The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his current left wrist condition was not caused by the August 15, 2001 compensable injury. A hearing was held on February 13, 2014 to consider the matter.

Issue

Whether or not the worker's current left wrist difficulties are related to the August 15, 2001 compensable injury.

Decision

That the worker's current left wrist difficulties are related to the August 15, 2001 compensable injury.

Decision: Unanimous

Background

The worker suffered an injury to his left hand on August 15, 2001 when a steel coil slipped and pinned his hand and wrist during the course of his employment as a crane operator. He attended an emergency department at a hospital and was diagnosed with a contusion to the dorsum of his left wrist. The doctor recommended two days of workplace restrictions to avoid use of his left hand. The worker returned to modified duties performing paper work for two days and then returned to his regular duties as a crane operator.

Twelve years later, in 2013, the worker contacted the WCB to advise that he was having ongoing difficulties with his wrist which he felt were related to his 2001 accident.

On April 19, 2013, the WCB advised the worker that no responsibility would be accepted for his current wrist difficulties based on the following rationale:

…you stated that you experienced an ongoing pinching in your left wrist following the injury but did not require follow up medical attention. In 2007, you were given a different controller for the overhead crane which you state caused your symptoms to increase and worsen. At this time follow up medical attention was sought. A letter from your doctor dated February 22, 2013 provides the diagnosis of osteoarthritis to the left wrist.

A contusion or bruise is caused when blood vessels are damaged or broken as a result of a blow to the skin. The normal recovery period of a contusion is two weeks.

Osteoarthritis is not generally known to be attributed to any specific job or occupation. It is a type of arthritis that is caused by the breakdown and eventual loss of cartilage of one or more joints.

In considering a claim for recurrent disability, where there has been no further injury or accident at work, entitlement to benefits depends on medical evidence and other information providing that the recent disability is related to a previous injury which "arose out of and in the course of" a worker's employment.

When considering the diagnosis of a wrist contusion and the normal healing process, no further medical treatment was sought until after the recurrence in 2007, and you worked your regular duties for several years without any further difficulties, it is the opinion of Compensation Services that we cannot relate your current left wrist difficulties to the left wrist injury sustained on August 15, 2001.

On June 11, 2013, the Worker Advisor Office appealed the above decision to Review Office. The worker advisor noted that the worker was transferred to a new office in April 2007 and was in charge of operating a crane with a new control box. The control box required frequent pushing of buttons which the worker said he often did with his left hand because of a previous right hand injury. While operating the new controls, the worker noticed a significant increase in his left wrist symptoms. The worker advisor referred to the February 22, 2013 medical opinion from his treating orthopedic surgeon which stated:

Currently, he has left wrist pain and x-ray evidence of arthritis secondary to scapholunate dissociation indicating that he likely tore the scapholunate ligament with his initial injury. The natural history of that problem is to develop arthritis over a long period of time, which he is now demonstrating.

Scapholunate advanced collapse does not result from minor injuries. It takes significant force to cause this ligament to tear and this could be explained by his injury 15 years ago.

The worker advisor concluded that the mechanism of injury, the worker's ongoing feeling of a "pinch" in the left wrist and the surgeon's statement that significant force would cause a scapholunate ligament tear, all supported, on a balance of probabilities, that the worker's current left wrist difficulties were related to his August 15, 2001 injury.

In a decision dated August 13, 2013, Review Office indicated that it was unable to find that the original workplace injury resulted in a scapholunate ligament tear or that the current diagnosis of scapholunate advanced collapse was the result of a degenerative progression of this condition. Review Office placed weight on the following in making its decision:

• the initial medical reports captured only superficial injuries of bruising and abrasions with associated tenderness.
• there was no documented mention of a mechanical joint related injury at the time of the accident.
• the worker did not require any medical follow up after the initial injury.
• the worker returned to his regular duties after two shifts unrestricted.
• there was no evidence of subjective complaints to the WCB, co-workers or the worker's employer regarding ongoing wrist problems until at least six years after the accident date.
• when the worker sought medical treatment in 2007 for wrist problems he did not contact the WCB and relate his difficulties at that time to his workplace injury.

Review Office concluded that there was no evidence other than supposition to support a probable relationship between the August 15, 2001 injury and the diagnosis of a scapholunate ligament tear. On January 6, 2014, the worker advisor appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

Following the hearing, the appeal panel met to discuss the case and requested additional medical information from the worker's treating physicians. Medical reports were later received and were forwarded to the interested parties for comment. On May 5, 2014, the panel met further to discuss the case and render its decision.

Reasons

Applicable Legislation:

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations, and policies made by the WCB Board of Directors.

Under subsection 4(1) of the Act, where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker by the WCB.

The Worker’s Position:

The worker was assisted by a worker advisor at the hearing. The worker's position was that he did not fully recover from the August 15, 2001 wrist injury and that his current left wrist condition was related to that injury. It was noted that on the day of the accident, the worker attended an emergency department were he was diagnosed with a left wrist contusion and soft tissue injury. Although he returned to his regular duties a few days later, he continued to experience a pinched feeling in his left wrist. The worker was able to cope with his left wrist condition for many years until he was transferred to a new location and had to operate machinery with different controls. He went to see an orthopedic surgeon on February 22, 2013 who opined that the worker had evidence of arthritis secondary to scapholunate dissociation and that he likely tore the scapholunate ligament with his initial injury. It was noted that the worker had an x-ray and bone scan of the left wrist in 1993, both of which showed no evidence of abnormality about the left wrist. This information supported that the worker did not have a scapholunate tear at that time. Medical literature indicated that scapholunate dissociation most commonly resulted from trauma, leading to "SLAC wrist" which was the most common pattern of degenerative arthritis in the wrist. Clinical signs of scapholunate dissociation usually presented with minimal swelling and pain localized over the dorsal scapholunate region. It was submitted that the evidence, on a balance of probabilities, supported that the worker's current left wrist condition was causally related to the August 15, 2001 incident.

The Employer’s Position:

A representative from the employer participated in the hearing via teleconference. The employer's position was that it supported the WCB's decision to not allow the claim. The employer expressed concerns regarding the delay in reporting the claim and seeking treatment. In addition, the worker had other medical interventions for his wrists which were treated as non-work related through an outside insurance provider. The employer noted that while the worker was still employed with them, he was able to perform his regular job duties right up until his last day of employment in August 2013. It was also noted that information on the WCB file indicated the worker played guitar seven days a week. It was submitted that there were outside influences other than just work which resulted in the worker's current left wrist condition.

Analysis:

The issue before the panel is whether or not the worker's current left wrist difficulties are related to the August 15, 2001 compensable injury. In order for the worker's appeal to succeed, the panel must find that there is a causal relationship between the worker's left wrist arthritis secondary to scapholunate dissociation and the injury he suffered at work on August 15, 2001. On a balance of probabilities, we are able to make that finding.

The panel gave consideration to the mechanism of injury described by the worker. He described having his hand up flat against a steel coil which tipped back and pinched his hand between the coil and a large L shaped hook. When his hand was pinned, his arm was outstretched and his left hand was cocked back as though he was making a "stop" motion. The coil was pushed up against the middle of the worker's left palm and the L shaped hook made contact with the back of his hand from the knuckles down to the wrist. Although at the time it may have seemed like there was minimal injury, the forces involved in the accident were significant. The coil weighed approximately 2,300 pounds. The worker's left hand was effectively immobilized between two pieces of steel when his wrist was pinned. There would be no "give" to the steel, so a soft tissue injury could well be expected to result from the trauma.

The symptoms from the injury on that day were sufficient to cause the worker to attend at a hospital emergency department to seek medical treatment. On examination, findings of tenderness were noted on the dorsal wrist and the worker was prescribed Tylenol #3. The worker's evidence at the hearing was that after the swelling from the initial trauma went down, he was left with a pinching or sharp pain right in his wrist joint when he moved his hand in a certain way. The panel accepts the worker's evidence and we find that this would be consistent with having suffered an injury to the scapholunate ligament.

The February 22, 2013 report from the orthopedic surgeon indicated that the natural history of a scapholunate dissociation would be to develop arthritis over a long period of time. In his opinion, this was in keeping with what had happened with the worker. The surgeon also indicated that scapholunate advanced collapse does not result from minor injuries and that it takes significant force to cause this ligament to tear. The panel accepts the orthopedic surgeon's opinion and we are satisfied on a balance of probabilities that the workplace accident of August 15, 2001 was sufficiently traumatic that the worker suffered a scapholunate dissociation which over time developed into an arthritic condition. We therefore find that the worker's current left wrist difficulties are related to the August 15, 2001 compensable injury.

The worker's appeal is allowed.

Panel Members

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

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 16th day of May, 2014