Decision #94/12 - Type: Workers Compensation

Preamble

The worker is contesting a decision made by Review Office of the Workers Compensation Board ("WCB), which determined that her bilateral carpal tunnel syndrome ("CTS") was not related to the performance of her job duties as a long haul driver. A hearing was held on August 2, 2012 to consider the matter.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

On February 9, 2012, the worker filed a claim with the WCB for injury to both wrists that she believed was caused by the repetitive nature of her job duties as a long haul driver. The worker described her duties as follows:

Steering the vehicle; shifting the gears; cranking up the dollies; attaching and releasing the airlines; opening and closing hoods for the pre trip; making the beds. We do not do any loading or off loading.

Information obtained from the employer was that the worker made no mention of any wrist issues prior to February 6, 2012. The worker stated that her symptoms began in the summer of 2011. When seen by a neurosurgeon on January 30, 2012, the worker was told she had carpal tunnel in both wrists.

A report from a neurologist dated January 30, 2012 confirmed that the worker had carpal tunnel syndrome ("CTS") in both her left and right wrists.

On February 15, 2012, the worker was contacted by the WCB to obtain additional information concerning her specific job duties, work history and the onset of her wrist symptoms.

In a decision dated February 15, 2012, the worker was advised that the WCB was unable to establish that her bilateral CTS condition arose out of and in the course of her work duties. The adjudicator noted that the majority of the job duties performed by the worker involved low force activity which was unlikely to contribute in a material way to the development of her CTS condition. The worker also performed a variety of other short duration tasks.

On April 4, 2012, the worker appealed the decision to Review Office. In her appeal, she relied on a report dated April 4, 2012 from her neurologist which stated:

"I understand her claim was denied and that she is appealing. I certainly support her appeal and agree that her carpal tunnel syndrome is related to her work…"

On May 14, 2012, a WCB review officer placed a memo on the file outlining the information he obtained from the worker regarding the nature and performance of her job duties.

On May 16, 2012, Review Office was unable to establish that the worker sustained an accident as defined in The Workers Compensation Act (the "Act"). Review Office placed weight on the following factors in making its decision:

  • the worker drove a semi-truck (long haul) with a trailer.
  • the truck driven by the worker had power steering. The worker could adjust her seat and steering wheel.
  • the worker was not required to manually load or unload the trailer.
  • the worker drove with both hands on the wheel. The worker's hands therefore were in a neutral position for the most part. The evidence did not support there was repetitive or forceful gripping involved in driving the truck.
  • a provocative workplace factor was not recognized.
  • the worker's CTS condition was bilateral which was indicative of an internal process.
  • the worker had several non-work-related risk factors for developing CTS.
  • the worker performed the same low force work demands for 9 years without incident.
  • Review Office did not accept that vibration from the steering wheel or gear shifter would cause CTS to develop,
  • on a balance or probabilities, gripping the steering wheel/gear shifter or vibrations would not be causative of CTS.
  • the other job duties described by the worker such as hooking and unhooking the trailer, making the bed in the truck, pre-trip inspections or attaching or releasing airlines are not done consistently enough to be considered repetitive in nature.

On July 5, 2012, a worker advisor acting on the worker's behalf, appealed Review Office's decision of May 16, 2012 to the Appeal Commission and a hearing was arranged.

Reasons

Applicable Legislation:

The Appeal Commission and its panels are bound by 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 bilateral carpal tunnel syndrome (“CTS”) arose out of and in the course of her employment.

Worker’s position

The worker was represented by a worker advisor at the hearing. The position advanced on behalf of the worker was that the bilateral CTS arose from the worker's duties as a long distance truck driver. Literature on CTS stated that work that involves high force or vibration is particularly hazardous for the development of CTS. The worker had been a long distance driver for ten years and there was constant vibration in both hands from holding both the wheel and the gear shift. Her hauls were from 2-5 days, or as long as 2 weeks and she and her partner typically drove 10-12 hour shifts. The worker's neurologist provided support in his January 30, 2012 and April 4, 2012 reports that the worker's bilateral CTS was related to overuse and vibration. It was submitted that on a balance of probabilities, the worker's CTS arose from her employment.

At the hearing, the worker gave evidence regarding the scope of her duties as a long haul driver. The truck that she drove was a slightly older truck, but very well maintained. It was a standard shift truck and she described it as comfortable to sit in. The steering wheel, air-ride seat and lumbar cushion were all adjustable. The worker's practice was to hold the steering wheel at eight and four o'clock, where the cross member was located on the wheel, and would maintain this position all the time. She would have a relaxed grip and her wrists were in a neutral position. Both hands would be resting on the wheel, with the middle knuckles resting on the cross member. The gear shift was located about six inches from her right leg and vibrated in a similar manner as the steering wheel. Gear shifting was involved in approximately 10 percent of her driving, mostly while in urban areas. The other 90 percent was highway driving.

The vibration which the worker felt caused her CTS was the motion and shaking which occurred while travelling on the highways, particularly Canadian highways. When the truck was not moving, there was minimal vibration. The worker described the vibration as a "slow vibration" and likened the degree of vibration to how it feels when you put your hand on a music speaker.

With respect to connecting and disconnecting loads at destinations, the worker described raising/lowering landing gear by turning a handle and attaching/detaching air lines and electrical. These tasks would typically take approximately 10 minutes so long as things worked smoothly.

Analysis

To accept the worker’s appeal, we must find on a balance of probabilities that she suffered injury by a workplace accident within the meaning of subsection 4(1) of the Act. In order to do so, we must find that her bilateral CTS arose out of and in the course of her work duties. Based on the evidence before us, we are not able to make that finding.

CTS is defined as the impairment of the motor and/or sensory function of the median nerve as it traverses through the carpal tunnel. It is caused either by intrinsic swelling of the median nerve or by extrinsic compression of the median nerve by one of the many surrounding structures of the wrist. CTS has a variety of causes. It can be caused by underlying systemic conditions such as rheumatoid arthritis, osteoarthritis, hypothyroidism and diabetes. Middle aged females, individuals with a high body mass index, smokers and people genetically pre-disposed to the development of CTS are also at increased risk for the development of CTS. It can also be caused by some work activities. There remains considerable debate in the medical literature as to what work factors may cause CTS. Occupational factors most commonly accepted to be associated with CTS include a wrist injury, frequent use of vibrating hand tools or any repetitive, forceful motion with the wrist bent, especially when done for prolonged periods without rest. It is generally considered that the greatest frequency of occupationally related CTS is found where the job duties involve high force and high repetition.

To decide this appeal, the panel must carefully examine the worker’s job duties to determine whether, on a balance of probabilities, they might have caused her CTS.

After considering the evidence before us, the panel is of the opinion that the worker’s bilateral CTS is not causally connected to her work duties. The job duties identified by the worker are not consistent with the type of duties typically associated with the onset of CTS symptoms. The primary activity identified by the worker as being causative of her CTS condition was holding the steering wheel, which was vibratory. The panel notes, however, that for the most part, the worker’s wrists were in a neutral position, and there was virtually no requirement for either high force or high repetition. There was no requirement to hold the wrists in an awkward position. The worker described her hands as having a "relaxed grip" on the center bar of the steering wheel. In the panel's opinion, none of the actions associated with driving the vehicle appeared to be causative of CTS. We do not accept that gripping of the steering wheel or vibration of the vehicle, as described by the worker, would cause CTS to develop. The vibration alone in the absence of a forceful grip and/or torquing of the wrist is not sufficient to find a work-related cause. The panel also notes that the worker’s condition is bilateral, which suggests a non-work-related etiology.

The panel also considered whether the worker's job duties performed while connecting and disconnecting loads may have contributed to her CTS. We find that they did not play a causative role in the development of her condition. The duties did not involve the degree of repetition, force, or awkward movement which would typically be associated with CTS. The panel also notes that these duties were only performed infrequently, at the start and end of trips, and the worker's evidence was that she shared these duties 50-50 with her driving partner. In the circumstances, we are unable to identify the degree of repetition which would be necessary to establish a causal relationship.

Given the foregoing, the panel finds that it is more likely that the CTS was caused by factors other than her work duties. On a balance of probabilities, the panel is unable to relate the worker’s bilateral CTS symptoms to her employment. We therefore find that the claim is not acceptable and the worker’s appeal is therefore denied.

Panel Members

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

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 5th day of September, 2012

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