The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that the development of his condition diagnosed as bilateral carpal tunnel syndrome was not related to his job duties. A hearing was held on October 16, 2013 to consider the matter.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

In December 2012, the worker filed a claim with the WCB for injuries to his hands, wrists and forearms which he attributed to carpal tunnel syndrome ("CTS"). The worker reported that his difficulties began in June 2010 during the course of his employment as a manager which entailed increased computer work.

The employer's accident report confirmed that the worker had ongoing problems with CTS. They noted that no specific date of injury was reported but that the worker completed injury forms on March 4, 2011 and December 18, 2012. The employer indicated that two ergonomic assessments had been completed but there had been a delay in receiving the recommended equipment. The worker's symptoms only arose after the worker took the manager position which increased his time spent on the computer. The worker did not incur any time loss and was awaiting surgery.

When speaking with a WCB adjudicator on January 31, 2013, the worker indicated that his bilateral wrist and forearm problems were due to his repetitive job duties which consisted of typing, mouse work and writing.

Medical information from an examination which took place on December 18, 2012 showed that the worker had a two year history of bilateral hand pain and numbness aggravated by use of the keyboard.

On December 18, 2012, the treating specialist reported that the worker had a two year history of intermittent numbness and paresthesia in both hands, worse on the right. EMG studies showed evidence of moderately severe impairment of median conduction across both wrists, somewhat worse on the right compared to the left. Although there were no significant changes in sensory latencies across the wrist compared with the November 2011 test, there had been some decline in motor amplitude, especially on the right. The specialist indicated that arrangements were being made for carpal tunnel release surgery.

On January 31, 2013, the worker was advised that his claim for compensation was not accepted as the WCB was unable to establish a relationship between the development of his symptoms and an accident occurring at work. This decision was based on the worker's history of job duties and the current clinical findings.

On February 12, 2013, the worker appealed to Review Office. On February 13, 2013, Review Office returned the worker's file to primary adjudication to conduct a further investigation.

Primary adjudication obtained copies of the ergonomic assessment reports dated June 22, 2010 and March 7, 2011 as well as the worker's injury forms from March 2011 and December 2012. Medical reports were also obtained from the worker's treating specialist dated November 22, 2011 and February 17, 2013.

On February 14, 2013, the worker advised his adjudicator that he first noticed symptoms in his right lower arm and wrist in June 2010. On March 4, 2011 he filed an injury near miss report and an ergonomic assessment was done. He had left and right wrist symptoms and also left arm and shoulder symptoms. The worker indicated that he started the manager position in 2008 which entailed an increase in computer work. When asked why he did not notice any symptoms earlier than 2010, the worker said it would take a year of typing before he would notice the symptoms. He felt that this was not surprising given that this type of injury occurs over a period of time. From 2011 to 2012 he noticed a significant deterioration in his wrists.

In a second decision dated March 5, 2013, primary adjudication advised the worker that no change would be made to the January 31, 2013 decision indicating that his claim was not acceptable. On March 7, 2013, the worker appealed to Review Office.

The employer's representative, on April 10, 2013, submitted to Review Office that they supported the WCB's position that the worker's bilateral CTS condition was not caused by his work duties. The representative noted that prior to starting the manager position in 2008, the worker was a manager in a different area. Both positions involved similar activities such as answering phones, answering emails, doing performance appraisals, writing job descriptions on the computer, working in the clinical area, attending meetings, meetings with clients' families and staff. Computer use varied from day to day and the worker's job duties were diverse.

In an email to Review Office dated April 30, 2013, the worker stated:

I believe my smaller carpal area to possibly have contributed to the development of CTS, but there is a clear correlation with my increase in keyboarding and the onset of symptoms. There is no other reasonable suggestion. I documented on several injury reports my increased symptoms, as well as did my part to remedy the situation, but was unable to reverse the damage that was already done…I would suggest WCB elicit the opinions of the attending physicians involved in my care.

On May 8, 2013, Review Office determined that the worker's job duties did not result in the development of his bilateral CTS. Review Office noted that the appropriate ergonomic adjustments had been made to the worker's workstation to alleviate common musculoskeletal symptoms and there was no indication that the workstation setup was a causal factor in the development of his condition. Review Office concluded that the worker's job duties did not involve a volume of keyboarding sufficient to have triggered the development of CTS. On May 21, 2013, the worker 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 bilateral CTS arose out of and in the course of his employment.

Worker’s position

The worker was self represented at the hearing. The worker explained that in his previous position with the employer, he did not do much computer work. He would only send occasional emails. More of his work involved meeting with clients and writing notes. It was a different sort of position. In October 2008, he started as a manager and his working conditions changed. Initially, he was sharing an office space with other supervisors so it was a shared computer set-up, which was not ideal from an ergonomic perspective. The worker's computer usage changed from ½ to 1 hour per day to up to 3 to 4 hours per day. In June 2010 the worker saw an ergonomist. The worker felt that the condition had been slowly developing over the period of time from October 2008 to June 2010. He recalled having some discomfort in his arms and hands but did not realize what it was for quite some time. Finally in June 2010 it became unbearable so he asked to see an ergonomist. He did not file an injury report at that time. As it was shared space, the worker was reluctant to have significant changes made to the office set up, but some minor changes were made. The plan was to follow up in August 2010 when the worker was to change offices.

The condition continued to develop and in March 2011 the worker filed an injury form. The worker understood that he did not meet the criteria identified by the WCB but he did not know what else could have caused his CTS. Another ergonomic assessment was done, which identified a number of issues, including mousing, reduction of carpal tunnel space, extensor and epicondylitis. Some further changes were suggested but took some time to implement. In September 2011, the worker changed jobs again and was put into another new office. An ergonomist came out again to assist with the office set up.

Overall, the worker felt that his symptoms were all related to computer use. He had taken steps to try to mitigate the circumstances, but despite ergonomic changes, he still required surgery in April 2013 for his CTS. The worker submitted that even if he was genetically predisposed to getting CTS, he felt it was exacerbated by his office set up and the typing required in his job. The worker noted that more recent medical literature supported a connection between typing and keyboarding and CTS. It was submitted that his claim be accepted.

Employer’s position

The employer was represented by an advocate at the hearing. It was submitted that the worker's bilateral CTS was not caused by his work duties and that good solid research validated the position that computer use was not associated with the development of CTS. Further, it was noted that the worker's computer use of three hours per day would not be considered excessive or repetitive activity for any type of motion. Ergonomic adjustments had been made to the worker's workstation, but these were minor changes and were made to alleviate common musculoskeletal symptoms. This did not imply that the set up of the desk was a causative factor in the CTS. The worker's job duties were varied and did not involve any degree of force, repetition, sustained awkward wrist flexions or motions that could possibly contribute to CTS. It was submitted that there was no compelling reason why the Review Office decision should be reversed.

Analysis

To accept the worker’s appeal, we must find on a balance of probabilities that he 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 his bilateral CTS arose out of and in the course of his work duties. Based on the evidence before us, we are not able to make that finding.

In deciding the appeal, the panel must carefully examine the worker’s job duties to determine whether they might have caused his bilateral CTS. After considering the evidence as a whole, we are unable to find that the work duties contributed to the CTS, either causally or as an aggravation or enhancement.

The worker has identified the increased computer use in his role as a manger as being the causative factor for his bilateral CTS. At the hearing, the worker described his typical workday while in the manager position from October 2008 to September 2011. Generally, he was in his office for most of the eight hour work day. Staff would occasionally drop in or he would have some meetings, but he was pretty much in the office for most of the day answering phones and using the computer. His computer work consisted of typing a lot of emails and memos, and filling in reports. He would occasionally type longer reports such as performance appraisals. The worker acknowledged that he did not do long periods of consistent typing. For example, he would not be typing a document for four hours with no breaks. On average, it would take him 3 minutes to type an email, but there were some emails which took up to 20 minutes to compose.

In September 2011, the worker changed to a different managerial position. In the new position, the worker had more outside meetings and was in his office less.

Typically, when considering a claim for work-related CTS, the panel will look for occupational factors such as 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. These are the types of activity most commonly accepted to be associated with the development of CTS. It is generally considered that the greatest frequency of occupationally related CTS is found where the job duties involve high force and high repetition.

In the present case, we are not satisfied on a balance of probabilities that such occupational factors are present. The worker's job duties did not involve any significant demands on the hands and wrists, whether through high force or high repetition. The worker was not required to make sustained use of the hands for extended periods of time and there was ample variation in duties. The worker moved from typing, to mousing, to answering telephone calls, to meeting with people. There was plenty of time for his wrists to rest and recover between tasks. There certainly was not any degree of continuous high volume, data-entry typing involved in his work.

The panel also notes that on multiple occasions, ergonomic assessments and modifications were performed on the worker's office set up, yet his CTS condition continued to worsen. His evidence was that he would experience some initial improvement, but that the symptoms would gradually return and worsen. The fact that the workstation was ergonomically correct suggests that a non-work related cause was at play. It is also relevant that although after September 2011, the worker's computer use decreased, he experienced a more prominent deterioration in his CTS condition between November 2011 and December 2012. If computer use was causative of his CTS condition, an improvement rather than a deterioration would have been expected.

Overall, the evidence does not support the finding that the worker's bilateral CTS was related to his work duties. Although the worker was not able to identify anything else in his life which may have caused the condition to develop, in many cases, CTS is an idiopathic condition and the cause for it is unknown. In order to find for the worker, we must be able to make some positive connection to his work duties, and unfortunately, we were unable to identify one in this case.

The panel therefore finds that the claim is not acceptable. The worker's appeal is dismissed.

Panel Members

L. Choy, Presiding Officer
R. Koslowsky, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 4th day of December, 2013