Decision #02/17 - 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 November 8, 2016
to consider the worker's appeal.
Issue
Whether or not the claim is acceptable.
Decision
That the claim is not acceptable.
Background
The worker filed a claim with the WCB for a head injury that occurred on March 14, 2016. The worker described the accident as follows:
I was working in my work area when I felt a sharp pain in my right leg above my knee. I told my partner…to go and get the supervisor…He is talking to me when I dropped backwards on my head. All I remember was the paramedics talking to me…
The Employer's Accident Report dated March 22, 2016 stated:
Worker fainted and collapsed due to non work health issues but hit head on floor when he collapsed.
The WCB obtained hospital information which showed that the worker was treated on March 14, 2016. The hospital report stated, in part, that the worker had a syncopal event at work and struck his head on concrete. There was loss of consciousness for 30 seconds. The worker was alert when the emergency medical response team arrived. There was a hematoma resulting to the head. The report also stated:
…complains of sudden onset tingling area on the lateral right thigh while welding at work which quickly turned into severe "needle, tingling" pain. Became sweaty and light-headed, asked to get supervisor and then remembers waking up on the floor and presumed hit left occiput on the floor.
The diagnosis outlined by the emergency department physician was vasovagal, scalp hematoma.
A report from a CT scan of the brain performed March 14, 2016 stated there was no significant intra or extra-axial abnormality identified. A subgaleal hematoma was seen overlying the left occiput. An associated calvarial fracture was not identified.
In a memo to file dated April 5, 2016, a WCB medical advisor commented that the diagnosis from the emergency room ("ER") visit was syncope or fainting. There were multiple triggers for syncope but no clear workplace factors were noted. The ER opined that it may have been triggered by leg pain but there was no indication that the pain was work-related. Based on the medical advisor's review of the file, there was no evidence that the worker's presentation was medically accounted for on the basis of any work factors.
In a decision dated April 11, 2016, the worker was advised that his claim for compensation was not acceptable. The adjudicator noted in the decision that according to the accident employer, the worker had never mentioned any difficulties with his right leg since he started with the company in 2001. The employer indicated that the worker had a ventilation fan on top of his work station and was required to wear a ventilation mask to ensure he had clean air.
The adjudicator also noted that if a worker loses consciousness while performing his duties and it is determined that the cause is unrelated to his work activities or that the work environment did not place the worker at an increased risk for injury, the claim will not be accepted.
In the worker's case, the adjudicator concluded that a relationship had not been established between his loss of consciousness and his work duties or work environment, and the WCB was therefore not responsible for his claim, including time loss or medical treatment.
On June 28, 2016, the worker appealed the adjudicator's decision to Review Office. The worker noted that he saw a specialist (physiatrist) who explained to him that his continuous leaning forward could have resulted in a specific nerve being injured or pinched, which caused him to faint.
In a report dated June 13, 2016, the physiatrist stated, in part:
…his presentation is most consistent with meralgia paresthetica, which is pressure on the lateral femoral cutaneous nerve of the thigh. This frequently occurs at the inguinal ligament. It is possible that with bending forward he experienced entrapment of this nerve and exacerbation of his symptoms.
On August 4, 2016, in response to an inquiry from Review Office, a WCB orthopedic consultant opined:
Meralgia Paresthetica is an entrapment syndrome of the lateral cutaneous nerve of the thigh. The most common anatomical site of the nerve entrapment is where this sensory nerve passes over or through the fibres of the inguinal ligament at the front of the groin.
Acute onset of symptoms of Meralgia Paresthetica is extremely uncommon. The usual presentation is of intermittent tingling and discomfort on the antero-lateral aspect of the thigh. There is a reported association with obesity and with the wearing of tight low-slung belts. It is extremely unusual for the painful symptoms to be of such acuity as to cause a vaso-vagal episode (faint or syncope). There is no established relationship to posture or hip flexion positioning, although some authors have suggested either hyperextension or hyperflexion at the hip to be precipitating movements. Clinical examination is usually adequate to establish a diagnosis. EMG testing is done to exclude alternative diagnoses such as spinal radiculopathy or peripheral neuropathy. Confirmation of the diagnosis is by injection of local anesthetic at the nerve site of entrapment. Such an injection ablates the symptoms, at least temporarily.
On August 22, 2016, Review Office confirmed that the claim was not acceptable. Review Office considered the worker's job description and the opinions outlined by the WCB medical consultants on April 5 and August 4, 2016, as well as the physiatrist's report dated June 13, 2016. Review Office placed more weight on the August 4, 2016 orthopedic consultant's opinion. Review Office stated they were unable to establish there was anything unique or specific to the worker's duties of leaning forward while welding which would create a causal relationship between the diagnosis of meralgia paresthetica and his employment, and the symptoms related to meralgia paresthetica would not cause a loss of consciousness. Review Office concluded that the worker's loss of consciousness was unrelated to his work activities and that the work activities and/or work environment did not place the worker at an increased risk for injury.
On September 6, 2016, the worker appealed Review Office's decision to the Appeal Commission and an oral hearing was arranged.
Reasons
Applicable Legislation and Policy
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.
Subsections 1(1) ("accident") and 4(1) of the Act set out the circumstances under which claims for injuries can be accepted by the WCB, and provide 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.
WCB Policy 44.05, Arising Out of and in the Course of Employment, provides general information on the interpretation of the phrase arising out of and in the course of employment, and states, in part:
Generally, an injury or illness is said to have "arisen out of employment " if the activity giving rise to it is causally connected to the employment -- that is, if it is caused by some hazard which results from the nature, conditions or obligations of the employment. To have occurred "in the course of employment," an injury or illness must have occurred within the time of employment, at a location where the worker may reasonably be, and while performing work duties or an activity incidental to employment.
Worker's Position
The worker was represented by a union representative, who made a presentation on his behalf. The worker's position was that he had a workplace accident for which he is entitled to compensation.
The representative submitted that the worker experienced a sharp pain in his right leg while leaning over and working on a piece of equipment. The pain caused him to feel faint, to sweat profusely, to fall over backwards and to hit his head solidly on the floor.
The representative submitted that it cannot be disputed that there was an accident, and that the worker's leg pain was caused by performing his work duties. The representative also submitted that the accident could have been prevented if the situation had been properly assessed at the time.
Employer's Position
The employer was represented by an advocate and by its Safety Manager and Safety Coordinator.
The employer's position was that the evidence failed to support that the worker's job duties had a causal relationship to his loss of consciousness. Meralgia paresthetica was the official diagnosis from the worker's specialist, who indicated that acute onset of that syndrome was uncommon. The medical opinion of the experts was that lifting or bending over would not likely have caused such an onset of symptoms.
The advocate submitted that there could be many reasons for someone to have a vasovagal attack. The employer acknowledged that there was a medical episode. It was their position, however, that this was not an accident arising out of the worker's employment as identified in the legislation. As there was no accident as defined by subsection 1(1) of the Act, the claim could not be accepted.
Analysis
The issue before the panel is claim acceptability. For the worker's appeal to be successful, the panel must find that the worker's loss of consciousness and head injury on March 14, 2016 were causally related to the performance of his work duties. The panel is unable to make that finding.
To be acceptable under the Act, a workplace injury must have been the result of an accident arising out of and in the course of employment. Based on our review of all of the evidence before us, the panel is satisfied that the worker's loss of consciousness occurred in the course of his employment. However, the panel is unable to find that the loss of consciousness, and subsequent fall and head injury arose out of the worker's employment duties.
The panel questioned the worker closely at the hearing with respect to his job duties, his work area and what happened on March 14, 2016. The panel accepts that the worker experienced pain in his left leg, and was working in an awkward posture. In our view, however, the evidence does not establish or indicate that the pain was related to his work or that his loss of consciousness was attributable to that pain or to any workplace conditions or activities.
The panel recognizes that the physiatrist commented in his June 13, 2016 report that it was possible that with bending forward, the worker experienced exacerbation of his symptoms. That comment suggests at best that this may have been a possibility. In the circumstances, and given the lack of any medical evidence to support that this occurred or may have occurred in this instance, the panel is unable to accord any weight to the physiatrist's comment.
The panel would note that we found the worker to be forthright and honest in answering our questions. The issue for the panel, however, is whether a causal relationship can be established between the worker's job duties and activities on March 14, 2016 and his loss of consciousness on that date. As indicated previously, the panel is unable to establish such a connection.
Based on the evidence before us, the panel therefore finds, on a balance of probabilities, that the worker's loss of consciousness and head injury on March 14, 2016 were not causally related to the performance of his work duties. Accordingly, the claim is not acceptable.
The worker's appeal is denied.
Panel Members
M. L. Harrison, Presiding Officer
R. Campbell, Commissioner
P. Walker, Commissioner
Recording
Secretary, B. Kosc
M. L. Harrison - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 5th day of January, 2017