The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that her claim for injury to her fingers and low back were not related to a workplace accident. A hearing was held on September 30, 2014 to consider the matter.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable for sacroiliitis.

Decision: Unanimous

Background

On February 3, 2014, the worker filed a claim with the WCB for back, middle fingers and sacroiliac joint pain that she related to sitting and typing all day at a computer during her employment as a case coordinator. The date of accident was January 3, 2014 and the worker reported her difficulties to a manager on January 14, 2014. The worker said she delayed in reporting as she took the weekend off and thought her condition would get better with self- treatment. Her first medical appointment was on January 13, 2014.

On January 13, 2014, the treating physician reported that the worker "sits a lot and types at her work." The worker complained of pain in her right hip, both wrists and the flexor aspect of both hands. The diagnosis recorded was flexor tendonitis and right-sided sacroiliitis. On January 14, 2014, the worker was diagnosed with a lumbosacral sprain by her treating chiropractor.

On February 3, 2014, the worker spoke with a WCB adjudicator with respect to her claim. The worker reported that the symptoms in her middle fingers began on December 30, 2013 and that her right finger was more symptomatic than the left. On January 3, 2014, the worker felt tightness and a burning sensation in her back and right hip and the pain level was 5/10. If she sat for too long, she would experience low back and right buttock discomfort. The worker noted that she typed approximately 4 to 5 hours per day and used the mouse with her right hand. The worker reported that an ergonomic assessment had been done several times and she felt that her office chair was the cause of her difficulties. The worker reported that she had been in the same position since 2000.

By letter dated March 25, 2014, the worker was advised that her claim for compensation had been denied as the WCB felt that her low back symptoms were not related to her work duties as there had not been traumatic injury or repetitive strain to the low back area. The WCB also felt that the diagnosis of flexor tendonitis in both middle fingers would require workplace activity involving repetitive and forceful job duties. It was felt that the task of keyboarding did not carry the necessary forces to cause this diagnosis. On April 2, 2014, the worker appealed the decision to Review Office.

On June 4, 2014, Review Office confirmed that the worker's claim for compensation was not acceptable. Review Office found no evidence to support that the worker's job duties caused the development of her bilateral hand symptoms. This was based on the findings that the worker's work station was ergonomically sound and there was nothing to indicate that her duties had changed appreciably in the days leading up to the onset of her symptoms. It was felt that the inflammation in the worker's hands were common in the general population and that the worker's symptoms reported to her doctor were diffuse rather than specific in nature.

Review Office also determined that there was insufficient evidence to support that the worker's sitting in her office chair was the discernible cause of her low back injury diagnosed as sacroiliitis. Review Office noted that the worker's back symptoms abated when adding a gel/memory pressure relief pan in her seat, but this did not explain the development of the condition in the first place. Review Office did not accept the worker's suggestion that sitting at her workstation typing represented a "...thing that is done and the doing of which arises out of, and in the course, employment..." that caused her injuries. It also found that there was no evidence of "...an event arising out of, and in the course of, employment." On June 23, 2014, 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.

The worker’s position:

The worker was self-represented at the appeal. The worker described her job duties as a care coordinator. The workload was described as demanding and the day-to-day activities were varied with no set pattern. The worker would spend a minimum of four to five hours per day, Monday through Friday, inputting assessments and completing forms on the computer. When the worker filed her WCB report of injury form in relation to her middle fingers and right back area, she felt it was necessary as she had already done all she could on her own to self-treat. When her condition did not improve, and she found that symptoms would reoccur upon her return to the office from days off, the condition became worrisome, physically limiting, and she felt that it needed to be recorded as a workplace injury.

The worker stated that she was very clear and certain that the typing required and the amount of sitting in a hard chair were the direct cause of her symptoms. The employer arranged for occupational therapy assessments of the work station and provided the worker with the opportunity to try many chairs and keyboard changes and the worker was thankful for these interventions. The worker had the same chair seat for thirteen years and after replacement of the seat pan, she experienced improvement in her back condition. The worker's symptoms had also greatly improved with alternating keyboards and being mindful to take breaks. The worker's recreational activities had not changed and she felt these were positive in keeping her healthy.

Overall, the worker felt that repetitive computer work sitting caused her injury, which had greatly improved with intervention. Her managers, physician and chiropractor all strongly supported her decision to appeal and agreed that her symptoms were work related. Her claim was not for time lost at work as none was taken. The claim was for chiropractic care and two items purchased at the recommendation of the chiropractor.

The employer’s position

An advocate appeared on behalf of the employer at the hearing. The employer took no position in the appeal and was present as an observer.

Analysis:

In order for the worker's appeal to succeed, the panel must find that there is a causal relationship between the worker's reported symptoms and her work duties. On a balance of probabilities, we are able to make that finding with respect to the sacroiliitis. After considering the evidence as a whole, the panel is satisfied that the work duties contributed to the worker's diagnosis of sacroiliitis.

The worker's evidence at the hearing was that the symptoms in her hands started in December 2013. She reported the symptoms in both hands, with the right dominant hand having more severe symptoms. The worker noted that she mouses and does more entering and keyboarding with her right hand. Initially, there was swelling and stiffness in her middle fingers, which increased with computer work. The fingers would also go in to a locking position. Since instituting changes such as taking regular rest breaks and alternating between a regular keyboard and an ergonomic keyboard, the condition had resolved, but was still slightly present. The worker considered herself to be 90 percent improved, but felt it would not completely go away as she was still regularly doing that activity (i.e. keyboarding).

With respect to her sacroiliitis, the worker indicated that the condition was on her right side. It was first reported on January 3, 2014. The worker had used the same office chair for over thirteen years and noticed that the seat pan no longer had any cushioning. It was "rock hard." Her chiropractor provided her with an air cushion which she could use until an ergonomic assessment could be completed. By the end of January, the worker was using a colleague's chair with an air cushion and noticed an improvement in her symptoms. Within four to five weeks, she started to feel better. In February 2014, she had a week off and "felt really good." When she returned back to work, the low back symptoms returned. After a new appropriate seat pan was provided in April 2014, the symptoms finally resolved.

At the hearing, the panel asked the worker about an ergonomic assessment of her work station which was conducted in 2012. At the time, the worker's chair was specifically adjusted for her body frame by installing specialized arm rests which accommodated her slighter build. The worker indicated that the 2012 ergonomic assessment had been initiated by her as she had been getting stiffness in the right side of her neck despite going for regular massage therapy. The seat pan, however, was not examined at that time.

On a balance of probabilities, the panel finds that there is sufficient evidence of non-ergonomic conditions related to the office chair seat pan to support finding a work-related cause for the worker's sacroiliitis. The panel accepts that the lack of padding on the seat chair, combined with the four to five hours of continuous sitting on a daily basis, are the types of conditions which may contribute to a low back sacroiliitis condition. The fact that her condition improved after replacement of the seat pan supports the finding that the office chair was a contributing factor. The panel therefore finds that the worker's diagnosis of sacroiliitis was causally connected to the workplace.

With respect to the worker's claim for her middle finger difficulties, the chiropractor's report of June 21, 2014 identified the diagnosis as moderate tenosynovitis on the right hand, concomitant with subluxation of the joints both proximal and distal between the 3rd and 4th metacarpals. The evidence at the hearing was that the worker had been provided with an ergonomic keyboard in 2005. In approximately September 2013, the worker had switched back to a regular keyboard as she was developing some issues with her elbow, similar to a tennis elbow (lateral epicondylitis) condition. At the time of the onset of the tenosynovitis in December 2013, the worker was using a regular keyboard.

It is the panel's understanding that to be causative of a tenosynovitis, the workplace activities would have to involve forceful, repetitive movements. We find that the worker's job duties of keyboarding do not constitute forceful, repetitive movements and we do not accept that workplace factors caused or contributed to the worker's hand conditions. Although the worker would be sitting at her computer for at least four to five hours on a daily basis, she was not continually keyboarding. She would also be mousing, writing and talking on the phone. The panel also notes that the activity of typing, whether on a regular or an ergonomic keyboard, does not involve a degree of forceful exertion which would tend to be causative of a tenosynovitis. While the worker's middle finger symptoms may have been more noticeable when she was typing, we do not find that this activity was causative.

The panels therefore finds that the worker's claim for sacroiliitis is acceptable. The worker's appeal is allowed in part.

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
M. Lafond, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 26th day of November, 2014