Decision #180/16 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his claim for compensation was not acceptable. A hearing was held on August 30, 2016 to consider the worker's appeal.
Issue
Whether or not the claim is acceptable.
Decision
That the claim is acceptable.
Background
The worker filed a claim with the WCB for difficulties with his right pinky finger that occurred at work on February 1, 2016 while operating heavy equipment.
The Employer's Accident Report stated:
He said there was a tendon in the palm in the right hand that is protruding and it was affecting the movement of his right pinky finger.
On February 17, 2016, a WCB adjudicator contacted the worker to obtain additional information related to his job duties and the onset of his right pinky finger condition. The worker indicated that he noticed swelling in his right pinky finger while operating heavy equipment. He felt the swelling was related to the pressure from operating the control levers. He said the pain in his finger would go away and then it became worse so he decided to seek medical attention. He was diagnosed with Dupuytren's contracture. The worker noted that he worked 10 to 14 hours a day, 20 days in a row, followed by one week off.
On February 19, 2016, the claim was referred to the WCB's healthcare branch to determine whether the Dupuytren's contracture was caused from using a joystick while operating heavy equipment. On February 19, 2016, a WCB medical advisor responded that Dupuytren's contracture is generally considered an idiopathic condition, and it was not likely that the worker's described job duties were associated with the development of this condition.
On February 24, 2016, the worker was advised his claim for compensation was denied, as the adjudicator found no evidence that hand injuries or occupations that involve vibration to the hands can cause the diagnosis of Dupuytren's contracture.
On March 29, 2016, the worker appealed the adjudicator's decision to Review Office. Included with the appeal was a medical report dated March 24, 2016, in which the treating physician opined:
[The worker]…is…diagnosed with Dupuytren's contracture to the right hand…Given the history and risk factors for this illness, it is of my expert opinion that this is most definitely a work related injury/illness that has etiology at work, exacerbated the injury at work as well as now incapacitated the patient from working.
In a decision dated April 25, 2016, Review Office confirmed the worker's claim for compensation was not acceptable as Review Office was unable to relate the diagnosis of Dupuytren's contracture to the nature of his job duties. On May 3, 2016, the worker appealed Review Office's decision to the Appeal Commission and an oral hearing was held on August 30, 2016.
Following the hearing, the appeal panel met to discuss the case and requested additional medical information, a copy of which was provided to the worker for comment. On October 13, 2016, the panel met further to discuss the case and render its decision on the issue under appeal.
Reasons
Applicable Legislation
The Appeal Commission and its panels are bound by The Workers Compensation Act (the "Act"), regulations and policies of the WCB's 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. [emphasis added]
Worker's Position
The worker was self-represented. The worker made a presentation and responded to questions from the panel.
The worker stated that he has operated heavy equipment all his life. While he was working at a remote jobsite in January 2016, his right hand started to swell up and he started being unable to open his hand. He tried putting a wrist brace on for a day or so, but it didn't help. He showed his hand to medical personnel on site, and was told that he needed to have it looked at by his regular doctor. When he saw his doctor, his hand had closed up so much that he couldn't straighten it anymore or put it in his pocket. The doctor referred him to a surgeon, who said he needed an operation, which was subsequently performed.
Employer's Position
The employer did not participate in the appeal.
Analysis
The issue before the panel is claim acceptability and whether or not the worker's right pinky finger condition arose out of and in the course of his employment. In order for the worker's appeal to be successful, the panel must find that the worker's condition was causally related to the performance of his job duties. On a balance of probabilities, the panel is able to make that finding.
In response to questions from the panel, the worker stated that in the 20 day rotation which preceded the accident date, he worked an average of 10 to 12 hours a day. He returned home on January 12, 2016 and took it easy during his week off. He had no problems with his hands up until that point. When the worker returned to work on January 20, 2016, the employer had taken the cap off overtime, and he was working 14 to 15 hours a day. Shortly after his return to work the worker started to realize that he had a problem. He could not remember precisely when that occurred. He said that his hand just started to get sore and slowly seemed to get worse and worse.
At the hearing, the panel carefully questioned the worker with respect to his job duties, the machines he operated, the controls on those machines, how he operated those controls, how much force he had to use in doing so, what each machine was used for and their movements, and the conditions at the jobsite. Based on the evidence, the panel is satisfied that the worker's job involved a high degree of repetition and force, as well as a significant amount of vibration.
Following the hearing, the panel requested additional medical information from the treating surgeon. The additional information received included an operative report dated May 26, 2016 which provides pre-operative and final diagnoses of Dupuytren's contractures right hand, and the procedure which was performed on that date, described as release Dupuytren's contracture right hand. A clinical note for a July 15, 2016 follow-up appointment noted that the worker reported that he could finally use his right hand without any limitations, and that he was advised at that point that he was ready to go back to work.
In response to inquiries from the panel with respect to the origin of the worker's condition and the occupational risk factors which would support the condition, the treating surgeon wrote:
In my professional opinion it is possible that his job duties exacerbated or caused his right hand condition. According to systematic review the incidence of Dupuitren's (sic) contracture is two to five times higher among workers exposed to repetitive handling tasks or vibration as compared with those not exposed (sic) such trauma.
It is the panel's understanding that Dupuytren's contracture can be of idiopathic or unknown origin. The panel accepts that other risk factors have also been associated with that condition in the medical literature, including repetitive, forceful or vibrating motion. The panel notes that this is supported by the opinions which were provided by both the treating physician and the treating surgeon. The panel further accepts the treating physician's opinion that the worker's condition was caused by or became symptomatic as a result of his work. In this regard, the panel finds that the increase of job duties and hours for the worker on his return to work on January 20, 2016, as well as the specific duties he performed at that time led to a work-related injury.
Based on the foregoing, the panel finds, on a balance of probabilities, that the worker's Dupuytren's contracture was causally related to the performance of his job duties.
The panel therefore finds that the claim is acceptable.
The worker's appeal is allowed.
Panel Members
M. L. Harrison, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
M. L. Harrison - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 1st day of December, 2016