The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that her claim for an injury to her right wrist and arm with the accident date of May 24, 2016 was not acceptable. A hearing was held on August 24, 2017 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 an injury to her right wrist and arm that she attributed to her work duties as a finance clerk, with the accident date of May 24, 2016. The worker stated:

Started work September 2011 as finance clerk. Started 6 days bi-weekly - typing, writing, etc. Early fall of 2015 started work 7 days bi-weekly - fatigue and pain has gradually been increasing and getting worse in right wrist and arm. Went to dr. on May 30, 2016. Right now have wrist and arm wrapped up for pain and support…

The employer's accident report dated May 31, 2016 stated:

Yesterday [worker] mentioned to me that she was having pain in her right wrist and arm. Also that she was having massages on it. She said it was from her computer work/repetitive work. I then encouraged her to make a claim and see a doctor, which she did. Her work entails computer/desk work, a great deal of data entry (numbers).

Medical reports consist of a doctor's first report for an examination of the worker's wrist (side not mentioned) on May 30, 2016 and a physiotherapy report for an assessment on June 15, 2016. The diagnosis outlined by the physiotherapist was right lateral epicondylosis.

On June 8, 2016, the worker discussed her claim with a WCB adjudicator. The worker provided details regarding the nature of her job duties with her employer and information related to the nature and onset of her right arm/wrist difficulties.

In a decision dated October 26, 2016, Compensation Services advised the worker that her claim for right arm/wrist difficulties diagnosed as lateral epicondylitis was not compensable as an accident had not been established. The adjudicator noted that there was no significant increase in the worker's job duties and no specific event was identified to account for the onset of her symptoms. Although the worker performed data entry for the majority of her day, the adjudicator could not identify job duties in the position to account for the diagnosis.

On December 1, 2016, the worker appealed the adjudicator's decision to deny her claim to Review Office. On December 2, 2016, Review Office advised the worker that her claim was being sent back to Compensation Services to further investigate her claim and review the former decision.

The worker provided the WCB with a referral letter from her treating physician dated May 30, 2016, which stated:

Thank you for seeing this 53 year old female patient right wrist pain. This is an overuse injury from work. She types a lot. She needs therapy but also ways to not reinjure.

On January 25, 2017, the WCB adjudicator noted the following information as provided by the worker's manager:

…about a year ago, the worker increased from a .6 EFT to a .7 EFT (increase of one shift over 2 weeks).

We discussed the job duties - 90% workstation - data entry, mousse work (sic). Said that she took on more of a payment role, use the calculate (sic) alot (sic) more. Said that she doesn't have much phone use. There has been no ergonomic assessments completed for workstation.

I asked if there was anything in the posiiton (sic) that would be considered forceful, twisting, gripping, grasping or flexsion (sic), she said no.

On January 18, 2017, a WCB medical advisor noted that he discussed the claim with the WCB adjudicator. He noted that the worker was diagnosed with lateral epicondylitis by the treating physiotherapist, and that the treating physician did not provide a specific diagnosis beyond "wrist contusion." In a memo to file dated June 8, 2016, it was recorded that the area of symptoms was the wrist, with subsequent forearm involvement. This was somewhat atypical for epicondylitis, where symptoms are primarily at the elbow, not at the wrist.

The medical advisor stated that whether the diagnosis was epicondylitis or wrist strain/contusion, neither condition would likely be accounted for by the reported work duties. He commented that data entry/computer work involving typing and mouse use is repetitive but low force in nature, and there was no evidence that performance of these duties would contribute to the development of epicondylitis or a significant strain injury. In view of the low forces involved, an "overuse injury" as proposed by the physician was not likely.

On January 25, 2017, Compensation Services wrote the worker to advise her that the WCB was unable to relate her job duties to the cause of her current difficulties, and was therefore unable to accept any responsibility for the claim, including time loss and medical treatment.

In February 2017, the worker appealed the adjudicator's decision to the Appeal Commission. The worker stated: "I am on the computer 4 days a week, typing, using a calculator, stapler, etc. At times when my wrist/arm are bothering me, I don't even have strength in my arm to use the stapler." On February 7, 2017, the Appeal Commission advised the worker that her appeal was being referred to Review Office for consideration.

On February 15, 2017, the employer's representative stated that they supported the worker's claim. The representative stated that the worker's hours of work had increased in the fall of 2015 and she had assumed more responsibility for data entry related duties.

On February 22, 2017, Review Office determined that the claim was not acceptable as it did not find that the diagnoses offered by the worker's healthcare providers, of a contusion and lateral epicondylosis (epicondylitis), resulted from the worker's clerical duties. It was therefore concluded that the worker did not sustain an injury from her work. In March 2017, 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 WCB's Board of Directors.

Subsection 4(1) of the Act provides that where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker.

"Accident" is defined in subsection 1(1) of the Act as follows:

"accident" means a chance event occasioned by a physical or natural cause; and includes 

(a) a wilful and intentional act that is not the act of the worker, 

(b) any 

(i) event arising out of, and in the course of, employment, or 

(ii) thing that is done and the doing of which arises out of, and in the course of, employment, and 

(c) an occupational disease, 

and as a result of which a worker is injured.

Worker's Position

The worker was self-represented. The worker made a presentation and responded to questions from the panel.

The worker's position was that the problems with her wrist and arm were due to her work duties, including writing, typing, and using the adding machine and stapler. She said that her wrist would crack a lot from her work on the computer, and from using the mouse and the calculator. She would also be using the stapler a lot. She was working constantly, and as she worked, her hand would become fatigued and she would lose strength in her forearm.

The worker said that she had had issues with her wrist for a number of years, but her wrist had started getting worse and worse. The fatigue started getting to the point where she would sometimes have no strength in her forearm, so she went to the doctor.

The worker said that her doctor referred her for physiotherapy. The physiotherapist did an assessment and started treating her with acupuncture in the top of her forearm and ultrasound. The worker said she already noticed an improvement after the first visit, but stopped going to physiotherapy after 3 visits when she was told that the WCB would not be covering her treatments.

In response to questions from the panel, the worker said that she worked with six different companies or housing complexes, doing the paperwork for each of them. She did data entry, which involved entering invoices, receipts and payments. She is right-handed, and said that she used her right hand to do her work.

The worker indicated that the majority of her time was spent working at the computer, and when she was using the computer, her hand was almost always on the mouse. The worker described how she would also use her stapler a lot, in particular, to staple cheque stubs to invoices.

The worker said that she did not know why she started having problems at this time. In response to a question as to which job duties she thought were most directly responsible for her problems, she commented that when writing in her bank deposit books, she would have to press harder, as she would be writing on more than one thickness of paper, with carbon paper in between. The worker said that she had to write codes on every invoice that she handled, and if she had to write a lot during the day, her hand would be more fatigued by the evening. When she was asked if regular writing also caused her problems, the worker responded that writing on the bank deposit book bothered her more, as she had to press harder.

In terms of the sequencing of her work, the worker indicated that she had a schedule of tasks to be completed each month, with deadlines as to when each task had to be done. She said that she would basically deal with one company or complex at a time, before moving on to the next one.

The worker also described a number of other tasks which she performed as part of her job duties, including getting cheques signed, attending to banking once or twice a week, dealing with tenants on a regular basis with respect to money matters, either on a drop-in basis or by attending at their unit, and responding to telephone inquiries from tenants.

Employer's Position

The employer was represented by the worker's supervisor. The employer's position was that it supported the worker's claim, and wanted her injury and treatments to be covered.

The representative stated that the employer's volume of work had been growing and the worker's hours had steadily increased from the time she was hired. The worker started work as a .5 EFT accounting clerk in 2011, went to .6 EFT about two years later, then to .7 EFT in late 2015. The representative stated that they do not have a lot of time to do their work, and there is a lot of pressure to get everything done in a limited period of time.

The representative indicated that the worker started complaining of a sore arm and wrist a couple of years ago. In the spring of 2016, the representative noticed that the worker's arm was being wrapped up and she was complaining of soreness and stiffness in her arm. On the advice of the employer's human resources director, the worker made a claim for injury in May 2016. Her claim was initially accepted, then denied. In the employer's view, the worker's claim should be acceptable.

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 right wrist and arm difficulties were causally related to the performance of her job duties. For the reasons that follow, the panel is unable to make that finding.

The worker's injury has been diagnosed as a wrist contusion and lateral epicondylitis.

The panel carefully examined each of the worker's job duties with her at the hearing. Based on our review of all of the information before us, the panel is of the view that the activities which the worker was performing were generally not of the type which would be associated with lateral epicondylitis or a wrist contusion.

The panel is satisfied, based on the worker's description of her hand and arm positioning at the hearing, that for all intents and purposes, the worker's wrist was generally in a neutral position while she was performing her work duties. The panel is also satisfied that the worker's use of the stapler, as described, did not involve a firm grip or repetitive grasping. The panel is further satisfied that the evidence does not establish that the worker's duties involved a significant or significantly forceful amount of writing on cheques, or more particularly, in the bank deposit book.

The panel notes that the evidence indicated that the worker's duties involved a number of regularly scheduled tasks which had to be completed by varying deadlines throughout each month. In the panel's view, the repetitive nature of the work was more on a monthly basis, as opposed to a daily or weekly basis.

The panel further notes that the worker performed a reasonable variety of other tasks in addition to data entry, including attending to banking, and dealing with tenants on a regular basis.

The panel recognizes that the work which the worker was performing was relatively fast-paced and stressful, and that the worker's duties involved a considerable amount of typing and mousing. However, the panel's general impression of the worker's job duties was that overall, her work was very busy work, but did not involve the type of prolonged or sustained force and repetition that is generally associated with or considered causative of lateral epicondylitis.

In conclusion, based on our review of the evidence, the panel finds that the worker's right wrist and forearm difficulties are not consistent with her job duties, as described. In the panel's view, the worker was symptomatic at work, but not because of her work.

Based on the foregoing, the panel finds, on a balance of probabilities, that the worker's right wrist and arm difficulties were not causally related to the performance of her work duties. The panel therefore finds that the claim is not acceptable.

The worker's appeal is denied.

Panel Members

M. L. Harrison, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

M. L. Harrison - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 20th day of October, 2017