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 the condition in his left elbow was not related to his compensable workplace injury of June 27, 2000. A hearing was held on November 28, 2012 to consider the matter.

Issue

Whether or not the worker's left ulnar neuropathy is related to his June 27, 2000 compensable injury.

Decision

That the worker's left ulnar neuropathy is not related to his June 27, 2000 compensable injury.

Decision: Unanimous

Background

The worker filed a claim with the WCB for left hand and forearm symptoms that he related to his employment that involved repetitive drilling, riveting and constant vibration. The date of accident was June 27, 2000. The claim for compensation was accepted and various types of benefits and services were paid to the worker based on the diagnoses of right lateral epicondylitis and left medial epicondylitis.

In a report to the attending physician dated April 28, 2011, a neurologist reported that the worker was concerned about numbness, weakness and wasting of his left hand. He reported that the worker's left arm problem began almost 10 years ago due to a job that involved a lot of repetitive use of the arms. While doing this job, the worker developed pain on the medial aspect of the left elbow. The pain was so severe that he switched jobs and was temporarily covered by the WCB. Sometime after that, (he was not sure when) the worker began to notice numbness and weakness of the left hand. The neurologist reported that based on EMG/NCS results, the worker had severe left ulnar neuropathy localized to the elbow. The neurologist reported that the worker was reapplying to the WCB since this may be related to his original injury.

On May 2, 2011, the worker spoke with a WCB adjudicator and provided information concerning his left arm difficulties. The worker reported that following his compensable accident in 2000, he always had symptoms in his left hand when he did any repetitive motion. He felt pain/tingling in his ring and pinky fingers on his left hand. He noted that his symptoms had now become worse and the muscle between the thumb and index finger was damaged and he could not spread his fingers apart. He noted that he can't straighten out his pinky finger and he just noticed degeneration around his thumb. The worker noted that he worked for a different company now as a power engineer fourth class, and that he resigned with the accident employer in 2002. He said he left that employment as he could not perform the duties and they were laying people off due to a shortage of work.

On May 11, 2011, a WCB medical advisor reviewed the worker's file and stated:

"At this time, the proposed left ulnar nerve decompression is not approved for the following reasons:

1. The condition for which this surgery has been proposed has not been approved as a WCB responsibility. This condition is different from the conditions accepted as WCB responsibilities.

2. Despite detailed medical reporting between 2000 and 2002, there were no findings described consistent with ulnar neuropathy. These clinical findings arose subsequently."

On May 13, 2011, the treating surgeon was advised by the WCB's healthcare branch that responsibility would not be accepted for the proposed left ulnar nerve decompression.

On May 13, 2011, the worker was advised of the WCB's position that his current left hand difficulties were unrelated to the work related injury from 11 years ago and that the WCB was unable to accept these difficulties as a recurrence on the 2000 claim.

On February 28, 2012, the Worker Advisor Office requested that the WCB reconsider its decision to deny the worker's claim for ulnar neuropathy. The worker advisor provided the WCB with a report from the treating neurologist dated February 13, 2012. The worker advisor noted the neurologist's opinion that the worker's ulnar neuropathy was "an inexorable progression, that began with the initial problem of medial epicondylitis." The neurologist also stated that the worker's current work involved "significant repetitive use of the arms as well as grasping and holding wrenches. In addition, he currently does a lot of driving for the job and leans on his left elbow." The worker advisor concluded that the neurologist supported that the worker's current left elbow problems were the result of his prior compensable injury and that it had been exacerbated by his current work activities.

At the request of primary adjudication, a WCB medical advisor reviewed the worker's file on June 14, 2012 with respect to the neurologist's opinion of February 13, 2012. The medical advisor stated that the diagnosis of left ulnar neuropathy localized to the left elbow was substantiated by clinical findings and the results of the NCS. The medical advisor also referred to file information to support that the left ulnar neuropathy was not medically accounted for in relation to the June 27, 2000 workplace injury or to the worker's current job duties. He noted that there was no medical evidence to support that a diagnosis of epicondylitis made in 2000 predisposes to the development of ulnar neuropathy with symptoms beginning in 2010.

In a decision dated June 22, 2012, the worker was advised that the WCB was not accepting responsibility for his left ulnar neuropathy as being related to his June 27, 2000 workplace injury based on the opinion expressed by the WCB medical advisor on June 14, 2012. On July 11, 2012, the worker advisor appealed the decision to Review Office.

On September 5, 2012, the worker provided Review Office with a medical report dated January 2002. The worker noted that his medial epicondylitis returned after working for only twelve days of repetitious work (two weeks training and two days work). This was after he was unemployed for six months.

In a decision dated September 13, 2012, Review Office referred to file information to support its decision that the worker's left ulnar neuropathy was not related to the June 2000 accident. Review Office noted that the WCB must adjudicate claims using a balance of probabilities. It stated that the worker had recovered from his compensable injuries (right elbow lateral epicondylitis and left elbow medial epicondylitis) as of February 20, 2001. It noted that the worker subsequently developed an ulnar neuropathy in his left elbow about 10 years later. There was no measureable or objective medical evidence on file to suggest there was any causal connection. Review Office stated that, on a balance of probabilities, it was unable to substantiate that the left elbow ulnar neuropathy "arises out of and in the course of his employment" from his past work with the accident employer or it was "predominately attributable" to his compensable medial epicondylitis after 9-10 years of no reported symptoms or medical treatments. On September 25, 2012, the worker advisor appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

On November 16, 2012, the worker advisor submitted seven witness statements and a photograph of the worker with a post pounder for consideration.

 

Reasons

Given the above facts, the panel finds that it is not probable that the worker's condition in 2000 to 2002 is the cause of his current left elbow condition.

The panel notes the worker's evidence that his left elbow condition never resolved. There is no medical confirmation of this assertion. The panel also notes that since 2002 the worker has worked at duties, such as truck driving, post hole pounding and forceful use of tools, that may cause left arm muscle and nerve problems. New injury claims arising from these duties are not before the panel.

The panel also acknowledges that the worker's neurologist supports a finding that the worker's current condition is related to his 2000 accident. We have considered this opinion; however, given the above facts, we are not able to find, on a balance of probabilities, that the worker's current condition is the result of his June 27, 2000 workplace injury. The panel gives greater weight to the June 14, 2012 opinion of the WCB medical advisor who had the opportunity to review the worker's complete file including records of early medical appointments. The medical advisor concluded that "Based on file information available, the diagnosis of left ulnar neuropathy is not medically accounted for in relation to the workplace injury of June 27, 2000."

With respect to the worker's position that his current elbow condition is a further injury pursuant to the Further Injuries Policy, the panel, as noted above, is unable to find a relationship between the June 27, 2000 injury and the worker's current condition. Accordingly, the panel finds that the worker's left ulnar neuropathy is not predominantly attributable to the June 27, 2000 compensable injury.

The worker's appeal is dismissed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 27th day of December, 2012