The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing a decision made by the Workers Compensation Board ("WCB") that his right wrist condition did not arise out of and in the course of his employment. A hearing was held on October 28, 2014 to consider the matter.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable as explained in the reasons.

Decision: Unanimous

Background

The worker filed a claim with the WCB for pain that he experienced in his right hand, wrist and forearm on November 29, 2013. The worker described the incident as follows:

As I was typing with my right hand, I felt a sharp pain in my forearm and hand whereby my hand clenched up like a claw and it wouldn't release for about 10-15 minutes. I had been typing for about an hour and before that (sic). This is my light duty job. I don't type normally. I'm entering an average of say, 300 number digits, 300 sets of numbers per shift and its a 4 hr. shift. I'm entering 4-5 numbers at a time and it's repetitive.

The worker advised the WCB that his typing had increased in the past 2-3 months where he was typing number digits repetitively for 4 hours per day, 5 days per week, due to a prior neck injury.

The worker indicated that he started his light duty job about 2 years ago. About March 2013, he broke his left wrist so he was off during the winter months. The worker said he mentioned his injury to 3 co-workers and an ergonomic assessment was completed.

When seen for medical treatment on December 5, 2013, the worker reported pain complaints in his right distal forearm and wrist. The diagnosis rendered was a repetitive strain/tendonitis right wrist/forearm injury.

On December 11, 2013, the worker was seen by a physiotherapist for an initial assessment. The worker described pain from hand to mid forearm which increased with hand use and gripping. The diagnosis outlined by the physiotherapist was De Quervain's tenosynovitis.

A WCB adjudicator called the worker on December 10 and 16, 2013 to discuss the work duties which the worker felt was the cause of his right hand, forearm and wrist difficulties. The WCB also obtained a copy of the ergonomic assessment report dated November 26, 2013.

On January 3, 2014, a WCB adjudicator referred the worker's file to the WCB's healthcare branch to obtain a medical opinion regarding the worker's current right hand, forearm and wrist condition. By way of background, the adjudicator noted that the bulk of the worker's duties involved entering data (numbers) into a computer. He noted that the worker had a prior claim history with the WCB for injury to his left arm/shoulder and neck. The adjudicator noted that the worker worked 4 hours per day, 5 days per week with certain work restrictions and that a workstation assessment was completed and that some recommendations were made. It was the worker's position that he was left hand dominant and was entering data into a computer with his right hand and that this was the cause of his injury. The adjudicator noted that the worker's workload had increased as another employee was away on sick leave and that the worker maintained his 4 hours per day as per his pre-accident restrictions.

In a response dated January 3, 2014, the WCB medical advisor noted that the current diagnoses on file were repetitive strain/tendinitis right wrist and forearm and De Quervain's (tenosynovitis). He noted that anatomical activities typically associated with strain/sprain of the wrist/forearm and De Quervain's would be forceful repetitive gripping, significant trauma, working with impact hammers or rock drilling. The medical advisor stated that a probable causation between keyboarding and the two diagnoses was not established in the scientific literature or in the medical reports currently on file.

On January 3, 2014, the worker was advised that no responsibility could be accepted for his right wrist and forearm difficulties as his work duties were not consistent with the forceful repetitive gripping that was typically associated with his right wrist/forearm condition.

On January 28, 2014, the worker appealed the WCB's decision to deny his claim with the assistance of his union representative. It was felt that the worker had a high vulnerability for injury due to the fact that his duties were highly repetitive, he was using his non-dominant hand to mouse and type, his work station needed ergonomic improvements, and he had permanent workplace restrictions for a neck and back injury that predisposed him to the development of his condition (De Quervains tenosynovitis). Based on these factors, it was contended that there was a causal relationship between the workplace injury and the worker's duties and that subsection 4(1) and 1(1) of the Act had been satisfied.

In a submission to Review Office dated March 13, 2014, the employer's representative stated that they supported the WCB's decision outlined on January 3, 2014. The representative provided articles to support that there was no relationship between keyboarding and De Quervain's tenosynovitis.

On March 20, 2014, Review Office determined that the claim for compensation was not acceptable. Review Office indicated that it reviewed the mechanism of injury, the anatomical movements required to perform the worker's job duties, the length of his shifts, and the delay in treatment and diagnoses offered in relation to the right wrist. It found that on a balance of probabilities, an accident as defined in subsection 1(1) of the Act had not been established. On May 6, 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 right wrist problem arose out of and in the course of his employment.

Worker's Position

The worker was represented by a union representative. The worker answered questions from the panel.

The worker's representative noted that, at the time of the injury, the worker was working in an accommodated clerical position due to a 2003 compensable injury. The worker's duties involved using a computer to receive and enter complaints about a service provided by the employer. The worker's shifts were 4 hours per day. The worker's representative reviewed the description of the incident that occurred on November 29, 2013. He noted that the worker was subsequently diagnosed with De Quervain's tendonitis of his right wrist/hand.

The worker's representative submitted that the worker's injury was caused by an increase in the worker's duties in one and one half months prior to the date of injury. The increase was due to the absence of a co-worker. The worker's representative described the worker's duties as entering numbers on a spreadsheet as well as using the mouse to navigate between 2-3 different screens per entry. He noted that the worker is required to make over 300 entries per shift with the associated use of the mouse for each entry. He referred to spreadsheets which were included in his written submission. He also noted that the worker is frequently using a phone, holding the phone with his left hand and using his right hand to perform the typing duties.

The worker's representative referred to literature provided with the written submission which supports the worker's position that De Quervain's tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the tendons at the back/outer aspects of the thumb and can be caused by writing or working on a computer. He also noted that the article suggested that a history of thumb, wrist, elbow, shoulder, neck or upper back injury may increase the likelihood of a patient developing this condition. He noted that the worker falls into this group.

The worker's representative noted that Review Office referred to an ergonomic assessment that was completed on November 22, 2013, a week before the worker's new incident. He advised that it is the worker's position that he mentioned his right wrist problem to the person performing the assessment.

The worker provided a detailed explanation of his duties and the November 29, 2013 incident. Regarding his duties the worker advised he:

• Copies and pastes materials using the mouse with his right hand.
• Uses the numeric key to enter some information.
• Uses two screens to make entries.
• Scrolls down each page using one finger.
• Only types the last 3 digits on the form.
• Reviews the information and determines whether the complaint is valid.
• On average there are 100 to 150 cases a day in his queue.
• Each transaction takes approximately 30 to 40 seconds.
• Co-worker was away so he was doing more work.
• There are no quotas, but he has a strong work ethic so does as much as he can.
• Takes 6 or 7 breaks during his 4 hour shift, but does not take a coffee break.
• Receives 1 to 12 calls each shift which take approximately 2 to 5 minutes to handle.
• Makes outbound calls to customers, currently about 10 calls but previously 4 to 5 calls.
  

In answer to a question, the worker advised that he had symptoms beginning in April or May 2013 but the symptoms were not to the same degree as in November. He was symptom-free prior to this. He said that in October 2013, his symptoms moved from his thumb into his wrist. With movement he had pain on either side of his wrist and trouble gripping. In November his hand was swollen.

The worker advised that he returned to work in January 2014. He is performing the same duties but has slowed down the pace.

In answer to a question about the diagnosis for the injury, the worker's representative advised that while there could be multiple diagnoses, the physiotherapist narrowed the diagnosis down to De Quervain's tenosynovitis.

The worker's representative submitted that on a balance of probabilities, the worker's claim is acceptable.

Employer's Position

The employer was represented by its Compensation Coordinator.

The employer representative disputed the worker's evidence that he raised the issue of his sore hand with the person performing the ergonomic assessment on November 22, 2013. He submitted that the absence of any mention of the right hand problem in the assessment supports the employer's position that the worker did not raise this issue. He also advised that he spoke with the person responsible for performing the assessment and that she denied that the worker advised her about his hand.

The employer noted the January 3, 2014 opinion of the WCB medical advisor that a probable causation between keyboarding and De Quervain's tenosynovitis or repetitive strain/tendonitis of the wrist/forearm is not established.

Regarding the worker's predisposition to De Quervain's, the employer's representative noted that the worker's neck injury occurred 12 years ago and that the worker has been working in accommodated duties for 5 years.

The employer's representative noted that medical literature indicates that the cause of De Quervain's tenosynovitis can be idiopathic. He also noted that the amount of repetition in the job is limited. He also said that the job is limited to 4 hour shifts and the worker takes time for breaks and phone calls. He said he could find no reference to the locking hand position which the worker experienced.

In answer to a question about the diagnosis for the injury, the employer representative advised that the subjective findings of the treating physician and the positive testing by the physiotherapist indicated a diagnosis of De Quervain's. However, the evidence does not demonstrate that the worker's duties caused this diagnosis.

Analysis

The issue before the panel is whether the worker's claim is acceptable. For the worker's appeal to be successful, the panel must find that the worker sustained an injury arising out and in the course of his employment. The panel is able to make this finding.

The panel notes the January 3, 2014 opinion of the WCB medical advisor which indicates that two diagnoses have been provided, namely:

• Repetitive strain/tendinitis right wrist/forearm, and
• De Quervain's (tenosynovitis)

The panel notes that the worker described an acute incident which occurred on November 29, 2013, specifically that while typing with his right hand he felt a sharp pain in the forearm and his hand clenched like a claw. The panel finds, on a balance of probabilities, that this incident is an accident arising out of and in the course of the worker's employment. Accordingly, the worker's claim is approved for a repetitive strain/tendonitis of the right wrist/forearm only.

In reaching this decision, the panel accepts the worker's physician's first report, dated December 5, 2013, which provides a diagnosis of repetitive strain/tendonitis right wrist/forearm that caused his right hand to "lock up." The panel finds this is a probable diagnosis given the description of the mechanism of injury and reported symptoms at that time. The panel also finds this condition was of short duration and had resolved by December 11, 2013 based on the absent findings related to a strain and the findings first identifying De Quervain's by the physiotherapist.

The panel is not able to find that the De Quervain's diagnosed by the physiotherapist was caused by work based on our careful examination of the job duties performed by the worker, the absence of complaints at the time of the comprehensive ergonomic assessment and the lack of recommendations with respect to the worker's right arm/hand positioning or his keyboard and mousing duties. The panel considers the later diagnosis of De Quervain's tenosynovitis to be an incidental finding. The panel considered the worker's job duties and is unable to conclude that the duties were causative of De Quervain's tenosynovitis.

The worker's appeal is allowed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 5th day of December, 2014