Decision #01/11 - Type: Workers Compensation

Preamble

The worker has an acceptable claim with the Workers Compensation Board ("WCB") for right carpal tunnel syndrome. The employer is disagreeing with the decision and submitted that the diagnosis of tendonitis was more in keeping with the nature of the worker's job duties. A hearing was held on December 2, 2010 to consider the matter.

Issue

Whether or not the claim for right carpal tunnel syndrome is acceptable.

Decision

That the claim for right carpal tunnel syndrome is acceptable.

Decision: Unanimous

Background

In June 2009, the worker filed a claim with the WCB for difficulties she was experiencing in her right hand and wrist. The worker stated that her symptoms started around May 29, 2009 when she felt pain in her hand and wrist and her fingers were going numb. The worker stated that she told a co-worker on June 1, 2009 that her hand and wrist were sore from using her knife. On June 2, 2009 the worker said that she told her main supervisor that her hand was very sore. On June 4, 2009, the nerves in her fingers were jumping and her hand was swollen so she left work and went to a hospital. She saw a doctor and was told she was getting carpal tunnel syndrome (CTS) in her right hand and she was then placed on light duties until June 14, 2009. The worker believed that her injury was caused from using dull knives in the workplace.

On June 9, 2009, the employer's accident report indicated that the worker was performing the job of bar cut for three weeks. A job description of this position was outlined as follows:

As [a carcass] comes down the line hanging from the shackle with the back bottom end in front of the operator, the operator is required to open up the cavity for further processing. The operator uses a knife to cut upwards. A horizontal cut is made leaving 1-1.5 inches from the vent cut (when bar cutting). Alternatively the operator may be instructed to perform a J-Cut by cutting vertically. When opening [a carcass] it is the operators responsibility to be careful in not nicking or cutting too far into the other meat. Knife and hands must be washed frequently to prevent cross contamination. Responsible for general housekeeping of the work area. Involvement in the continuous improvement program is required. Other related duties as assigned.

On June 9, 2009, the worker provided the WCB with the following information:

  • she started employment with the accident employer in October 2008 and first noticed symptoms on June 1, 2009
  • there were no changes to her job duties. The worker is right handed and she cuts with her right hand. She has been doing this job since April/May of this year
  • the knives she used were dull and she asked for replacement knives. Her request for new knives was denied and they were not replaced
  • the worker did one job (bar cut) for half an hour then switched to gland cut for the next half hour
  • a bar cut is a smaller knife and gland cut is a larger knife
  • it does not take a lot of pressure to cut through a carcass but this week was hard because the knives were dull (like trying to cut through raw meat with a butter knife)
  • the worker told her supervisor on June 1, 2009 that her wrist was starting to get sore. She requested new knives on June 3, 2009 and June 4, 2009
  • the worker had no prior problems with her right wrist. She was diagnosed with CTS on the left hand about 10 years ago. She said it was related to her job, ie checking telephone books with hot glue and was off work for 18 months
  • she did a lot of knitting - a couple of days a week - but had not knit since March. The worker also does yard work. She smoked a pack about every 3 days and had been smoking for 25 years.

On September 10, 2009, the worker's claim for compensation was accepted based on the diagnosis of right wrist tendonitis.

Further medical reports on file revealed that the worker underwent nerve conduction studies and was seen by a neurologist. The worker was diagnosed with right CTS and ulnar neuropathy of the right elbow.

On October 27, 2009, the worker's file was referred to the WCB's healthcare branch to provide the case manager with an opinion as to whether the diagnosis of right CTS and ulnar neuropathy was consistent with the worker's symptoms and the nature of her job duties. On November 25,

2009, the WCB medical advisor responded that the right CTS diagnosis was consistent with the worker's symptoms and that the right ulnar neuropathy diagnosis was an incidental finding. Based on a review of the worker's job description described by the case manager, the medical advisor indicated that the worker performed repetitive wrist flexion and extension, an activity that was reported as an etiology for the development of CTS. The medical advisor indicated that the worker's age, smoking history, knitting activities and prior left hand CTS played a minor role and that the worker's right wrist/hand symptoms were related to her work activity.

On November 25, 2009, the worker was advised that the WCB was accepting the diagnosis of right CTS and the proposed CTS surgery.

On January 4, 2010, an advocate representing the employer appealed the WCB's decision to accept responsibility for the worker's right CTS condition. In her submission to Review Office, the advocate outlined the job descriptions for a meat salvager, bar cut and the operation of an air-powered gland cutter. The advocate stated "It is our position that the job tasks performed since October 2008 were not 'repetitive' enough to support this condition as arising out of her employment. To be accept (sic) as a responsibility of the WCB it must be shown that the job tasks performed are those that require forceful repetitive wrist motion (>1000hr). High force, high repetition and duration may have a synergistic effect or regular frequent use of vibrating tools." She stated that none of these factors were present in the job tasks performed by the worker.

On January 26, 2010, the worker's union representative responded to the employer's submission of January 4, 2010. The union representative described the wrist movements that are involved while performing the bar cut and gland removal jobs and also detailed process line speeds. He noted that the element of force on the bar cut job was a significant factor for developing wrist and forearm injuries, including CTS. The union representative noted a number of other factors to consider:

  • the worker blamed the dull knives for causing her wrist injury
  • the worker's symptoms were alleviated on the weekend and were aggravated during the week while at work
  • a WCB medical advisor assessed the worker's non work related risk factors as minor
  • a neurologist opined that the worker's CTS was due to overuse
  • the June 4, 2009 hospital report noted that there was swelling in the worker's wrist when she reported to the emergency department indicating an acute response to her work activities.

The employer's advocate provided Review Office with a further submission dated February 11, 2009. It was indicated that the worker was hired on October 27, 2008 to perform the job of meat salvage which she did until December 19, 2008 when she was laid off. On March 20, 2009 the worker was rehired to perform the job of meat salvage. She also rotated into the position of gland removal. The worker did not perform the job of bar cut from October 27, 2008 to December 19, 2008 and March 20, 2009 to April 24, 2009. The worker started training for the job of bar cut on April 27, 2009 and had been rotating into this position every half hour for no more than 3-4 weeks when she notified the employer on June 4, 2009 that she was experiencing pain in her right wrist.

The advocate further noted that the line speed for the time the worker was performing bar cut (April 27 to June 4, 2009) was 12 carcasses per minute. Within an hour, the worker would have been performing 360 cuts with a knife for bar cut and 720 cuts with an automatic spinning blade for gland removal. She noted that the gland removal and bar cut positions both require minimal force. Even if the knifes were dull while performing bar cut and causing additional force, the worker was only rotating to this task every half hour therefore only performing 360 cuts in an hour. It was noted that the knives are sharpened daily and each employee has more than one knife assigned to them. It was the employee's responsibility to make sure their knives were in good working order. The advocate stated that the diagnosis of tendonitis was correct for the injury reported by the worker rather than CTS.

On February 2, 2010, Review Office determined that the worker's claim for right CTS was acceptable. In making its decision, Review Office relied on the opinion expressed by the neurologist (report dated September 22, 2009) that the worker's condition was brought on through overuse and due to the repetitive nature of the duties and the volume of cutting being performed. It relied on the WCB medical advisor's opinion that the job description could well be causal for the production of the worker's symptoms leading to the diagnosis of CTS. Review Office indicated that the gland removal duties would not produce CTS based on the video demonstration of the job tasks and felt that the bar cut position would more likely be the cause of her CTS. On March 5, 2010, the employer appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

Reasons

Applicable Legislation:

The Appeal Commission and its panels are bound by The Workers Compensation Act (the "Act"), regulations and policies of the Board of Directors. Subsection 4(1) of the Act provides:

4(1) 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. (emphasis added)

The key issue to be determined by the panel deals with causation and whether the worker's CTS arose out of and in the course of her employment.

Employer's position

An advocate and a representative of the employer were present at the hearing. It was submitted that the employer was not challenging the claim or that the worker had a right hand problem, but rather they were challenging the accepted diagnosis of CTS. They noted the tasks performed, the tools used, the number of repetitions per hour and the length of work history were not consistent with activities generally accepted as contributing to the development of CTS. They felt the initial compensable diagnosis of right wrist tendonitis was a more accurate outcome of the worker's job duties and the Panel should overturn the Review Office decision.

At the hearing the employer presented evidence that the worker was rotated between two line positions, bar cut and gland removal, every 30 minutes using different wrist motions for each task. Also, the line speed of 12 carcasses per minute that were processed and the job rotation resulted in only 360 cuts per hour at the bar cut task.

Employment records confirm that she spent only 24 working days on the bar cut position prior to her report of injury. Further, each employee is provided with 3 sharp knives at the beginning of their shift and has a knife sharpening block at their station to ensure a sharp edge is maintained throughout the day. The gland removal job consisted of removal of an oil sack from each carcass with an air powered rotary knife using minimal force or wrist movements.

Worker's position

The worker was assisted by a union representative at the hearing. The position advanced on behalf of the worker was that a clear indication was present at the beginning of a possible right wrist CTS that was later confirmed by a nerve conduction study in September 2009. They felt that the WCB medical advisor's review and opinion confirming a CTS diagnosis resulted from work duties was the correct decision and should be upheld.

At the hearing the union representative noted that the employer's records indicate hours worked at a specific pay rate but do not indicate what work was being done. While the worker was hired in October 2008 at an entry level job class 1, due to a shortage of people on the bar cut job the worker was immediately trained and assigned to that position throughout her probationary period. After the December layoff, she was recalled in March 2009 to specifically replace the regular worker at the bar cut position and as of March 10, 2009 was immediately placed into the bar cut and gland removal jobs.

In respect to line speed, the union representative noted that after being hired in October 2008, the line speed at that time was 28 plus carcasses per minute in the period prior to Christmas. On being recalled in March the line speed was approximately 16 carcasses per minute. In relation to the dullness of the knives, this matter had been discussed by the workplace safety and health committee on a regular basis as an ergonomic hazard. The union representative also had the worker describe the types of carcasses processed and demonstrate how the actual cuts in both the bar cut and gland removal position were done.

Analysis:

In order for the employer's appeal to be successful, we must find, on a balance of probabilities, that the worker did not suffer an injury by an accident arising out of and in the course of her employment. In order to do so we must find that her right wrist CTS was not causally related to her work duties. Based on the evidence before us, the panel accepts that the worker's right wrist CTS was causally related to her work duties. Therefore the employer's appeal must fail.

Through testimony of both the worker and a member of the workplace safety and health ergonomic subcommittee, the union representative was able to clarify the duties involved in both the bar cut and gland removal jobs. The worker described in detail the hand and wrist motions used in the bar cut job as well as the gland removal job and demonstrated those motions to the panel. The panel observed that there are wrist motions of both flexion and extension to perform the two strokes required to complete the bar cut job.

The testimony of the witness was related to the types of musculoskeletal injury complaints and solutions they dealt with. She was able to provide evidence for the panel on the issues related to line speed and dull knives. It was also noted that when the processing is at or exceeds 17 carcasses per minute, there are two workers placed in the bar cut position but the gland removal position remains at one person no matter how many carcasses per minute the line speed is at.

Information was provided on the various sizes and weights of meat processed and the production line speed was from 14 to 28 carcasses per minute depending on the time of year, with the average winter/spring line speed of 16 per minute. The summer/Christmas line speed is 28 per minute for smaller carcasses and 22 for the larger and heavier carcasses.

The witness's evidence was that on an average of 15 times per shift there would be a stoppage of the production line for either mechanical or Food Inspection Agency reasons that lasted up to 10 minutes. After the line production is resumed, the number of carcasses per minute is increased to take care of the 16 carcasses per minute that arrived during the stoppage.

The witness's evidence was that the issue of dull knives was an ongoing and significant problem. They had requested that a designated person sharpen all knives at the beginning of the shift and the individual workers were then required to use a small knife sharpening block to keep the edge keen after every 7 or 8 cuts. They had also addressed the issue of the gland cutter with the final resolve being the replacement of the old mechanical cutter with an air powered wizard knife.

When asked by the panel about the problem with the dull knives, the witness noted:

"When your knife is sharp, your knife's (sic) doing the work. Its just like going through butter. If your knife is dull it’s a different story. You're going like this and trying to push it over like that.…..A sawing, a push - you're pushing with your knife."

The witness further commented that it would take about three to four pulls of the knife through the sharpening block to re-sharpen the knife but due to having to decontaminate the blade by dipping it in a hot pot and time constraints, the workers would only have time for one pull in the sharpener.

The worker also testified that she had 3 knives for the bar cut job that would have to be sharpened after cuts on eight or nine carcasses if she had time to re-sharpen them in the sharpening block.

When asked about the job rotation by the panel, the worker testified that most often, the job rotation was done individually and took approximately 3 minutes to complete. At certain times, her replacement had to wait for a person to relieve them which caused her to stay on her job for 40 minutes before being relieved. She noted, "It all depends on who's rotating and if they're able to move from their position to the next position." Later she noted, "the majority of the time we'd switch off anywhere from 30 to 35 minutes."

When asked about line speed while she worked her various positions, the worker's evidence was that the lowest line speed ever used was 15 carcasses per minute during the spring time from March to June 2009. The highest line speed was very fast at 28 carcasses per minute from October to December 2008 while she was learning the job. It was again noted that at 28 carcasses per minute there were two production workers at the bar cut position.

As to the gland removal position, it was the worker's evidence that the three to five pound tool used in the period before June 4, 2009, required her to constantly hold a lever in a down position while lifting the cutting machine vertically across the meat to remove the oil gland. The gland falls from the cutter or is dislodged with a wrist flicking motion. In order to hold onto the cutter machine, the worker used three layers of wet paper towel while gripping it tightly to avoid losing her grip.

The worker also testified that the cutting machine would vibrate in her hand due to the spinning blade and also, as the blade became dull or nicked throughout her shift, the vibrations would be worse. The worker noted this to be a significant amount of vibration, stronger than an electric razor, but the employer representative noted that she had held this tool and she would estimate the vibration to be the equivalent of an electric razor.

The employer was asked to clarify their calculations of the number of cuts per minute from their written submission. It was their evidence that the bar cut job was one cut that required two cutting strokes in a horizontal position that opened the meat for further processing. They noted that, "So the task, if it requires two cuts, two strokes, that's one cut per se."

This would mean that using their line speed estimate of 12 carcasses per minute the total number of actual cutting strokes per half hour would have been 720. This cut was used on smaller carcasses and was different than the "J" cut used once or twice per month on the large heavier carcasses.

The panel accepts the co-worker's testimony regarding the line speed and number of carcasses per minute during the time period prior to June 4, 2009 in which the worker developed right wrist CTS, as well as the evidence related to problems with dull knives.

After review of the information presented in the file and at the hearing, the panel finds that several of the factors generally accepted to be causative of CTS were present in the worker's job duties. Specifically:

  • At the bar cut job, there was continuous right hand activity making cuts in two directions on each carcass for periods of between 30 to 40 minutes, with no significant opportunity for rest;
  • The manner of performing the cuts demonstrated by the worker at the hearing involved repetitive flexion/extension of the wrist;
  • While at the gland removal job using an air powered cutter, the worker was required to exert a significant degree of grip pressure to activate the cutter, which was combined with an element of vibration;
  • Over the course of the work day, the worker was required to apply increased pressure/force when flexing and extending her wrist to make the cuts due to increased dullness of the knife blade.

Overall, the panel accepts that the duties being performed by the worker involved the degree of repetition, force and vibration which is associated with the development of CTS. We therefore find on a balance of probabilities that the worker's right CTS was causally related to her work duties and that she suffered an injury by a workplace accident within the meaning of subsection

4(1) of the Act. Accordingly, the employer's appeal is dismissed.

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 10th day of January, 2011

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