The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing decisions made by the Workers Compensation Board ("WCB")to deny her claim for compensation and payment of benefits beyond July 25,2013.  A hearing was held on April29, 2015 to consider these matters.  

Issue

Whether or not the claim is acceptable; and

Whether or not the worker is entitled to benefits after July 25, 2013.

Decision

That the claim is acceptable; and

That the worker is not entitled to benefits after July 25, 2013.

Decision: Unanimous

Background

In March 2013, the worker filed a claim with the WCB for difficulties she was experiencing with her right shoulder, elbow and hand which she related to constant clicking on a computer mouse. The worker reported that she first noticed symptoms around January 2013 which involved right shoulder pain going down to her hand and numbness in her fingers. The worker noted that she was in a car accident in 2010 and that she returned to work after the accident on a reduced work week.

On March 26, 2013, the worker provided a WCB adjudicator with information about her claim with MPI related to the 2010 motor vehicle accident ("MVA".) She stated that MPI placed her into a graduated return to work program and by February 2012 she was back to full time hours. The worker stated that the pain in her right shoulder had been ongoing and that she had never recovered from the injury. The only time she did not have symptoms was when she was not at work.

On April 10, 2013, the treating physiotherapist provided a narrative report to the WCB stating that the worker was seen for treatment at the clinic in March 2007 for a lower extremity injury, in August 2010 following the MVA for neck and back pain, and on March 18, 2013 with complaints of right-sided neck pain, headaches, and numbness in her right arm. On April 15, 2013, the physiotherapist diagnosed the worker's condition as a repetitive strain injury to her right shoulder girdle with right C5 nerve root irritation. The physiotherapist also noted that the worker would be sent for testing to assess whether she also had early signs of carpal tunnel syndrome ("CTS").

On April 18, 2013, the WCB accepted the worker's claim and physiotherapy treatment was authorized for a strain to the right shoulder girdle with nerve root impingement. The worker performed modified duties while undergoing physiotherapy treatment.

On August 5, 2013, a WCB physiotherapy consultant reviewed the file information in response to questions posed by initial adjudication. The physiotherapy consultant concluded:

The current diagnosis appears to be chronic nonspecific neck and arm pain. A possible carpal tunnel syndrome was noted on the July 25, 2013 physiotherapy discharge form. It is now 4.5 months since the compensable injury date. The mechanism of injury was increased use of a mouse. The April 15, 2013 fax from the physical therapist diagnosed repetitive strain injury to the right shoulder girdle with right C5 nerve root irritation. The worker has had prior ergonomic modifications to her workstation. It is difficult to relate this diagnosis to the mechanism of injury. The diagnosis of carpal tunnel syndrome would not be accounted for in relation to this mechanism of injury...The worker was involved in a motor vehicle accident in 2010 which affected her neck and shoulder region. It is difficult to relate the current restrictions to the compensable injury.

By letter dated August 13, 2013, a WCB adjudicator advised the worker that her current presentation did not appear to be medically related to the March 18, 2013 injury and there was no medical requirement for restrictions. The case manager noted the worker had prior ergonomic modifications done to her workstation and it was difficult to relate the physiotherapist's diagnosis of right shoulder girdle with right C5 nerve root irritation to her mechanism of injury. The case manager stated that the diagnosis of CTS was also not accounted for in relation to the mechanism of injury. Note was made that the worker was involved in a MVA in 2010 which affected her neck and shoulder region. It was confirmed that wage loss and medical aid entitlements would not be authorized beyond July 25, 2013.

On July 5, 2014, the worker appealed the decision to Review Office.

On September 22, 2014, the employer's representative outlined the employer’s position that the worker's right shoulder and elbow problems were not associated with her work station set-up but were due to a pre-existing injury resulting from the 2010 MVA. The employer representative suggested that the diagnosis of right shoulder with C5 nerve root impingement was not compatible with the mechanism of injury 4.5 months before. The employer indicated support for the WCB medical opinion of August 5, 2013 that the current diagnosis was chronic, non-specific neck and arm pain and agreed that the condition was difficult to relate to the mechanism of injury 4.5 months before.

On October 8, 2014, Review Office advised the worker that the employer was questioning the initial adjudication of her claim as they felt that her work station did not cause her right arm and shoulder difficulties.

On October 20, 2014, the worker provided Review Office with a further submission that included MRI results dated July 13, 2014 of the right elbow and a report from her treating physician dated September 4, 2014. The treating physician indicated a diagnosis of epicondylitis of the right elbow, which has become a chronic condition. The results of the MRI of the elbow showed “…findings suspicious of sprain of the lateral ulnar collateral ligament and possible of the radial collateral ligament.” A consultation to an orthopedic surgeon was being arranged.

In a further submission to Review Office dated October 30, 2014, the employer's representative stated that the findings of the July 13, 2014 MRI and new diagnosis of right lateral epicondylitis are not compatible with the mechanism of injury of clicking a computer mouse. On November 6, 2014, the worker provided a final submission to Review Office.

On November 14, 2014, Review Office determined that the worker's claim was not acceptable and there was no entitlement to benefits.

On January 7, 2015, the worker appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

Reasons

In considering this appeal, the panel is 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(2) of the Act provides that wage loss benefits will be paid until the loss of earning ends. Subsection 27(1) provides that medial aid will be paid by WCB for so long as is necessary to cure and provide relief from the injury.

Worker’s Position

The worker’s position is that the claim is acceptable and she is entitled to benefits beyond July 25, 2013 because the diagnoses of right elbow epicondylitis and strain to the right shoulder girdle with nerve root impingement were directly related to her work. She ascribed the onset of symptoms to an increased workload, including additional responsibilities in respect of data entry and resultant mouse clicking. The worker noted that her symptoms arose only when at work and that when she is not working, she does not experience any symptoms. She noted that her duties were not adjusted when she was on the reduced work week, and that during that same time period, there were frequently staff shortages resulting in an additional workload.

With respect to the issue of benefits beyond July 25, 2013, the worker noted that upon resuming a five-day work week, from the previous reduced four-day work week, there was a decrease in her symptoms, but that she continues to experience pain from her neck down to her arm when her workload increases, for example during payroll weeks or when data entry requirements increase.

Employer's Position

The employer, through its representative, took the position that there is no cause and effect relationship established between the reported mechanism of injury (mouse clicking) and the injury sustained by the worker.

The employer accepted the findings of the WCB’s physiotherapy consultant that the worker’s condition was difficult to relate to this mechanism of injury. The worker’s diagnoses of right shoulder girdle strain and right arm lateral epicondylitis are not explained by the mechanism of injury described by the worker. The employer noted that the worker’s right shoulder and arm problems go back for years, pointing to the worker’s pre-existing injury arising out of a motor vehicle accident in 2010. The employer noted that the worker’s complaints persist despite ergonomic changes to her workstation, changes in staffing and changes in the worker’s duties.

The employer’s position is that the worker’s claim should not be accepted, but if it is, that the decision to end benefits as of July 25, 2013 was correct based upon the medical information and diagnosis.

Analysis and Decision

There are two issues before the panel for determination:

1. Whether or not the claim is acceptable?

2. Whether or not the worker is entitled to benefits after July 25, 2013?

In order to find that the worker’s claim should be accepted, the panel must find on a balance of probabilities that the worker suffered personal injury by accident arising out of and in the course of employment. Then, if the panel concludes that the claim is acceptable, the second question, whether the worker is entitled to benefits after July 25, 2013, must be determined. To find that the worker is entitled to benefits after July 25, 2013, the panel must find on a balance of probabilities that at that time, the worker continued to suffer personal injury as a result of an accident arising out of and in the course of employment that would require medical aid or cause her to suffer a loss of earnings after that date.

The worker’s March 2013 claim was for difficulties she was experiencing with her right shoulder, elbow and hand. She noted that she first noticed symptoms around January 2013, of right shoulder pain going down to her hand and numbness in her fingers. The worker related her symptoms to constant clicking on a computer mouse.

An April 4, 2013 workstation ergonomic assessment noted that:

· the worker’s mouse is placed too far away, requiring her to overreach in order to access it;

· the worker’s phone is too far away, requiring overreaching when answering and dialing;

· the worker’s chair is too low in relation to the desktop, causing her to reach up to access the keyboard and mouse.

The worker described her workload in the period of late 2012 through the spring of 2013 as having been increased due to a project-related increase in responsibilities as well as staff shortages. She described her work duties as primarily desk-based, including reaching for and talking on the telephone while making notes at a computer, as well as data entry and mouse clicking. Although ergonomic changes had been implemented to address issues identified through an October 2011 functional capacity evaluation, the worker’s description of her workstation and the ergonomic assessment from 2013 point to the worker’s continued use of her right arm to reach for her mouse and telephone.

The physiotherapist’s report of April 10, 2013 notes that the worker took on additional duties in the workplace and was not provided any assistance to lighten her load. The physiotherapist concludes that the cause of the worker’s complaints “lies with the increase in workload above normal” and suggests that a decrease in workload, not just workdays, would be required to address the medical findings.

The worker, in her submission, noted that when she subsequently reduced her working hours to address the symptoms she was experiencing, her responsibilities were not adjusted so that during the reduced work week, she did more work each day than would have been required on a daily basis in a normal five-day work week. She also noted that upon returning to a five-day work week, her symptoms were reduced.

The evidence shows that the worker had a pre-existing, non-compensable condition in her right shoulder and neck, arising out of a motor vehicle accident that occurred in 2010. The worker’s evidence is that the resulting pain in her neck and shoulder never went away.

The April 10, 2013 physiotherapist’s report notes that the worker was treated with physiotherapy in 2010 through 2011 for mid-thoracic and neck pain as well as headaches arising out of this motor vehicle accident. At that time, treatment focused on the worker’s trapezius muscles and rhomboid muscles. Trigger points were noted into the right trapezius, splenius group and levator scapula muscles. When the treatment ended in March 2011, the worker’s range of motion was improved and there were no trigger points noted in the right shoulder girdle region or cervical spine. At that time, some ergonomic changes were implemented in the worker’s workstation and the worker was working a reduced workweek. That continued from February 2011 to January 2012.

In the April 2013 physiotherapy assessment, the worker’s physiotherapist noted the worker’s complaints of right-sided neck pain, headaches, and numbness in her right arm. On April 15, 2013, the physiotherapist diagnosed the worker's condition as a repetitive strain injury to her right shoulder girdle with right C5 nerve root irritation and queried whether there might be evidence to support a further diagnosis of carpal tunnel syndrome. He noted that the symptoms of numbness were new and had not been previously present.

The medical findings from April 2013 confirm that the worker’s range of motion was decreased. Tenderness was noted in the right C4-5 facet joints and trigger points were noted in the right trapezius and splenius muscle group. Physiotherapy treatment continued through the spring and summer of 2013. With treatment, the worker’s range of motion in her cervical spine increased while trigger points in the right trapezius muscles decreased.

The medical findings indicate a strain injury in the right shoulder and neck region in March 2013. This is the same area injured by the worker in the non-compensable motor vehicle accident of 2010.

Later findings ruled out a diagnosis of carpal tunnel syndrome. A July 31, 2013 nerve conduction study report indicates that there is no evidence of “carpal tunnel syndrome or ulnar neuropathy. As well, there is no electrical evidence of radial neuropathy.”

Having regard to the worker’s description of her work duties in the period leading up to March 2013 and the ergonomic assessment of April 2013, we find on a balance of probabilities that the worker’s right shoulder strain injury is related to her workstation ergonomics and resultant postural issues arising from overreaching for her telephone, mouse and keyboard in the course of her work, which were sufficient to aggravate her pre-existing right shoulder and neck issues.

We would therefore accept the worker’s claim for right shoulder girdle strain with nerve root impingement as arising out of and in the course of her employment.

Having concluded that the claim is acceptable, we must also determine whether the worker is entitled to benefits after July 25, 2013.

The medical findings with respect to the diagnosis of right shoulder girdle strain with nerve root impingement indicate that on July 25, 2013, the worker’s left side flexion had increased to 75% from earlier findings of 60% flexion. At the same time, the medical findings indicate decreased trigger points in the right trapezius. The worker’s physiotherapist at that time suggested a home program of stretches and ice.

The medical findings indicate that the issues relating to the right shoulder girdle strain appear to have resolved by July 25, 2013. No further physiotherapy findings with respect to this diagnosis have been provided beyond that date. This is consistent with the conclusion reached by the WCB physiotherapy advisor who noted on July 26, 2013 that a home exercise program would suffice and did not approve any further physiotherapy.

Ongoing investigations relating to the worker’s complaints of right elbow pain resulted in an additional diagnosis, on September 4, 2014, of lateral epicondylitis of the right elbow. There is no evidence before us to support a conclusion that this diagnosis is related to the accepted mechanism of injury.

Based upon the evidence before us, we find on a balance of probabilities that the worker is not entitled to benefits after July 25, 2013.

Panel Members

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

Recording Secretary, B. Kosc

K. Dyck - Presiding Officer

Signed at Winnipeg this 18th day of June, 2015