The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by Review Office of the Workers Compensation Board ("WCB") that her right wrist difficulties diagnosed as de Quervain's tenosynovitis were not related to her job duties as an administrative assistant. A hearing was held on October 30, 2012 to consider the matter.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

The worker filed a claim with the WCB for injury to her right wrist with the date of accident listed as January 11, 2012. The worker stated:

There was no specific incident. I have tendonitis in my right wrist, which in hindsight, started when we moved into the new [location]. There has been no ergonomic assessment done on my work station and I believe this is the cause of the soft tissue injury. The date of January 11 is when my family doctor diagnosed it as a soft tissue injury and referred me to a physiotherapist. It is not getting much better and I have just realized that it is my desk set up that has caused and is aggravating the injury. The only time off I have taken is for physio appointments.

The Employer's Incident Report stated:

This was initially diagnosed in January of 2010. The employee did not make the connection between the injury and the new desk set-up right away. It does, however, correspond with us moving to the new [location] and a new desk set-up. The only time missed is for physio appointments.

A Physiotherapy Initial Assessment report dated May 30, 2012 noted the following description of injury: "Pain onset after office was re-located and her computer set-up was changed." The diagnosis rendered was de Quervain's tenosynovitis.

On May 31, 2012, a WCB adjudicator obtained the following information from the worker:

• she had been working at her new workstation since November 1, 2011.
• the worker noted that the issues with her workstation was that the mouse she used on the keyboard tray was at a bad angle for her wrist. The keyboard tray does not adjust.
• the worker worked full-time as an administrative assistant and 80 percent of her day was working on the computer.
• the worker used her right hand to operate the mouse.
• the worker said she did not submit a WCB claim sooner as she didn't relate it to a specific incident. As her condition was not improving, she thought it was due to something she did on a continuing basis.
• the worker indicated that she played golf but had not been able to since her symptoms started.

The worker's file was reviewed by a WCB medical advisor on June 4, 2012 at the request of the adjudicator. The medical advisor outlined the following opinion:

1. The most likely diagnosis affecting the worker's right wrist was de Quervain's tenosynovitis.
2. This diagnosis may occur idiopathically but if actions are implicated in the causation, those that involve forceful repetitive grasping or abrupt movements involving the wrist may be involved.

By letter dated June 8, 2012, the worker was advised that her claim for compensation was denied as a relationship between her right wrist diagnosis of de Quervain's tenosynovitis and her job duties could not be established. The decision was based on the opinion expressed by the WCB medical advisor that the diagnosis of de Quervain's tenosynovitis most often occurred idiopathically (unknown cause) or that it could develop from forceful repetitive grasping or abrupt movements of the wrist. Although the worker's job duties of computer keyboarding and mouse use can be repetitive, it did not involve forceful grasping and gripping and it was not established that awkward posture was a causative factor for the condition. On June 20, 2012, the worker appealed the decision to Review Office.

On July 6, 2012, Review Office determined that the worker's claim was not acceptable. Review Office placed weight on the following in making its decision:

• De Quervain's tenosynovitis occurred idiopathically.
• Having the mouse positioned at an angle that was not ideal would not cause one to forcefully or repetitively grasp/grip an object. There are other possible causes of de Quervain's tendosynovitis.

Based on the whole of the evidence, Review Office stated it was unable to establish on a balance of probabilities that the worker's right wrist difficulties were related to her actions and activities in the workplace. On July 17, 2012, the worker appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

Reasons

Applicable Legislation:

The worker is employed by a federal government agency or department and her claim is therefore adjudicated under The Government Employees Compensation Act (“GECA”). Under the GECA, an employee who suffers a personal injury by an accident arising out of and in the course of employment is entitled to compensation. The GECA defines accident as including “a willful and an intentional act, not being the act of the employee, and a fortuitous event occasioned by a physical or natural cause.”

Pursuant to subsection 4(2)(a) of the GECA, a federal government employee in Manitoba is to receive compensation at the same rate and under the same conditions as a worker covered under The Workers Compensation Act (the “Act”). 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 de Quervain’s tenosynovitis arose out of and in the course of her employment.

Worker’s position

The worker was self-represented at the hearing. The worker explained that her de Quervain's tenosynovitis symptoms initially started in January 2012 and at first, she did not relate them to her workplace. She went to see her family doctor who referred her to a physiotherapist. After a few treatments, the physiotherapist pointed out to the worker what her injury was and that was when the worker was able to relate the symptoms back to her work set-up. Her office had just been relocated in November 2011 and she had a new desk set up. It was the worker's position that her condition was caused by repetitive use of her hands while performing her job duties.

At the hearing, the worker gave detailed evidence regarding her job duties. The employer was a government agency with approximately 50 staff and at the time when she first noticed her symptoms, the worker was the only administrative assistant. Her job duties included the following:

Employer’s position

Two representatives from the employer appeared at the hearing. The employer did not take a position on the appeal, but wanted to be available to answer any questions the panel may have.

Analysis

To accept the worker’s appeal, we must find on a balance of probabilities that the worker's de Quervain’s tenosynovitis arose out of and in the course of her work duties. We are not able to make that finding.

In order to find for the worker, the panel would need to make a positive connection between the actions she was performing while at work and the kinds of activities which are typically associated with the development of de Quervain's tenosynovitis, namely activities involving a combination of forceful and repetitive wrist or thumb movements. Those types of movements simply were not present in the worker's day to day job duties. The panel found that the worker's right arm and hand movements were varied and she was not required to sustain a particular posture for any extended period of time. There was no forceful repetitive grasping or abrupt movements of the wrist or thumb. The panel thoroughly examined the worker's job duties but we were unable to identify any occupational risk factors associated with her activities. We could find no obvious reason as to why her work would cause her to develop de Quervain's tenosynovitis in her right wrist. There was temporal concordance between her move to a new work station and the onset of the pain in her wrist, but that alone is not sufficient to establish a claim. This is particularly so given that the new work station has been assessed ergonomically with no significant issues identified.

Based on the foregoing, the panel is unable on a balance of probabilities to relate the worker’s de Quervain’s tenosynovitis to the work duties which were being performed by her for the accident employer. The worker’s appeal is dismissed.

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 30th day of November, 2012