The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on August 31, 2000, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on August 31, 2000.

Issue

Whether or not the claimant is entitled to payment of wage loss benefits beyond March 10, 1999.

Decision

That the claimant is not entitled to payment of wage loss benefits beyond March 10, 1999.

Background

In 1994, the claimant submitted a claim for compensation benefits indicating that she developed pain in her left shoulder, elbow, wrist and hand during the course of her employment as a meat cutter. The initial diagnosis was a strain to the left wrist and left lateral epicondyle. The claim was accepted as Workers Compensation Board (WCB) responsibility and benefits were paid accordingly.

On March 3, 1999, primary adjudication determined that the claimant had recovered from the effects of her 1994 accident and that benefits would be discontinued as of March 10, 1999. The following is a brief summary of the medical information noted throughout the file leading to this decision:

• on May 5, 1994, an orthopaedic specialist noted that the claimant had an overuse syndrome of the left upper extremity, resulting in carpal tunnel syndrome, left wrist extensor tendonitis, medial and lateral epicondylitis of the elbow and subacromial bursitis of the left shoulder. On July 4, 1994, the specialist stated that the claimant’s left shoulder pain was secondary to residual AC joint pathology. The left elbow status was better and nerve conduction studies (NCS) were arranged due to ongoing left medial compression symptoms. The results of the NCS were later reported as showing no evidence of CTS.

• on November 8, 1994, a WCB medical advisor indicated that the claimant still had a significant disability relating to the left shoulder and that her left shoulder problem was multi-factorial. The claimant showed evidence of adhesive capsulitis of the left shoulder, rotator cuff tendonitis, left AC joint tenderness, and myofascial pain of the left shoulder muscles. There was no evidence of any tendonitis in the left elbow or carpal tunnel syndrome. The medical advisor concluded that the claimant was not totally disabled and could perform sedentary duties with restrictions.

• following examination of the claimant on October 24, 1995, a WCB medical advisor outlined the following three differential diagnoses: a subacromial impingement syndrome with an associated stiff and painful shoulder; a left shoulder adhesive capsulitis; chronic splinting of the left shoulder occurring as a functionally mal-adaptive response to discomfort. The claimant was not suffering from a myofascial pain syndrome in the posterior cervical/posterior shoulder region.

• on January 6, 1996, an independent radiologist reviewed two left shoulder arthrograms dated October 27, 1994 and November 9, 1995. The radiologist concluded that a significant change was clearly evident between the two examinations in that a full thickness rotator cuff tear was confirmed on the recent exam, but was not clearly present on the 1994 study. Both exams showed evidence of adhesive capsulitis with progression between the two studies.

• the claimant was assessed by a sports medicine specialist on January 29, 1996. On February 5, 1996, a WCB medical advisor recorded that the specialist’s clinical findings were indicative of adhesive capsulitis. Examination findings were not suggestive of a rotator cuff tear.

• on October 10, 1996, the claimant underwent a left shoulder manipulation under anesthesia which was approved by the WCB, followed by physiotherapy treatments.

• on February 17, 1997, the orthopaedic surgeon commented that the left shoulder manipulation made no difference to the claimant’s condition. A left shoulder arthroscopy and left rotator cuff repair was suggested.

• the claimant underwent a left shoulder arthroscopy and open acromioplasty on May 1, 1997. Post-operatively, the diagnosis was left shoulder impingement syndrome and no rotator cuff tear was found. By July 28, 1997, the orthopaedic surgeon noted that the claimant had no impingement, had good strength and had excellent motion.

• on September 22, 1997, a Vocational Rehabilitation Counsellor (VRC) wrote to the claimant advising that her return to work program would commence on September 22, 1997 and that modified duties consisted of trimming back fat and defatting.

• the attending physician reported on January 22, 1998, that the claimant’s chronic pain was getting worse. Subjective complaints were pain to the left shoulder and elbow. By February 18, 1998, the claimant complained of pain in her left neck, shoulder and elbow.

• on May 13, 1998, the VRC documented that the claimant was performing her pre-accident work duties for 5 hours per day on the pork line. Effective May 8, 1998, the accident employer closed its operation and it was uncertain whether or not the plant would reopen again in the future.

• the claimant was assessed by a WCB medical advisor on June 25, 1998. The diagnosis rendered was left lateral epicondylitis which was consistent with the claimant’s work tasks. Recommendations were made for the claimant to undergo physiotherapy/rehabilitation directed at the elbow and forearm and for the use of a forearm strap to offset the stresses on the lateral epicondyle. The claimant later began physiotherapy on July 23, 1998.

• in a September 18, 1998 report, the attending physician noted that the claimant’s left elbow was tender. There was slight swelling over the lateral epicondyle. There was tenderness over the attaching aponeurosis and muscles to the mid forearm. There was slight decrease in strength on the wrist extension and hand grip. The left shoulder was quite tender over the biceps tendon, subacromion area, acromio-clavicular joint, and trapezius muscle. On September 29, 1998, a WCB medical advisor commented that she was unable to explain the claimant’s increase in symptoms and the discrepancies noted in the reported range of motion. Further physiotherapy was authorized.

• on November 10, 1998, a WCB medical advisor noted that the claimant’s onset of epicondylitis features in late December and early January appeared to come on during the course of her tasks at work. Based on the call in exam of June 22, 1998, the medical advisor stated that a cause and effect with work tasks was supported. However, the claimant had not been exposed to work tasks since May 8, 1998 when the employer ceased its operations. The apparent change in status from the call-in in June to the presentation at physiotherapy in July was unexpected as the claimant was not performing any work tasks. Continued symptoms through the wrist, elbow and shoulder were not, in the medical advisor’s opinion, directly related to the compensable injury as there was no ongoing work exposure to explain this. Based on the foregoing, the recent change in symptoms were more likely related to other explanations, and not to the work tasks from December 1997 to winter/spring of 1998.

• on February 18, 1999, a WCB medical advisor commented that the recent reports received from the attending physician documented minimal tenderness at the left lateral epicondyle. “At this point, ongoing symptoms of ‘pain left forearm’, on balance, do not relate directly to the compensable injury.”

On May 6, 1999, a union representative contended that based on the medical evidence, the claimant was still partially disabled and that the WCB should continue its responsibility for provision of wage loss benefits including vocational rehabilitation services beyond March 10, 1999. The case was forwarded to Review Office for consideration.

In a decision dated July 30, 1999, Review Office confirmed that the claimant was not entitled to wage loss benefits beyond March 10, 1999 and that no responsibility could be accepted for the claimant’s ongoing complaints beyond March 10, 1999.

Review Office noted in its decision that the claimant received wage loss benefits over five years for an injury which began as a strain to the left wrist/elbow and then progressed to the left shoulder, with no further mention of either left wrist or elbow as being a problem. It was noted that more recently, the left elbow became the main problem with the left shoulder having normal range of movement with surgery confirming there was never a tear of the rotator cuff. Review Office agreed with a WCB orthopaedic specialist that the claimant did not require restrictions as a result of her left shoulder injury or to the left elbow condition. Review Office said it was unable to explain the origin of the left forearm pain given the fact the claimant had not worked in such a lengthy period of time.

On June 27, 2000, the union representative appealed Review Office’s decision and an oral hearing was convened on August 31, 2000.

Following the hearing and discussion of the case, the Appeal Panel requested that additional information be obtained from the claimant’s treating orthopaedic specialist. A report was subsequently received dated October 25, 2000, and was forwarded to the interested parties for comment. On November 23, 2000, the Panel met to render its final decision with respect to the issue under appeal.

Reasons

We asked the treating orthopaedic specialist to comment on any change to the claimant’s left shoulder condition from his first assessment in 1996 to that of his 1999 examination. In a letter to the Appeal Commission dated October 26^th, 2000, he replied as follows: “The above noted letter showed that my assessment in 1999 seemed to show predominantly tenderness over the left trapezius muscle with less pain coming from the anterolateral humeral head (the rotator cuff) and AC joint. Therefore it was felt that most of the patient’s pain in 1999 was coming from C5-6 osteoarthritis, shown on X-ray.”

In addition, the specialist was also asked to comment on the clinical findings that supported a diagnosis of cervical osteoarthritis at C5-6 and whether this condition was related to the compensable injury or to non-compensable factors. “The clinical findings that support C5-6 osteoarthritis are the X-ray changes. The findings that support cervical spine osteoarthritis are the X-ray findings and palpation, finding most of her tenderness in trapezius, left trapezius likely being referred pain from the cervical spine. This would likely be noncompensable (sic) factors.”

We find based on the weight of evidence that the claimant’s continuing left shoulder difficulties subsequent to the termination of benefits were, on a balance of probabilities, as a result of her C5-6 cervical osteoarthritis and not the compensable injury. We further find that any restrictions in force after March 9, 1999 would be due to the claimant’s pre-existing non-compensable osteoarthritis. With respect to the claimant’s arm, elbow and wrist, the claimant testified these conditions were basically all right at the present time and that it was her shoulder, which was giving her the most problem. “Like right now it’s mostly my shoulder now. This is getting better. It’s just the shoulder, when I touch here it’s just sore, very tender.”

After having considered all of the evidence, we find and conclude that the claimant is not entitled to payment of wage loss benefits beyond March 10, 1999. Accordingly the claimant’s appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
C. Monk, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 15th day of December, 2000