1971, the claimant sought yet a third opinion concerning the ringing in his ears. This third physician submitted a Doctor’s First Report of Injury form to the WCB on or about May 6^th, 1971, in which he advised: “This patient did not inform us that it was a workman’s compensation problem, nor that he had seen another doctor. Claimed he had severe tinnitus associated with working with a trip hammer. We were unaware he was involved in any accident.” The suggested working diagnosis was acoustic trauma. The physician noted that the claimant seemed overly emotional and that the claimant had been advised to use ear protectors.

The claimant continued to experience a high level sound “like high tension wires” and this was driving him crazy. He sought psychiatric assistance for this condition at a local hospital in late April 1971. Hospital history notes of case treatment dated May 5^th, 1971 state in part: “Rest not helping. Still depressed re. Ringing in ears & has trouble accepting that there’s no cure. Reassured that it will improve. Told to go back to work. Pt. [ie. patient] must go thru (sic) a grief reaction just as tho (sic) he had cancer etc.”

Further psychiatric evidence on file strongly suggested that the claimant has had pathological fears and delusions, which go back many years. The psychiatric diagnoses ascribed on May 10^th, 1971 to the claimant’s condition were “psychosis” and “depression”.

The term psychosis is defined in Taber’s Cyclopedic Medical Dictionary as meaning: “A term formerly applied to any mental disorder, but now generally restricted to those disturbances of such magnitude that there is personality disintegration and loss of contact with reality. The disturbances are of psychogenic origin, or without clearly defined physical cause or structural change in the brain. They usually are characterized by delusions and hallucination, and hospitalization generally is required. This condition is manifest in the behavior, emotional reaction, and ideation of the patient, who fails to mirror reality as it is, reacts erroneously to it, and builds up false concepts regarding it. Behavior responses are peculiar, abnormal, inefficient, or definitely antisocial. The psychopathic personality reacts badly because of intrinsic emotional differences playing upon an undistorted world of reality.”

In the fall of 1971, the claimant requested that his claim be referred to a Medical Board of Reference (the forerunner of the present day Medical Review Panel). On December 28, 1971 a summary of his case was prepared for the Medical Board:

“Mr. [the claimant] has filed a claim with the Workmen’s Compensation Board regarding ‘affected nerves, badly affected hearing and also a loss of hearing."

The claimant is 39 years of age, employed by the [name of company] as a blacksmith in the [name of workplace]. He has been examined by three Otolaryngologists and audiograms show a high tone notch maximal at 4,000 cycles. The patient also was complaining of tinnitus.

The Workmen’s Compensation Board is fully prepared to accept that the man’s high tone hearing loss is probably related to noise exposure within his occupation. The loss, however, does not occur within the speech range and at present is not at a pensionable level. This, so far as the board is concerned, is not a point at issue.

This man, however, has taken a considerable period of time off work because of his ‘nervous condition’ and he wants to be compensated for this time loss. The board Medical Department has recommended that there was no need for him to be off work because of his hearing problem and the Board itself has declined to pay him compensation. The man has objected to this ruling and requests a Medical Board of Reference.”

The claimant proposed the third physician, whom he consulted, as his nominee to the Medical Board of Reference. According to a memorandum on file dated January 6^th, 1972, this doctor felt the patient would be better served if he chose someone else. The doctor is recorded to have said that the patient was “labile” and had many problems. He indicated that the claimant had demanded medical reports to cover time off work. The doctor believed the claimant should not have missed work because of the high tone hearing loss. In a conversation with the WCB’s Chief Medical Officer, the doctor purportedly reiterated “that he feels so strongly that this man is simply out to get something, that his testimony might serve to influence the Panel against the man and he did not want to do that”. Consequently, the doctor declined to be a member of the panel.

The Medical Board of Reference interviewed the claimant on March 30^th, 1972. The following report was ultimately provided to the WCB.

“It is understood that in March 1971 the claimant was assigned to a trip hammer and shortly afterwards he noticed persistent right sided tinnitus during working hours. Initially the tinnitus disappeared after work, but subsequently has become constant. It is also noted that he has worked as a Blacksmith for all of his working life.

The otologic examinations indicate, and the Board accepts, that this man has a high tone deafness with a maximum incidence at 4,000 cycles. The Board also accepts that this hearing loss is due to acoustic trauma, occupational in origin. Nevertheless, we feel that this hearing loss has probably been present for some time prior to March of 1971. It is considered probable, however, that the move to a more noisy environment in March 1971 may have increased or have produced the right sided tinnitus and has presumably also increased the amount of cochlear damage. It is to be stressed that the hearing loss is bilateral and that even though the tinnitus was described by Mr. [the claimant] as initially right sided, he himself has subsequently reported bilateral tinnitus.

The Medical Board has carefully considered whether Mr. [the claimant] is fit for employment in his trade as Blacksmith or for any other type of work. It is the opinion of the Medical Board that Mr. [the claimant] should be advised and we understand he is prepared to wear ear protectors in any future employment of any kind, which involves working in noisy surroundings. It is our opinion, therefore, that he is fit to return to his trade as a Blacksmith, provided that ear protectors are worn and provided also that consistent exposure to the higher noise levels is avoided.

It is the Medical Board opinion that it was not necessary for this patient to be off work because of the aforementioned hearing loss, other than for the time required for the hearing examinations.”

Since 1971 the claimant has had a number of episodes of major depression as well as a lot of what has been described as “inter-episode ambient depressive feelings”, which have apparently continued up to the present time. The claimant’s brother, who acted as advocate, placed a great deal of reliance on a former treating psychiatrist’s opinion, which is contained in a letter dated October 20^th, 1999. The psychiatrist stated in part as follows:

“Since I obviously was not in professional contact with Mr. [the claimant] in 1971, I am only able to hypothesize the relationship between his tinnitus and his subsequent episode of depression. My comment would be that the depression followed rapidly when the tinnitus became severe enough to force his resignation, and I believe it is justifiable to recognize a causal relationship between the two.

Mr. [the claimant] has not enjoyed good mental health since 1971. He has not, of course, been depressed throughout this time, but I believe it is reasonable to deduce that his recurrent bouts of depression were initiated by the tinnitus, and that the continuing tinnitus was largely to blame for the ambient depression which has certainly interfered with his enjoyment of life throughout the intervening years.”

We note the psychiatrist goes on to say, however, “In the nature of such conditions, it is not possible to prove a relationship between the two conditions, but I truly believe that the balance of likelihood is certainly in favor of a causal relationship existing between the tinnitus and his subsequent depressions.”

We have carefully reviewed the medical evidence on the file and note that certain medical reports from the early 1970’s strongly imply that the claimant had substantial personal and family difficulties, which were contemporaneous with and preceding the occurrence of his tinnitus. This is contrary to the hypothesized relationship noted by the claimant’s psychiatrist in his October 20, 1999 report. These difficulties including the diagnosis of depression were identified as requiring psychiatric treatment. As such, we find that there is, on a balance of probabilities, no direct causal relationship between the claimant’s tinnitus and his diagnoses of psychosis and major depression. We further find the preponderance of evidence does not support the claimant’s contention that as a consequence of his compensable injury he became totally disabled. We accept the findings of the Medical Board of Reference in 1972 that the claimant was fit to return to his trade as a blacksmith. The claimant did in fact return to the workforce as a real estate salesman approximately two and one-half years after his accident. We also find that any wage loss sustained by the claimant would be attributable to his non-compensable psychiatric condition. Accordingly, the claimant’s appeal is hereby dismissed.