Decision #86/15 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB")that she was not entitled to further benefits in relation to her compensableinjury. A hearing was held on June1, 2015 to consider the matter.
Issue
Whether or not the worker is entitled to benefits afterAugust 27, 2014.
Decision
That the worker is not entitled to benefits after August 27,2014.
Decision: Unanimous
Background
On October 9, 2012, the worker injured her right hand and wrist when she caught her hand between two steel doors. The worker was diagnosed with a soft tissue injury to her thumb region and on September 30, 2013, the worker underwent surgery to remove a right volar carpal ganglion.
By letter dated December 18, 2013, the worker was advised that compensation benefits would be paid to December 29, 2013 inclusive as it was felt that she had recovered from the September 30, 2013 surgical procedure and was capable of returning to her pre-accident duties.
Subsequent to the decision dated December 18, 2013, a WCB medical advisor reviewed the file information and opined that the probable diagnosis related to the October 9, 2012 incident was nonspecific right wrist and hand pain. The medical advisor was uncertain as to whether the later development of the ganglion was related to the compensable injury given the overall nonspecific and vague complaints and limited objective findings early in the clinical management phase, including symptoms about the palmar/volar wrist and forearm up to the elbow. The medical advisor commented that the worker's presentation was mostly residua of ganglion surgery with some elements of non-specific hand and wrist pain.
In April 14, 2014, the WCB accepted responsibility for the worker's ongoing difficulties and compensation benefits were reinstated.
On May 21, 2014, a plastic surgeon reported that the worker was presenting with pain in the area of the right dorsal carpal ganglion and an MRI was being arranged.
On June 11, 2014, the right wrist MRI report stated: "A very small volar ganglion persists. There is no evidence of a dorsal ganglion."
In a further report dated July 18, 2014, the plastic surgeon noted that the worker had swelling in her fingers, tingling, paresthesia and pain up her arm. It was felt that the worker's symptoms appeared compatible with Carpal Tunnel Syndrome ("CTS").
On July 21, 2014, a WCB medical advisor opined that the diagnosis of CTS was not related to the initial compensable injury and that the removal of a ganglion would not typically be associated with the development of CTS. The medical advisor stated that a specific patho-anatomic diagnosis was not currently apparent. The medical advisor opined that the worker's current hand and wrist symptoms was not causally related to the initial crush injury that occurred some 22 months ago.
In an August 1, 2014 report, the treating physician stated: "Her current diagnosis is post ganglion surgery right wrist with neuropathy of the right hand possibly related to carpal tunnel syndrome and vitamin B12 deficiency." The physician noted that the worker should avoid repetitive flexion and extension of the right wrist and was able to work with a wrist splint during the daytime. Hopefully, the worker could return to full work duties as of October 1, 2014.
On August 20, 2014, the worker was advised that based on the mechanism of injury, the accepted diagnosis and the time that had passed, her current difficulties were not accounted for in relation to the October 9, 2012 workplace injury. Entitlement to medical aid or wage loss benefits would not be paid beyond August 27, 2014.
On September 15, 2014 the worker appealed the above decision to Review Office. On October 10, 2014, the employer submitted to Review Office that there was no basis to overturn the August 20, 2014 WCB decision.
On November 10, 2014, Review Office determined there was no entitlement to benefits beyond August 27, 2014. Review Office's opinion was that the worker suffered a soft tissue injury to her right wrist at the time of the compensable accident and that the secondary diagnosed ganglion was also related to the claim. Review Office agreed with the July 21, 2014 WCB medical opinion that the worker's CTS was not related to the initial injury. While the development of CTS occurred at some point between February 8, 2013 and August 14, 2014, Review Office did not feel it was related to the removal of a ganglion at surgery. The operative report showed that the median nerve was not addressed by the surgeon nor was there any evidence of a post- operative complication involving the median nerve.
Review Office concluded that the worker's symptoms described as CTS, were not related to the claim and there was no objective evidence of another condition that could be substantiated in relation to the claim. On December 28, 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.
The worker has an accepted claim for an injury arising from an October 9, 2012 accident. She is seeking wage loss and medical aid benefits after August 27, 2014.
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(1) of the Act provides that wage loss benefits will be paid: “…where an injury to a worker results in a loss of earning capacity…” Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such a time as the worker’s loss of earning capacity ends, or the worker attains the age of 65 years. Subsection 27 (1) of the Act provides that the WCB "...may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident."
Worker's Position
The worker attended the hearing with her husband. She reviewed the events relating to her injury and her medical treatment, and answered questions from the panel.
The worker noted there are conflicting medical reports on her file. She said that initially she had surgery to remove a ganglion. Subsequently was advised that she has CTS, but was told by a neurologist that she does not have CTS. She does not think she has CTS and speculated that perhaps the surgeon who removed the ganglion injured a nerve. She said her family physician suggested this as a possibility. The worker's husband suggested that the CTS may be due to the WCB forcing the worker back to work too soon.
The worker described the incident which resulted in her right hand being caught between two heavy metal doors. She could not remember the exact details of the accident. She said that she had a big bruise right in the middle of her hand and had pain in her thumb.
She advised that her family physician put her off work "Just for having this wrist and I can't work with it, because of what my job entitles (sp)." She acknowledged that the condition is described as mild and that she takes medication for it. She described the pain as "It's like sharp pain in my wrist, and then my hand sometimes falls asleep just from being whatever."
Regarding the reference to neuropathy in both wrists, the worker said "I might have back then, but I was kind of working on and off too. So it was, you know hard when you're working with your one hand and not using the other one. So maybe I was experiencing a little bit--"
The worker advised that she had returned to work for a while last summer. At the current time she is not working. The worker advised that she can't go back to her job so may have to stop working at her employer and find other work.
The worker confirmed that she does not have any pain at the site of the surgery. She said that her strength has never returned even though she went to physiotherapy. At the time of the hearing she was not getting physiotherapy but was doing exercise at home.
Employer's Position
The employer was represented by an advocate who provided a written brief which he reviewed with the panel.
The employer representative submitted that based on the evidence on file, including the WCB medical advisor's opinion that the worker's CTS is not due to her work accident/injury, the employer agrees with the WCB decision. He noted that the worker initially sustained a soft tissue injury to her hand and thumb region, and the claim was accepted by the WCB based on that diagnosis. He noted that since then, the symptoms have varied and have morphed into CTS-like symptoms.
The employer representative noted that in August 2014, the WCB medical advisor rejected the CTS as being related to the original injury. He noted that the diagnosis does not correlate with the initial diagnosis of the work injury. He noted that Review Office commented that CTS can be idiopathic, developing from unknown causes. He said the employer agrees with the Review Office conclusion that based upon a balance of probabilities, the CTS is not related to the workplace.
Analysis
The WCB has determined that the worker's current right wrist difficulties are no longer related to her workplace injury. The worker disputes this finding and is seeking wage loss and medical benefits after August 27, 2014. For the worker's appeal to be approved, the panel must find that the worker continues to sustain a loss of earning capacity and requires medical aid as a result of the injury. The panel was not able to make these findings.
At the hearing, the panel asked the worker numerous questions about the accident, the resulting injury, the medical treatment she received, her attempt to return to work, and her current abilities and activities. Weighing this information and the information on file, the panel finds, on a balance of probabilities, that the worker is not entitled to benefits after August 27, 2014.
The panel notes that the diagnosis of CTS was identified after the accident date but was ruled out in a nerve conduction test on February 8, 2013. Then in July 2014, after more than a year, the diagnosis of CTS was again presented. The panel is not able to relate this diagnosis to the accident.
The panel accepts the July 21, 2014 opinion of the WCB medical advisor that CTS would not appear to be related to the workplace injury or the removal of the ganglion.
The panel notes that the worker did not return to regular duties after the accident and is currently not working. The panel can find no work-related explanation for the development of the CTS condition well after the accident. Nor can the panel find any work-related explanation for the worker's current complaints of pain or inability to work, from the work duties performed by the worker.
The worker's appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 7th day of July, 2015