The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his bilateral carpal tunnel syndrome was not related to his job duties asa truck driver.  A hearing washeld on March 10, 2015 to consider the matter.  

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

On July 29, 2014, the worker filed a claim with the WCB for pain in both wrists. The worker reported that he first noticed symptoms in early 2014 and that he sought medical attention in March 2014. The worker indicated that he has worked in the trucking industry since 1974 and that he had been diagnosed with carpal tunnel syndrome ("CTS").

The employer's accident report indicated that worker reported on July 30, 2014 that he had CTS .

In a memorandum to file dated August 25, 2014, a WCB adjudicator documented information she obtained from the worker regarding the onset of his hand symptoms, his past employment history and details of the medical treatment he received. The worker reported that his symtpoms were caused by repetitively holding the steering wheel and shifting gears during the past 40 years of driving. He noted that hanging on the steering wheel involved pressure especially during winter time for a duration of several hours at a time. Repetitive flexion/extension was also required with shifting gears when he used to drive trucks with manual transmissions.

The worker indicated that direct pressure was required when cranking dolly legs on a regular basis. He said the winter months caused him strain when he had to dolly down or up. Since being with his recent employer, he used a dolly less than 5% of the time in any loading or unloading. Prior to 2002 for 30 years, he used a dolly 50% of the time.

Medical reports on file showed that the worker sought medical treatment in February 2014 and that nerve conduction studies dated July 16, 2014 confirmed bilateral CTS, severe on the right and moderate on the left.

In a decision dated September 15, 2014, the WCB advised the worker that his claim for CTS was not compensable. The WCB noted that CTS was a condition that could develop from work- related and non work-related factors and that work-related factors included high force and repetitive motions of the wrist involving twisting, gripping, pulling, flexion/extension and significant exposure to power or vibratory tools.

The WCB acknowledged that the worker's job duties over a period of 40 years involved constant holding of the steering wheel, shifting gears and cranking dollies in between driving. The duties, however did not involve a sufficient degree of occupational factors required for the development of CTS. The cranking of dollies were of short duration and were not performed continuously. The vibration felt while holding the steering wheel would be minimal compared to a worker using vibrating hand tools like jackhammers. Therefore the WCB was unable to establish that the worker's bilateral CTS arose out of and in the course of his employment.

On October 14, 2014, the Worker Advisor Office appealed the WCB's decision to deny the worker's claim. The worker advisor submitted that the evidence supported the onset of the worker's symptoms correlated with long distance driving in a thirteen speed rig on rough roads in the spring and frequent shifting, which met the requirements for the development of CTS.

On December 10, 2014, Review Office confirmed that the claim was not acceptable as it was unable to establish a causal relationship between the development of bilateral CTS and the worker's employment as a truck driver. Review Office noted that the worker's wrist symptoms only began in early 2014 and that there had been no changes in his job duties or workload after being employed with his employer for about 12 years. The job duties performed by the worker did not entail high force or high repetition and gripping the steering wheel or movement of the vehicle would not cause CTS to develop. It was also Review Office's opinion that driving during adverse weather conditions was a common occurrence as part of the worker's driving history and that this would not contribute to the development of CTS. Review Office noted that the worker's CTS was bilateral in nature which was indicative of an internal process as being the cause of the condition. It therefore was unable to account for the onset of the worker's bilateral wrist symptoms in 2014 based on his job duties.

On December 12, 2014, the worker advisor appealed Review Office's decision to the Appeal Commission and an oral hearing was arranged.

Reasons

Applicable Legislation

The Appeal Commission is bound by The Workers Compensation Act (the “Act”), regulations, and the 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 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. [emphasis added]

The key issue to be determined, is causation. In other words, whether the worker’s bilateral CTS arose out of and in the course of his employment.

Worker’s Position

The worker was self-represented at the hearing. The worker submitted that his duties entailed occupational work factors which put him at risk for developing CTS. He felt that, in particular, the constant vibration from holding the steering wheel as a long distance trucker caused or contributed to his CTS.

At the hearing, the worker gave evidence with respect to the scope of his duties and answered questions from the panel. The worker advised that he has been employed as a long distance trucker since 1994. He has been with his current employer since 2002. Since 2008, he has been driving a 2005 truck with air ride seat, air ride cab, and air ride suspension. The truck has power steering. The steering wheel is approximately 20 inches in diameter and the angle is adjustable. Typically, the worker has the wheel placed a 30 degree forward angle with the result that his wrists are bent down and forward slightly. He has the option of positioning the wheel to suit his preference. He tends to hold his hands at the "10 and 2" position and he shifts his position when he experiences discomfort or numbness. There is an armrest which he uses sometimes. He is able to drive from time to time with just one arm on the steering wheel while he rests the other. Many of his trips are to the United States. He notes that the roads across much of the US tend to be in better condition or better maintained which reduces the vibration when driving. The vibration ranges from minor on smooth roads to very severe on rougher roads. He tends to grip the steering wheel more tightly in adverse weather, especially in snow and ice. Weather conditions, even in winter months, however, will vary over the course of a trip so that it was unlikely that an entire trip would be in adverse conditions without a break.

He described his typical trip as four to eight days in length, driving 11 to 13 hours per day. He estimated that he averages 11,000 miles per month.

The worker also gave evidence with respect to the shifting that he does during driving. As he has a bigger truck now, he does less shifting than he used to years ago. Most of the shifting occurs when he comes into towns and cities, with significantly less shifting on freeways, particularly when they are flat.

For a span of approximately 5 to 6 years during the early part of his career, the worker’s job duties included flat deck work which involved tarping, chaining and strapping. The rest of his career, however, was what he described as ‘pin to pin’, meaning that he would hook and unhook his vehicle with very little physical involvement in loading or unloading, aside from manually cranking the dolly legs.

The worker stated that he first noticed his right wrist symptoms in January 2014 when he began to experience numbness in his hand, particularly in his thumb and pointer finger. The numbness eventually spread to his middle finger and involved shooting pain at the base of the thumb and problems with his palm. Although he also experienced some problems with his left wrist and hand, it was not to the same degree as the right. Wrist braces were made for both wrists but did not seem to help significantly.

On or about May 23, 2014, while on a long-distance trip through Ontario to the United States, the worker began to experience severe pain in his left shoulder and neck, along with increased numbness in both wrists. Despite medication, he was unable to control the pain. As a result, he went off work. He was diagnosed with degenerative changes in his shoulder. Nerve conduction studies were also done which showed bilateral CTS, categorized as severe in the right hand and moderate in the left. In October 2014, he underwent surgery for his right sided CTS. The surgery has improved, although not entirely eliminated, his symptoms. He returned to work on November 21, 2014. He reports some increased numbness in his left wrist and hand.

Overall, the worker felt that his wrist symptoms were related to his employment as he was unable to identify another potential cause of his CTS. It was submitted that his claim be accepted.

Analysis

To accept the worker’s appeal, the panel must find on a balance of probabilities that the worker suffered injury as a result of a workplace accident, within the meaning of subsection 4(1) of the Act. In order to reach that conclusion, the panel must find that the CTS was causally related to his work duties. Based on the evidence, we are unable to reach that conclusion.

CTS is defined as the impairment of the motor and/or sensory function of the median nerve as it traverses through the carpal tunnel. CTS is caused by either intrinsic swelling of the median nerve, or by extrinsic compression of the median nerve by one of the many surrounding structures of the wrist.

CTS has a number of causes. Some of the most commonly accepted occupational factors associated with CTS include: wrist injury, frequent use of vibrating hand tools, and any repetitive or forceful motion with the wrist bent, particularly when done for prolonged periods without rest. Generally, CTS is more commonly found where the job duties involve high force and high repetition.

To decide this appeal, the panel must consider the worker’s job duties to determine whether, on a balance of probabilities, those duties might have caused or contributed to his CTS.

After considering the evidence as a whole, we are unable to find that the work duties either caused or contributed to the worker’s CTS.

On balance, after considering the nature of the work duties performed, the panel is not persuaded that the worker’s job duties caused his bilateral CTS. The overall impression was that the duties performed by the worker were not the type which are typically associated with the development of CTS, nor were the duties performed during his last trip in May 2014 likely to have led to the development of CTS. The medical evidence confirms that the worker ceased work predominantly as a result of his neck and shoulder pain and not as a result of increased wrist symptoms. It also appears that the CTS was an incidental finding during the nerve conduction study. The worker’s wrists while driving were in a neutral position. There was no forceful or constant grip with vibration for long periods and no hyperextension of the wrists. There was no significant degree of repetition, force or awkwardness in the worker’s duties for either wrist that would typically be associated with the development of CTS. Further, the panel notes that the worker’s CTS condition is bilateral, which typically suggests a non-work related cause. We therefore find that the worker’s development of CTS was unrelated to the activity performed in his job. We further find that the worker’s bilateral CTS was not aggravated by his job duties and there was no medical evidence to support an aggravation of the condition.

Based on the foregoing, the panel is unable to relate, on a balance of probabilities, the worker’s bilateral CTS to the work duties which were being performed by him as a long distance trucker.

We therefore find that the claim is not acceptable and the worker’s appeal is denied.

Panel Members

K. Wittman, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

K. Wittman - Presiding Officer

Signed at Winnipeg this 7th day of May, 2015