Decision #115/13 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that there was no causal relationship between her eye condition and the low humidity levels in her work building or working long hours in front of a computer. A hearing was held on September 11, 2013 to consider the matter.Issue
Whether or not the claim is acceptable.Decision
That the claim is not acceptable.Decision: Unanimous
Background
In January 2012, the worker filed a claim with the WCB for an eye condition that she related to low humidity levels and lighting in the workplace. The worker stated that she began to notice symptoms in early 2011. Her eyes became red and sore and her eye lids were itchy. She had sinus issues as well and did not feel healthy. Her symptoms seemed to get better when at home or away from the workplace. The worker indicated that she moved to a new work location/building in October 2010. She kept on working until November 27, 2011.
A Doctor First Report for an examination on October 25, 2011 diagnosed the worker with allergic conjunctivitis bilaterally.
A Doctor First Report for an examination on November 16, 2011 diagnosed the worker with scleritis.
The Employer's Incident Report dated January 24, 2012 outlined the opinion that the worker's eye condition was not related to her work environment. The employer noted that the new building had the same relative humidity levels as any other building or home that does not use a humidification system. The employer noted that acute bilateral scleritis can also be attributed to other underlying health concerns.
In a decision dated March 22, 2012, the worker was advised that her claim for compensation was not acceptable. The adjudicator referred to humidity levels taken at various facilities owned by the employer between February 10 and February 15, 2012. It was found that the relative humidity levels in the new building were higher than some of the other tested areas. It was also noted that the established standards of maintaining relative humidity between 30 to 60% were based on comfort and not on health and safety. The adjudicator noted that the worker's diagnosed condition of scleritis was a condition normally caused by immune complex-related vascular damage and subsequent chronic granulomatous response. The worker was advised that the WCB was unable to establish that she suffered a personal injury as a result of an accident arising out of and in the course of her employment or that there was a relationship between her eye condition and the work environment.
In a report dated April 18, 2012, the treating physician stated: "This is a note to clarify that at this point with a negative work up for auto immune disease, [the worker's] condition ie scleritis was probably caused by long periods of time in front of a computer in a dry environment. Scleritis can be caused by many things, autoimmune disease is just one of the many possibilities."
In a report dated May 2, 2012, a treating specialist diagnosed the worker with chronic dry eye secondary to meibomian gland dysfunction ("MGD"). He noted that this condition resulted in significant ocular surface irritation, particularly in areas of a dry environment. It was usually exacerbated by activities such as reading and computer usage wherein the natural blink rate tends to diminish.
On May 14, 2012, a WCB medical advisor reviewed the worker's file and stated:
"1. The diagnoses affecting the claimant are Meibomian gland dysfunction and a Salzmann's nodule.
2. There are numerous conditions associated with Meibomian gland dysfunction. Salzmann's nodules can occur in response to a chronic irritating influence. For Meibomian gland dysfunction, one recognized cause is exposure to low humidity environments. Particularly, computer work in these low humidity environments has been identified as causative for this condition."
On May 18, 2012, the worker advised the WCB that she was told to remain off work indefinitely by her treating physician. The worker said her eyes were still bothering her but they were not as bad as when she was working. The worker indicated that she applied for long term disability benefits through an insurance carrier and was awaiting their decision.
On May 30, 2012, the WCB medical advisor clarified his opinion outlined on May 14, 2012. He stated:
"1. There are a multitude of other possible causes.
2. Although working and computer work in low humidity environments have been identified by some authors as related to the condition in question, the observation that the condition persists despite six months away from the workplace would make it unlikely that low humidity in the workplace is the cause."
Based on the medical opinions expressed by the WCB's healthcare branch in May 2012, the worker was advised on July 9, 2012 that there would be no change to the previous WCB decision.
On July 24, 2012, the treating physician stated: "This is to certify that [the worker] suffers from meibomian gland dysfunction that results in significant ocular discomfort due to dry eyes, particularly while performing prolonged visual tasks such as reading and computer work. It is a chronic condition that can be controlled to some degree but is not easily resolved."
On September 7, 2012, a worker advisor requested reconsideration of the decisions made on March 22 and July 9, 2012. The worker advisor noted that the worker's job duties required her to view five monitors at all times. The worker worked 12 hour shifts and there were no scheduled breaks. The breaks consisted of running to the kitchen or the washroom, otherwise the screens are constantly monitored. The worker advisor commented that the worker did not have any eye difficulties prior to moving to the new building in October 2010. The evidence supported that the humidifier was not functioning in the new location. This combined with the worker's long hours in front of a computer screen contributed to the onset of her eye condition.
On September 17, 2012, the WCB adjudicator reviewed the worker advisor's submission but was unable to conclude that the worker suffered a personal injury as a result of an accident or that her employment was the dominant cause of her eye condition. The adjudicator noted that the worker's eye condition did not resolve despite being away from the workforce for several months. On September 25, 2012, the worker advisor appealed the decision to Review Office.
On October 15, 2012, the employer's representative submitted to Review Office that the medical evidence did not support the worker's eye condition of MGD was either caused by her work duties or the work environment. Therefore, the claim did not meet the definition of an accident and there was no loss of earning capacity directly attributable to the workplace.
The worker later provided Review Office with a rebuttal submission. As the worker provided detailed information regarding humidity related issues experienced by her and other co-workers which were not previously documented to the file, Review Office returned the claim back to primary adjudication to review the new information.
On October 31, 2012 the worker advised the WCB that her symptoms have improved but she still had occasional dry eye symptoms. It depended on where she was and what she was doing. She used an eye lubricant, warm compresses and lid hygiene. The worker noted that she requested a work accommodation from her employer and her doctor has indicated that she needs to work shorter shifts with frequent breaks. She was then offered a different position in August 2012 but it was a dusty environment and was not suitable for her.
In November 2012, the WCB contacted a co-worker identified by the worker who stated that the air was dry in the new building and his throat and eyes were dry. Another individual from the workplace health and safety committee confirmed that there were several other co-workers who complained about low humidity levels. On November 4, 2012 the health and safety member submitted an e-mail to the case manager which contained five co-worker statements detailing various symptoms they experienced in the new work location. A second e-mail was submitted on December 10, 2012 outlining four other workers' symptoms.
On December 3, 2012, a WCB medical advisor stated that MGD is a chronic condition of the eyelid that causes redness, inflammation and irritation of the eyelids and eyes and that occupational exposure to dry air or computer screens is not known to cause MGD.
On December 18, 2012, primary adjudication determined that there would be no change to the previous WCB decision. Based on the information provided by the co-workers and the WCB medical opinion of December 3, 2012, there was insufficient evidence to establish that the worker's eye condition was the result of low humidity levels in the work environment. On January 4, 2013, the worker advisor submitted a further appeal to Review Office.
On April 25, 2013, Review Office determined that the claim was not acceptable as the evidence did not establish that the worker suffered personal injury by an accident arising out of and in the course of employment. Review Office indicated that there was insufficient evidence on file to support that working in levels of low humidity combined with computer work was a causal factor in the development of MGD. It also found that as the worker's condition did not resolve when she was away from the work environment, the work environment was not an aggravating factor. Review Office referenced the WCB medical advisor opinion dated December 3, 2012 and an internet article in making its decision.
On April 30, 2013, the worker advisor appealed Review Office's decision to the Appeal Commission and an oral hearing was arranged.
Reasons
Applicable Legislation and Policy
In considering appeals, the Appeal Commission and its panels are bound by The Workers Compensation Act (the Act), regulations and policies of the Board of Directors.
Subsections 1(1) and 4(1) of the Act set out the circumstances under which claims for injuries can be accepted by the WCB, and state that the worker must have suffered an injury by accident that arose out of and in the course of employment. Once such an injury has been established, the worker is entitled to the benefits provided under the Act.
The WCB Board of directors established WCB Policy 44.10.20.10 (the "Pre-Existing Conditions Policy") which addresses the issue of pre-existing conditions when administering benefits. The policy provides definitions for the terms aggravation and enhancement. Specifically:
B. Definitions:
1. Aggravation: The temporary clinical effect of a compensable accident on a pre-existing condition such that the pre-existing condition will eventually return to its pre-accident state unaffected by the compensable accident.
2. Enhancement: Where a compensable injury permanently and adversely affects the pre-existing condition or makes necessary surgery on a pre-existing condition.
It sets out the circumstances when the WCB will be responsible to pay benefits for a pre-existing condition.
The worker disagrees with the WCB and Review Office decisions that her claim is not acceptable. The key issue to be determined by the panel deals with causation and whether the worker’s eye condition arose out of and in the course of her employment or was aggravated or enhanced by her employment.
Worker's Position
The worker was represented by a worker advisor who made a presentation on behalf of the worker and asked the worker questions regarding her claim.
The worker advised that she was employed as a dispatcher in a communication center for 11 years. She worked 12 hour shifts, 2 days and 2 nights. Her duties include answering calls, monitoring computers and dispatching by radio. She advised that in October 2010 the dispatch center moved into a new facility. She noticed that her eyes were becoming sore after working in the new facility for a few months. It became noticeable by April 2011, when she first sought medical treatment.
Initially the worker thought that her eyes had become light sensitive when working the night shift. She also felt her duties which increased from watching 3 monitors to watching 5 monitors during the 12 hour shift were contributing to her condition. She told the panel that late in 2011 she heard there were problems with low humidity in the new facility. She believes that the dry air and long hours looking at computer screens are the cause of her condition.
The worker advised that she has been diagnosed with MGD. She advised that this is a condition which is treatable but not curable. She said that as long as she follows her daily eye care treatment plan, she is not disabled. She said her eyes are fine now and sometimes are 100%. This is because she is very attentive to her condition and treatment. She does have flare ups which occur when she goes into buildings where the air is very dry. As an example, she noted that when attending a large retail store her eyes became sore from the dry air so she had to promptly leave.
With respect to medical support for her claim, the worker said that she spoke with the treating specialist (ophthalmologist) and optometrist but both said it would be difficult to prove her condition resulted from or was caused by her work environment. She noted that the specialist did not tell her that her work did not cause her condition.
The worker advisor noted that the worker did not have any eye difficulties prior to relocating to the new communication centre. Her work duties require that she spend long hours viewing screens. She said that information supports that the new communication centre had a problem with low humidity. She noted that literature on MGD says this condition can result from exposure to dry air and computer screens. She submitted that the information supports, on a balance of probabilities, that low humidity and long hours viewing computer screens, were dominant factors in causing the onset of the worker's eye condition.
As an alternative, the worker advisor said that if the employment did not cause the condition, the evidence shows that it aggravated her condition and that she had to cease working in the centre due to the aggravated condition.
Employer's Position
The employer was represented by an advocate. The representative advised that the employer agrees with the WCB and Review office decisions. He submitted that there is simply insufficient evidence to support any workplace cause for the development of the worker's MGD. While he noted there is some evidence that the worker's eyes were aggravated at the workplace, he said the evidence does not support that an aggravation occurred. He said that if there was an aggravation, the duration of the aggravation was short lived.
Analysis
The issue before the panel is whether the worker's claim is acceptable. For the worker's appeal to be successful, the panel must find on a balance of probabilities that the worker's eye condition was caused by her employment or was aggravated or enhanced by her employment. The panel was not able to make these findings.
The panel finds, on a balance of probabilities, that the worker's eye condition did not arise out of or in the course of her employment and was not aggravated or enhanced by her employment.
In reaching this decision, the panel relies upon the opinion of the WCB medical advisor who reviewed the file and medical literature on causes of MGD. In a memo dated December 3, 2012, he opined that:
"Meibomain Gland Dysfunction (MGD) is a chronic condition of the eyelid that causes redness, inflammation, and irritation of the eyelids and eyes. This condition may be difficult to treat and the irritation becomes chronic in many cases. Occupational exposure to dry air or computer screens is not known to cause MGD, and removal of an individual from the computer screen would not normally influence the natural history, nor would one expect a resolution of the symptoms with removal of the affected individual from dry air or computer use."
The panel also relies upon the opinion of the treating optometrist noted in a report dated April 1, 2013 that:
"The condition is not caused by her work environment however the symptoms would certainly be more pronounced at work due to the dry air in the building and her task of monitoring computer screens for several hours."
The panel notes that the treating ophthalmology specialist provided no opinion on causation although he acknowledges that the "patient feels it is aggravated in the work place environment." The panel finds that the absence of an opinion from the specialist does not support a finding that the workplace environment caused the worker's condition.
There are other medical opinions on the file; however, the panel finds that the weight of evidence does not support a finding that the worker's eye condition (MGD) was caused by her employment. The panel believes that it is most likely that the worker had a pre-existing condition that was developing at the time of the move to the new communication centre. The relationship between the developing symptoms and the work can best be described as coincidental but not causative.
It was also argued that the worker's employment aggravated the worker's eye condition. The panel notes the worker's evidence that she first noticed the condition after she started working in the new dispatch center. She did not know what caused the condition but initially thought it was lighting and continued computer use. She later thought that it was caused by the low humidity in the workplace combined with the computer use. The worker's evidence at the hearing was that after leaving the workplace and with diligent care, her eyes have improved and currently do not bother her but remain sensitive to dry environments. She said she recently had to leave a retail store because the air was too dry.
The panel is not able to find that the work environment aggravated her pre-existing condition. It appears that the worker's condition is easily irritated, but recovers when it is removed from the source of irritation as noted in the example of the visit to the retail store. The treating optometrist stated that her symptoms may be more pronounced while at work. The panel does not consider that "more pronounced" symptoms amount to an aggravation. While it may be possible that the workplace increased the symptoms of the worker's condition, the panel finds, on a balance of probabilities, that it did not aggravate the condition as that term is used in WCB Policy. The panel notes that there was no documented evidence of a "temporary clinical effect" or indication of waxing or waning of symptoms. The only relief the worker had was when she performs her treatment regime.
The worker suggested that continual computer monitoring may also have been a factor in her condition. The panel notes that the worker performed the same duties for over 11 years, and had more than 9 years without symptoms. The panel finds that the medical evidence, and in particular, the medical literature referenced by the WCB medical advisor, does not support a finding that the worker's job duties (computer monitoring) were causative of her condition.
The panel also finds no evidence of a change in her condition that would constitute an enhancement as defined by the pre-existing conditions policy.
Given the above findings, the panel concludes that the worker's claim is not acceptable and her appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 17th day of September, 2013