Decision #143/14 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his claim for carpal tunnel syndrome was not acceptable. A hearing was held on October 27, 2014 to consider the matter.Issue
Whether or not the claim is acceptable.Decision
That the claim is not acceptable.Decision: Unanimous
Background
On September 2, 2014, the worker filed a claim with the WCB for carpal tunnel syndrome ("CTS") in both hands which he related to his workplace duties. The worker reported:
Progressively over the last five years I have encountered an increased loss of feeling and pain in both hands. There is a direct correlation with my workplace where system changes occurred where paper files were eliminated to the point where all work is currently being done on computers with electronic files. Objectively this must be work related as during weekends and vacations my hands feel better and come Monday evening my hands start hurting and by Friday...they really hurt. Also, in January 2009 I had a Ergonomic Assessment at work where desk modifications were suggested. These suggestions were overlooked. Had these modifications been made, my hands might be okay now. Have been referred to surgeon for surgery.
The Employer's Incident Report indicated that the worker provided his director with an e-mail on July 9, 2014 stating that he had been diagnosed with bilateral CTS which was probably work related. The employer noted that no specific incident had been reported.
In a medical report dated July 8, 2014, a physical medicine and rehabilitation specialist noted that the worker complained of tingling and numbness in his fingertips for over two years. It happened mostly at night and when grabbing onto objects like the steering wheel while driving. After considering electrodiagnostic test results, the specialist diagnosed the worker with bilateral median neuropathy at the level of the wrist, as seen in CTS. The intensity of his neuropathy was in severe range on the left hand and mild range on the right hand.
In September 2014, a WCB adjudicator spoke with the worker to obtain detailed information related to the specific job duties which he felt had caused his CTS condition. The WCB also considered an ergonomic assessment of the worker's work station taken in 2009.
On September 8, 2014, the worker was advised that his claim for compensation was not accepted as it was determined that his job duties were varied in nature and they did not expose him to significant work-related factors resulting in the development of CTS. On September 8, 2014, the worker disagreed with the decision and an appeal was filed with Review Office.
On September 18, 2014, Review Office met with the worker to obtain additional information related to his job duties, personal health factors, etc. The file was then referred to a WCB medical advisor who was asked to provide an opinion as to whether or not there was a causal connection between the worker's job duties and his bilateral CTS condition. The WCB medical advisor opinion is dated September 24, 2014.
On September 28, 2014, Review Office confirmed that the claim was not acceptable as it was unable to find that the worker's job duties caused the development of bilateral CTS. Review Office provided evidence and reasons to support its conclusion that the worker's bilateral CTS did not arise out of the performance of his job duties or his desk set up. It also could not establish that the worker continuing to perform his job duties with his desk set up aggravated or enhanced his bilateral CTS condition. On October 1, 2014, the worker appealed Review Office's decision to the Appeal Commission and an oral hearing was arranged.
Reasons
Applicable Legislation
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.
This appeal deals with claims acceptance. 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. He submitted that his bilateral carpal tunnel syndrome is caused by his work duties.
The worker advised that he worked for the employer for 35 years and recently retired. He provided a brief chronology of his condition:
· 2005 numbness in his wrists. · 2009 work duties changed, move to electronic files requiring more computer work. · 2011 physician prescribed splints which eased pain and numbness. · 2014 nerve conduction studies show bi-lateral carpal tunnel. · November 2014 surgery scheduled for one wrist. The worker advised that an ergonomic assessment of his work area was performed in January 2009. He said that several changes were recommended but not implemented. He feels that the failure of the employer to make the ergonomic changes contributed to his condition. He noted that the assessment recommended that:
"Due to the way this desk is set-up it is difficult to support the arm properly while mousing.
OT recommends: During periods of intense computer use: move computer towards the centre of the desk - keeping the mouse, keyboard + monitor straight - support the (r) arm on the armrest to mouse"
He also noted that the assessment indicated that the worker's "straight desk does not allow both a computing area + a paperwork area. Subsequently the computer has been angled to slightly into the corner. This creates too much reach, + anchoring on the desk while mousing...a l-shaped or u-shaped desk would be preferable and allow better ergonomic work postures...."
The worker advised that he did not ask for changes to be made to his workstation.
In answer to questions from the panel, the worker provided a detailed description of his duties. This included the following information:
· he is responsible for supervising approximately 7 staff, who work remotely away from the office. He communicates with them via a computer. · prior to 2009 he only used a group communication program and e-mail. · the office moved to paperless files in 2009 and this resulted in major changes: The worker provided photographs of his workstation which he referenced in outlining how he performs his work. In answer to a question, the worker demonstrated the position of his wrist while typing. He agreed that the wrists were bent approximately 30% downward. His forearms were not in contact with the surface of his desk to maintain this position. He said he uses his 2nd and 3rd fingers to type and his right hand to mouse. The worker advised that when he is on vacation or away from work, his hands do not hurt but during a work week his hands are very sore. The worker said that this establishes a cause and effect relationship. The worker advised that he has done some research on the causes of CTS and that there is some literature to support a work cause. Regarding why his left carpal tunnel was found to be worse during testing, he suggested that it may be related to the awkwardness of the position that he holds his hands in on the desk. Subsequent to the conclusion of the hearing, the worker wrote to the panel to advise that he made an error in reply to a question asked by the panel. Analysis The issue before the panel is whether the worker's claim is acceptable. For the worker's appeal to be acceptable the panel must find, on a balance of probabilities, that the worker's duties either: 1. Caused his bilateral carpal tunnel condition, or; 2. Aggravated or enhanced a pre-existing carpal tunnel condition. The panel was not able to make any of these findings. The panel finds that the worker's claim is not acceptable. The panel questioned the worker extensively on his duties, changes in his duties, posture and the use of his hands. Upon considering all the evidence, the panel finds that while the worker uses a computer for a large part of his work day, his activities do not involve significant amounts of typing or data entry. He types few original documents, and enters little data. Rather he spends significant time reading information on a screen which previously was only available on paper files. He does maneuver amongst screens and uses cut and paste tools in some aspects of his duties. The panel is unable to find that the worker's use of a computer at work is sufficient to be causative of the worker's condition or to have aggravated or enhanced a pre-existing condition. In reaching the above conclusion, the panel also considered the worker's diagnosis of bilateral CTS with the left wrist being in the severe range while the right wrist is in the mild range. The panel notes that the worker used his right hand more than his left yet the diagnostic evidence is that his left hand is worse. The panel notes that this does not support a finding that the worker's condition is related to or caused by his workplace duties. In this regard, the panel relies upon the September 24, 2014 opinion of the WCB medical advisor that "It is unlikely that the worker's currently reported bilateral, left worse than right carpal tunnel symptoms are related to his workplace activity." Regarding the position of the worker's wrist, the panel notes that the ergonomic assessment found that the worker's wrists were in a neutral position. This is consistent with the worker's evidence at the hearing that he bent his wrists downward. The wrist downward posture is not conducive to causing CTS given the lack of force or end range positioning. While the worker provided different information after the hearing, the panel places greater weight on the worker's original testimony which is supported by the observations made during the ergonomic assessment. Given the panel's finding on the extent of keyboard use involved in his duties, the panel does not attach weight to the employer's lack of action on the ergonomic assessment given that the recommended actions were not targeted at ergonomic deficiencies associated with the development of CTS. The panel does not find the workstation set-up to be a contributory factor in the cause of the worker's CTS condition. The worker's appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 14th day of November, 2014