The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that her ongoing left eye difficulties were not related to her compensable injury of January 10, 2012. A hearing was held on April 29, 2014 to consider the matter.

Issue

Whether or not the worker is entitled to benefits in relation to the January 10, 2012 compensable injury.

Decision

That the worker is not entitled to benefits in relation to the January 10, 2012 compensable injury.

Decision: Unanimous

Background

On April 10, 2012, the worker filed a claim with the WCB for a left eye condition that she related to the following work event on January 10, 2012:

I was in a foster placement home for a meeting. I had previously been in this home with no problems. On leaving I had a fairly severe allergic reaction to the cat. My left eye, over time, became very swollen and to date is still swollen and irritated.

Initial medical reports showed that the worker sought treatment from a family physician on January 19 and again on March 20, 2012. On the January 19 visit, the worker reported eye irritation attributed to her contact lens. The diagnosis at that time was inflammation of the left eye. When next seen on March 20, the worker reported left eye itchiness for a two month period despite using eye drops. The worker reported that her left eye itchiness and discomfort developed after visiting a client's home with a cat.

The worker was seen by an opthalmologist on March 1, 2012. The diagnosis rendered was keratitis. In a follow-up report dated May 4, 2012, the specialist stated:

...follow-up appointment on March 13, 2012 her visual symptoms were actually worse with considerably more light sensitivity particularly on the left side. She had been out of contacts over the preceding 2 weeks....Initially this certainly sounded like allergies as there was significant itching involved. Now there is evidence of epidemic keratoconjunctivitis coincidental with her allergic reaction. I am not sure of the exact environment in which she works but it is not unusual for people with significant light sensitivity to require a short period of time away from work until this subsides. At most this is usually a few days.

On June 8, 2012, the WCB adjudicator spoke with the physician's office who had treated the worker on January 19 and March 20. The receptionist stated: "...the doctor had noted the worker's complaints of injury were the result of an allergic reaction to a cat resulting in eye irritation. (Worker was wearing contact lens at the time of this irritation.)"

A WCB medical advisor outlined the following opinion on July 9, 2012:

• epidemic keratoconjunctivitis was the current diagnosis which was related to infection of the cornea and conjunctiva with a strain of adenovirus and was not related to cat allergy.
• there was no objective information to support a diagnosis of allergy to cats. There was no record of allergy testing done in the past or during this episode.
• as of a March 13, 2012 follow-up appointment with the ophthalmologist, the worker was still symptomatic from the viral infection and there were no subsequent reports.
• medication at this time was likely related to the viral infection.
• there was no evidence to support a relationship between her current symptoms and hypothetical exposures at work.

On September 6, 2012, the WCB advised the worker that her claim for compensation had been denied based on the WCB medical opinion outlined on July 9, 2012.

On November 16, 2012, the worker submitted medical information from an allergist to support that her eye condition was work-related. The allergist reported that the worker had been seen at the allergy clinic on July 5, 2012 and she tested positive to dust mite, grass pollens, cat and dog. The worker was prescribed with histamine eye drops and corticosteroid nasal spray but continued to have difficulty with injected conjunctivae, pruritus and a burning sensation.

Following consultation with the WCB's healthcare branch, the worker was advised on January 28, 2013 that no change could be made to the previous WCB decision. The adjudicator stated:

...you have a long history of pre-existing allergies and around the time of January 10, 2012 developed symptoms consistent with acute allergic left eye conjunctivitis and keratoconjunctivitis (a condition related to infection with a virus). It is possible that exposure to a cat, dog, dust mite, or grass may have contributed to the flare up of allergic conjunctivitis. Typically, acute allergic conjunctivitis is characterized by an intense episode of itching, redness, tearing, and eyelid swelling. Symptoms can be severe but usually resolve within 24 hours of removal from the offending allergen.

The Healthcare Advisor further stated that he is unable to relate your chronic eye symptoms and multiple diagnoses to exposure to a cat more than one year ago. Therefore, there is no change in our decision.

By letter dated August 12, 2013, the family physician reported that the worker was seen in clinic on February 12, 2013 with complaints that both upper eyelids were itchy. Her eyes themselves were not itchy or red until she rubbed at her lids. The physician's diagnosis was allergic dermatitis (contact versus atopic). In response to the question: "How is this condition a result of her work environment and exposure to cats?" The physician stated that the worker had a long standing history of intermittent mild symptoms of atopy since her teens, including:

• brief periods of generalized itchiness, watery itchy eyes, rhinitis and eczema
• exposure to animals, perfumes, and smoke had been triggers
• symptoms would be annoying but not unpleasant and would settle within day
• the home visit January 10/12 set off the persistent, intense symptoms, which she noticed immediately upon leaving the home
• this is similar to a person known to have asthma being exposed to a known trigger causing an exacerbation of their asthma (i.e. an asthma attack)

The family physician also reported that the worker had fully recovered as the acute flare of allergic dermatitis had settled.

On August 21, 2013, the WCB medical advisor conducted a complete review of the file and concluded as follows:

A variety of conditions related to the left eye, both eyes, and other unrelated pre-existing medical conditions have been highlighted above. Related to a reported single exposure to a cat in a residence the claimant was attending on January 10, 2012, the objective medical evidence would support a diagnosis of temporary aggravation of a pre-existing allergy to cats involving the left eye conjunctiva...There is no objective medical evidence to support a relationship between exposure to a cat on one single occasion and the various other left eye-related conditions, such as epidemic keratoconjunctivitis, stye, possibly a chalazion, and more recently allergic dermatitis...Aggravation of a pre-existing allergic conjunctivitis secondary to a one-time exposure to a cat in an individual allergic, as has

been documented by a positive test to cats in the remote past, would normally result in eye symptoms that might last a few days following removal of exposure and treatment with appropriate medications. Concurrently, she also appeared to develop epidemic keratoconjunctivitis in her left eye (which subsequently resolved), a stye, and possibly a chalazion more recently. I am unable to confirm a relationship between the chronic eye symptoms reported and a one-time exposure to a cat in the workplace more than 1 1/2 years ago.

On August 26, 2013, based on new medical information submitted by the worker and the August 21, 2013 opinion of the WCB medical advisor, primary adjudication accepted the worker's claim based on the diagnosis of a temporary aggravation of a pre-existing condition (allergy to cats) involving the left eye conjunctiva, resulting from her single exposure to a cat when she attended a client's residence on January 10, 2012. With respect to compensation benefits, the worker was advised that she was not entitled to any wage loss benefits given that there had been no initial time loss from work related to her exposure. The worker was also advised that the WCB would not accept responsibility for any ongoing medication costs as they were not related to her exposure to a cat in the workplace in January 2012.

On October 28, 2013, the Worker Advisor Office appealed the WCB's decision of August 26, 2013 to Review Office. The worker advisor outlined the view that the worker's eye condition was related to incorrect diagnosis and inappropriate treatment; that the evidence showed that there was a relationship between the worker's chronic eye symptoms and the January 10, 2012 exposure to a cat; and that had the worker received the correct diagnosis and appropriate treatment in the beginning, her symptoms would have resolved quickly.

In a decision dated January 3, 2014, Review Office referred to medical evidence on file to support that the worker's ongoing left eye difficulties was not related to the January 10, 2012 compensable injury and therefore she was not entitled to benefits. On January 15, 2014, the worker advisor appealed Review Office's decision to the Appeal Commission and a hearing was held on April 29, 2014.

Reasons

Applicable legislation and Policy:

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

Subsection 39(1) of the Act provides that wage loss benefits will be paid: “…where an injury to a worker results in a loss of earning capacity…” Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such a time as the worker’s loss of earning capacity ends, or the worker attains the age of 65 years. Subsection 27(1) provides that medical aid will be paid by the WCB for so long as is necessary to cure and provide relief from the injury.

Worker’s position:

The worker was assisted by a worker advisor at the hearing. It was the worker's position that she reacted to exposure to a known allergen in a client's home on January 10, 2012 and that her ongoing left eye condition was associated with that incident. The worker had a known allergy to cats and on the day of the incident she spent approximately 1 1/2 hours in a client home that had a cat. Following the visit she experienced the onset of itchy, red and swollen eyes. She initially self-treated with over the counter eye drops but when symptoms did not improve, she sought medical attention. The worker saw various physicians for her ongoing left eye condition but never received a correct diagnosis nor proper treatment. It was not until she saw a family physician on February 12, 2013 and was diagnosed with contact dermatitis that she received any relief. The family physician prescribed an eye cream and her eye symptoms soon resolved. It was submitted that the evidence supported that the worker's ongoing eye condition was associated with the January 10, 2012 incident and she should be entitled to coverage of benefits.

Employer's position:

The employer was represented by its compensation benefits coordinator. The employer's position was that it agreed with the WCB's decision to accept the worker's claim as an aggravation of a pre-existing allergic condition. However, based on the objective medical documentation on the claim file, it was submitted that a relationship between the ongoing left eye difficulties and the compensable injury could not be established.

Analysis:

The WCB has accepted that the worker suffered a temporary aggravation of a pre-existing allergy when she was exposed to cats during the course of her employment on January 10, 2012. It determined, however, that the workplace incident did not result in any entitlement to medical aid or wage loss benefits. The question for this panel to decide is whether the worker suffered a loss of earning capacity or required any medical aid as a result of the January 2012 exposure.

Following the date of exposure, the worker experienced continuing problems with her eyes. She did contract a viral infection to her eyeball (keratoconjunctivitis or "bubbles") but at the hearing, the worker indicated that she considered that condition to be separate from her work related injury. The worker explained that her claim related to her diagnosis of contact dermatitis. She felt that after coming into contact with the cat hair/dander, she developed an allergic reaction which never resolved until she was prescribed a steroid cream by her family physician in 2013. The worker indicated that her claim was primarily for the cost of all the medications she was prescribed, but were ineffective as she not correctly diagnosed until February 2013.

At the hearing, the worker readily admitted that she did not have any medical expertise, but that she felt that she was entitled to coverage for the eye itchiness which she experienced on an ongoing basis from the date of exposure on January 10, 2012, until the condition resolved with the application of steroid cream in February 2013. The basis for her claim was essentially the continuity of symptoms.

Unfortunately, the medical evidence does not support the worker's position that her ongoing eye problems related to contact dermatitis had a continuing causal relationship to her exposure to cats on January 10, 2012. The WCB medical officer indicated that an exposure to a known allergen may cause a flare up of allergic conjuctivitis, typically characterized by an intense episode of itching, redness, tearing and eyelid swelling. While the symptoms may be severe, they usually resolve within 24 hours of removal from the offending allergen. A one-time exposure would not cause the chronic eye symptoms reported.

The August 12, 2013 letter from the family physician acknowledged that the January 2012 home visit set off the persistent, intense symptoms, but did not specifically relate the worker's ongoing eye difficulties to this exposure. The letter concluded with the statement: "The acute flare of allergic dermatitis has settled," thus suggesting a temporary acute, rather than chronic condition.

The panel also notes the worker's acknowledgement at the hearing that although she continued to experience problems with her eye for over a year, it was a fluctuating condition which went up and down. There would be short term periods of relief where there would be no symptoms, but then it would deteriorate and start back again. This is consistent with a series of acute flare-ups which would be caused by repeated exposures to allergens. The panel finds that these subsequent allergic reactions would be separate and apart from the work-related exposure on January 10, 2012.

Based on the foregoing, the panel finds that the worker's compensable injury was limited to a temporary aggravation of pre-existing allergy which did not cause her any loss of earning capacity or which required any medical aid. We therefore find that she is not entitled to benefits in relation to the January 10, 2012 compensable injury. The worker's appeal is dismissed.

Panel Members

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

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 25th day of June, 2014