The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decisions made by the Workers Compensation Board ("WCB") that:

Date of Accident - June 10, 2006:

1. Responsibility was not accepted for the September 13, 2019 left wrist surgery as being related to the June 10, 2006 accident; and

2. The worker was not entitled to benefits effective September 13, 2019.

Date of Accident - September 13, 2019:

The claim was not acceptable.

A hearing was held on December 1, 2021 to consider the worker's appeal.

Issue

Date of Accident - June 10, 2006:

1. Whether or not responsibility should be accepted for the September 13, 2019 left wrist surgery as being related to the June 10, 2006 accident; and

2. Whether or not the worker is entitled to benefits effective September 13, 2019.

Date of Accident - September 13, 2019:

Whether or not the claim is acceptable.

Decision

Date of Accident - June 10, 2006:

1. Responsibility should not be accepted for the September 13, 2019 left wrist surgery as being related to the June 10, 2006 accident; and

2. The worker is not entitled to benefits effective September 13, 2019.

Date of Accident - September 13, 2019:

The claim is not acceptable.

Background

Date of Accident - June 10, 2006

The worker has an accepted WCB claim for an injury to his left wrist that occurred when he fell, landing on his left wrist, after attempting to break down a fence at work on June 10, 2006. The worker was initially diagnosed with a repetitive strain injury in the left wrist extensor/pronator muscles, with symptoms of pain when using his wrist/forearm in the dorsal and radial forearm extending to his elbow. On October 2, 2006, the worker's file was reviewed by a WCB medical advisor, who opined that the worker's compensable diagnosis was a wrist strain, not a repetitive strain injury, as there was a specific incident that occurred on June 10, 2006.

The worker continued to work his regular duties and receive physiotherapy treatment but reported ongoing difficulties with his left wrist. On January 5, 2007, the worker's treating family physician noted the worker had plateaued with physiotherapy and requested the WCB arrange for an MRI for the worker. The March 8, 2007 MRI indicated "Distal radioulnar joint and proximal carpal space effusions are noted with no discrete evidence of a triangular fibrocartilage complex tear." After reviewing the MRI, the worker's family physician requested the WCB expedite an appointment for the worker to a plastic surgeon.

On September 7, 2007, the worker was seen by the plastic surgeon who recommended an arthroscopic assessment of the worker's left wrist to assess the triangular fibrocartilage complex (TFCC) and rule out any other carpal or ligament injuries. The surgery was authorized by the WCB on September 10, 2007, and the worker underwent the procedure on September 13, 2007. The surgical report noted the worker's wrist pain was "…likely related to the lunotriquetral instability and surrounding associated synovitis." The worker received a further course of physiotherapy after the surgery, returned to modified duties on November 26, 2007 and full regular duties on January 3, 2008.

On March 13, 2009, the worker attended an examination with a WCB physiotherapy consultant to assess his entitlement to a permanent partial impairment ("PPI") rating resulting from the workplace accident. On March 19, 2009, the WCB advised the worker that he was entitled to a PPI award based on a PPI rating of 3.2%.

On February 6, 2018, the worker contacted the WCB to advise he had been experiencing ongoing and increasing symptoms in his left wrist. The worker advised that his symptoms were manageable after the workplace accident and subsequent surgery, but he noticed approximately six months ago that the pain was increasing with small movements and his wrist was becoming aggravated with performing the activities of daily living. The worker noted he had advised his treating family physician of the increasing symptoms, and she recommended he attend further physiotherapy treatment. The worker advised the WCB that his workload had not changed, and while he had mentioned the difficulties to friends, co-workers, and supervisors at work, he had not made a formal report.

On February 8, 2018, the worker's treating family physician provided the WCB with two encounter notes from her clinic for the worker's attendance related to his wrist difficulties, and on February 9, 2018, the WCB advised the worker that they would cover some ongoing treatment related to his left wrist difficulties and would attempt to expedite an appointment with a specialist to help address his ongoing issues.

On March 22, 2018, the worker attended an assessment with a second plastic surgeon. The plastic surgeon examined the worker, noted tenderness over portions of the worker's left wrist, and recommended a further MRI study to "…rule out either a volar wrist ganglion versus de Quervain's tenosynovitis or any type of lunotriquetral pathology." The MRI was performed on April 11, 2018 and indicated "Slightly excessive carpal joint fluid which may relate to nonspecific synovitis. Very tiny volar ganglion at the lateral radiocarpal joint likely of no significance." At a follow-up appointment with the second plastic surgeon on April 19, 2018, the surgeon recommended a left wrist arthroscopy to debride the synovitis and remove the ganglion. The surgery was authorized by the WCB for diagnostic purposes on May 9, 2018, and performed on May 22, 2018. The worker again received physiotherapy and returned to work on his full regular duties on September 19, 2018.

On November 7, 2018, the worker was seen for a follow-up appointment with the treating plastic surgeon. The surgeon reported the worker had returned to work but was "…complaining of pain just to the radiocarpal interval on the volar and dorsal aspect of his radial left wrist" with the pain becoming worse with activities involving extension of the wrist. A further MRI was recommended to assess whether the worker had developed a ganglion. The MRI, performed on November 28, 2018, indicated minimal excessive carpal joint fluid without evidence of a definite ganglion cyst and mild edema at the radial aspect of the distal pole of the scaphoid, with no fracture line demonstrated. At a further follow-up with the treating plastic surgeon on December 20, 2018, the surgeon recommended the worker monitor his wrist for six months then return for re-assessment, with further surgery being indicated as a possibility.

On February 7, 2019, the worker's file was reviewed by a WCB plastic surgery consultant. The plastic surgery consultant reviewed the medical information on the worker's file and noted the finding of a radial wrist ganglion had not been accepted as part of the worker's claim. The consultant opined that the "…new finding of minimal subchondral edema at the radial aspect of the distal pole of the scaphoid bone is not likely patho-anatomically accounted for in relation to the workplace injury/accepted diagnosis on file." On February 11, 2019, the WCB advised the worker that they had determined his current difficulties were not related to the June 10, 2006 workplace accident and responsibility would not be accepted for treatment of his ongoing left wrist issues.

On March 27, 2019, the worker attended a follow-up appointment with the treating plastic surgeon, who noted the worker had "…very specific pinpoint tenderness right at the junction of the radius and the scaphoid" and recommended a radial styloidectomy. On April 4, 2019, the WCB plastic surgery consultant reviewed the medical information, along with the worker's file. The consultant noted her previous opinion that the recent findings of a wrist ganglion and subchondral edema at the distal scaphoid had not been accepted as part of the worker's claim, and that after discussing the file with the worker's WCB case manager, financial responsibility for the proposed radial styloidectomy would not be accepted by the WCB. On April 5, 2019, the worker's treating hand surgeon was advised that the WCB would not provide funding for the proposed surgery. On April 9, 2019, the WCB advised the worker that the February 11, 2019 decision remained unchanged and responsibility would not be accepted for his ongoing left wrist difficulties.

On January 7, 2020, the worker's union representative submitted a December 6, 2019 letter from the worker's treating plastic surgeon, a January 5, 2020 letter from the worker, and a medical article, and asked that the WCB reconsider their earlier decisions to deny responsibility for the worker's ongoing wrist difficulties. The representative noted that the information supported the worker's left wrist did not heal fully and as the worker continued to perform his full regular duties, he developed increasing difficulties, which now required further surgical intervention and treatment. Also provided was a copy of the September 13, 2019 surgical report indicating the worker underwent a left first dorsal extensor compartment release and left radial styloidectomy.

On March 4, 2020, the information which had been submitted was reviewed by the WCB plastic surgery consultant, who opined that based on her previous reviews of the file and the new medical information received, there was no apparent basis to alter her previous medical opinion that a relationship between the worker's current left wrist difficulties and the June 10, 2006 workplace accident could not be established. On April 1, 2020, the WCB advised the worker that their decision remained unchanged.

On June 23, 2020, the worker's union representative requested that Review Office reconsider the WCB's decision. It was submitted that the worker continued to require treatment and surgery for his difficulties, which he related to the original workplace accident on June 10, 2006. On September 21, 2020, the employer provided a submission in support of the WCB's decision, a copy of which was provided to the worker on September 22, 2020.

On October 9, 2020, Review Office determined that the surgery of September 13, 2019 was not related to the June 10, 2006 accident and there was no entitlement to benefits as of September 13, 2019. Review Office acknowledged the worker had a physical job and his radial wrist problems could have arisen from his duties. Review Office found, however, that there was no reported injury to the radial side of the worker's wrist until 2018, and a causal relationship could not be established between the worker's radial wrist difficulties and the June 2006 workplace injury or related surgeries. Review Office further found that as the September 13, 2019 surgery was not related to the workplace injury, the worker was not entitled to wage loss benefits as of that date.

Date of Accident - September 13, 2019

On February 3, 2021, the worker filed a Worker Incident Report with the WCB reporting he had surgery on his left wrist on September 13, 2019, as a result of repetitive work and repetitive strain injuries. The worker noted he had been advised by his treating hand surgeon that the injury may have been caused by the workplace accident that occurred on June 10, 2006 or from the repetitive nature of his job duties.

The worker provided the WCB with specific details of some of his job duties and noted his left wrist symptoms had been persistent to some degree since the workplace accident in June 2006. The employer provided an Employer's Incident Report to the WCB on March 25, 2021 advising of the worker's report of a repetitive strain injury from his previous workplace injury, which resulted in surgery on September 13, 2019.

On March 29, 2021, the WCB advised the worker that his claim was not accepted. The WCB advised that they had determined that while his job duties were physically demanding in nature, they would not be considered repetitive. The WCB further noted that the worker had not sought medical treatment for a repetitive strain injury.

On April 19, 2021, the worker's representative requested that Review Office reconsider the WCB's decision. The representative noted the worker's position was that he was injured as a result of his work duties in the environment of a pre-existing wrist injury as a result of the June 10, 2006 workplace accident and continuing instability. On June 11, 2021, the employer provided a submission in support of the WCB's decision, and the worker's representative provided a response to that submission on June 22, 2021.

On June 23, 2021, Review Office determined that the worker's claim was not acceptable. Review Office found that the evidence on file did not support the worker sustained a repetitive strain injury to his left wrist. Review Office further found they could not relate the need for the surgery to the worker's job duties, which were noted to vary greatly. Review Office noted the reference by the worker's representative to the worker having a pre-existing condition, but found there was no mention of any findings of pre-existing or degenerative conditions within the worker's left wrist. Review Office therefore concluded that they could not establish an accident had occurred arising out of or in the course of the worker's employment and his claim was not acceptable.

Both Claims

On July 19, 2021, the worker's representative appealed the Review Office decisions on both claims to the Appeal Commission and a hearing was arranged for December 1, 2021.

Following the hearing, the appeal panel requested additional medical information prior to discussing the case further. The requested information was later received and was forwarded to the interested parties for comment. On June 8, 2022, the appeal panel met further to discuss the case and render its final decision on the issues under appeal.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the The Workers Compensation Act (the "Act"), regulations made under the Act, and policies established by the WCB's Board of Directors. The provisions of the Act in effect as of the date of the worker's accident on each claim are applicable.

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.

What constitutes an 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.

Section 37 of the Act outlines the compensation which is payable to workers, as follows:

Compensation payable 

37 Where, as a result of an accident, a worker sustains a loss of earning capacity or an impairment, or requires medical aid, the following compensation is payable:

(a) medical aid, as provided in section 27;

(b) an impairment award, as provided in section 38; and

(c) wage loss benefits for any loss of earning capacity, calculated in accordance with section 39.

The WCB's Board of Directors has established WCB Policy 44.10.80.40, Further Injuries Subsequent to a Compensable Injury (the "Policy"). The Policy applies to circumstances where a worker suffers a separate injury which is not a recurrence of the original compensable injury, but where there may be a causal relationship between the further injury and the original compensable injury. The Policy provides, in part, that:

A further injury occurring subsequent to a compensable injury is compensable:

(i) when the cause of the further injury is predominantly attributable to the compensable injury; or 

… 

(iii) when the further injury arises out of the delivery of treatment for the original compensable injury.

Worker's Position

The worker was represented by a worker advisor, who provided a written submission in advance of the hearing and made an oral presentation to the panel. The worker responded to questions from his representative at the hearing, and the worker and his representative responded to questions from members of the panel.

The worker's position was that his radial-sided left wrist issues are either related to continuing to perform his regular work duties after his compensable injury which left him with permanent wrist instability, or a new accident resulting from performing his work duties with a pre-existing compensable wrist instability.

The worker's representative submitted that the radial-sided left wrist issues are as a result of the worker suffering permanent instability in his left wrist due to the June 10, 2006 accident. That instability, in combination with continuing to work his regular duties which are very physically demanding and require forceful wrist motions, caused not only the recurrence of the ulnar-sided symptoms, but also the radial-sided symptoms.

The worker's representative submitted that the worker was advised by his first treating plastic surgeon that his permanent wrist instability would lead to further damage to the wrist, and that continuing to perform his work duties would accelerate further injuries.

The worker's representative noted that the evidence shows that the worker continued to suffer wrist pain and symptoms, and that this was worse after any work shift where he was required to perform forceful wrist movement.

In response to questions from his representative, the worker said that his wrist has never been the same since his original injury. He said he dealt with the symptoms throughout the years, but noticed it was getting progressively worse to the point where he felt he could not manage it, at which point he decided to have it looked at again. He said it would be very difficult to pinpoint exactly where the pain would come from when he was active at work as his entire wrist would be sore. The worker indicated that his job duties had increased over the past six years in the sense that he is more involved, being at a more senior level, and doing other tasks as well, including training.

It was submitted that the job duties had the potential to cause injury and synovitis, especially with pre-existing damage and instability resulting from his June 10, 2006 workplace accident. The worker's representative noted that the file evidence showed the worker had synovitis and edema throughout the wrist joint, but the WCB indicated it would only take responsibility for some of the synovitis. The representative submitted that the wrist joint is compact and it would be difficult to determine the exact cause of these symptoms when the entire wrist joint has excess fluid and synovitis. The representative submitted that it would seem unreasonable to state that the WCB is only responsible for synovitis on one side of the wrist, when the synovitis is throughout the joint.

The worker's representative submitted that the worker performing duties on an unstable wrist caused the synovitis and edema on the radial side of the worker's wrist. The representative submitted that the connection to the work duties is clear, and the only question is whether the best fit is as a result of secondary injury to the 2006 accident, or a new claim resulting from the worker's forceful duties on a pre-existing unstable wrist. It was submitted that the most appropriate scenario is that the current wrist difficulties are related to the effects of the 2006 accident and subsequent surgeries. Alternatively, this could be considered a new or subsequent injury resulting from this instability.

Employer's Position

The employer was represented by its Workers Compensation Coordinator, who participated in the hearing by videoconference. The employer's representative made a submission at the hearing, and responded to questions from members of the panel.

The employer's representative advised that they were in agreement with the WCB that the worker's ongoing left wrist issues are not related to his workplace injury or the previous approved surgeries on the worker's left wrist. The representative further submitted that the worker's ongoing left wrist issues requiring surgery in September 2019 had no relationship to his compensable injury, and asked that the panel dismiss the appeal with respect to that issue on the 2006 claim.

The employer's representative noted that the worker underwent treatment for his left wrist and returned to full duties in January 2008. There was no report of any difficulty with his radial wrist area between this return to work and his PPI examination in 2009, and following this, there did not appear to be any report of radial-sided issues at the left wrist until he contacted the WCB in 2018. The representative noted that the worker had resumed his regular duties during this period of time. The representative submitted that if the work was responsible for this increase in symptoms in relation to the 2006 accident, they would have expected the symptoms would have appeared well before 2018.

The employer's representative submitted that the available medical evidence does not support that there is a pathoanatomic relationship between the 2006 workplace injury and the worker's current radial wrist findings that resulted in the need for the most recent styloidectomy surgery. The representative noted that the area responsible for the September 13, 2019 injury is a distinct anatomical location which has never been accepted as compensable. The employer's representative asked that the panel place significant weight on the opinions provided by the WCB plastic surgery consultant.

With respect to the September 13, 2019 claim, the employer's representative submitted that there is no objective information to suggest that the worker's left radial wrist issues are in any way related to his work duties. The representative submitted that the position that the development of these issues and need for surgery are related to the cumulative effect of such activities is speculative, and without any medical foundation.

The representative noted that while the worker had indicated that his treating plastic surgeon told him his radial wrist issues could have been caused from repetitive work, the surgeon had also stated that she could not determine a specific cause and effect. The representative submitted that there is nothing provided in the file on this claim that can support the worker's radial left wrist symptoms are the result of a cumulative effect of his normal duties.

In conclusion, the representative submitted that the evidence does not support that the worker's claim is acceptable, and asked that it be dismissed.

Analysis

Date of Accident - June 10, 2006:

Issue 1: Whether or not responsibility should be accepted for the September 13, 2019 left wrist surgery as being related to the June 10, 2006 accident.

For the worker's appeal on this issue to be successful, the panel must find, on a balance of probabilities, that the September 13, 2019 left wrist surgery was causally related to the June 10, 2006 workplace accident or related surgeries or treatments. The panel is unable to make that finding.

The panel confirmed at the hearing that the issue dealt only with the September 13, 2019 surgery, where the procedure performed involved a left first dorsal extensor compartment release and left radial styloidectomy. Based on our review of all of the information which is before us, the panel is unable to find that the medical evidence supports that this surgery was related to the June 10, 2006 compensable injury or related surgeries or treatments.

The panel acknowledges that in her December 6, 2019 letter to the worker's union representative, on file, the treating plastic surgeon wrote that "With regards to the radial-sided synovitis …arising from the radial aspect of the wrist, it certainly could arise from trauma to the wrist…Certainly previous surgeries or procedures could result in joint space narrowing at the radioscaphoid interval" and added "Unfortunately, I cannot give cause and effect…" The panel is unable to attach weight to that opinion, given its speculative nature.

The panel places weight on the April 4, 2019 opinion of the WCB plastic surgery consultant, who opined, in part, in response to an inquiry as to whether the current diagnosis was related to the original compensable injury that:

Based on review of the recent/updated medical information on file, the current proposed diagnosis is narrowing at the radioscaphoid joint (i.e. early degenerative changes at the radial wrist), and a radial styloidectomy has been proposed.

With regard to the new diagnosis of narrowing at the radioscaphoid articulation, a patho-anatomic basis to account for same in relation to the accepted diagnosis at the lunotriquetral ligament is not apparent. This matter is substantiated in light of the medical reports close to the time of injury which noted medial (i.e. ulnar) wrist tenderness, a September 7, 2007 treating plastic surgeon's report which noted ulnar sided wrist symptoms, and a September 13, 2007 wrist arthroscopy report, which noted normal articular surface of the distal radius, scaphoid and lunate, and intact, normal scapholunate and radiocarpal ligaments and no radioscaphoid arthritis.

The panel also places significant weight on the March 4, 2020 opinion of the WCB plastic surgery consultant, who noted the medical information on file has been reviewed and opined, in part:

It was noted in a September 7, 2007 treating plastic surgeon's report that since the workplace injury, [the worker] reported pain at the ulnar aspect of the left wrist, and the examination of that day was tender to palpation at the TFCC with no other abnormalities. For clarity, the ulnar aspect of the wrist is on the pinky side, as opposed to the radial aspect which is on the thumb side, representing distinct anatomical locations in the wrist…

In the event of an acute radial wrist injury, it would be anticipated that there would be symptoms and findings reported at the radial wrist/area of injury at the time on (sic) injury and in close temporal proximity to the injury. This was not the case following the June 10, 2006 injury; rather, ulnar sided wrist pain was reported and a September 13, 2007 left wrist arthroscopy (the gold standard for diagnosis of wrist joint/ligament injuries) did not note radial sided pathology, including no scapholunate ligament tears, ganglion, or radial arthritis….

In light of the localized ulnar sided injury, and the normal findings noted at the radial wrist in the 2007 arthroscopy report, the medical evidence on file does not support a patho-anatomic basis on which to account for radial sided findings over 10 years later in relation to the 2006 workplace injury.

The plastic surgery consultant went on to state, with respect to the treating plastic surgeon's opinion:

In a December 2019 correspondence report, the treating plastic surgeon stated that she could not provide a cause and effect. The treating plastic surgeon stated that the type of findings noted at the radial wrist, i.e. a radial ganglion and radioscaphoid arthritis, could arise from trauma, such as repetitive trauma or from falling on an outstretched hand. The above notwithstanding, the medical evidence on file in this particular case does not support such a relationship to the specific June 2006 workplace injury…With regard to joint narrowing/arthritis, this is typically a chronic, degenerative condition. In the case of post-traumatic arthritis, this may develop in a joint over time following a significant injury such as a fracture, dislocation, or torn ligament. In this WCB claim, the medical evidence indicates no such injury to the radial wrist/scapholunate ligament in relation to the June 2006 workplace injury. In addition, the wrist arthroscopy would not be expected to result in subsequent joint space narrowing...

In summary, the medical evidence available on file does not support a probable patho-anatomic relationship between the 2006 workplace injury and the current radial wrist findings…

While the worker's representative argued that there was synovitis throughout the left wrist joint and this could be related to the compensable injury or previous compensable surgeries, the panel notes that there is a lack of medical evidence to support this suggestion in the circumstances of this case.

Following the hearing, the panel requested an opinion from the worker's treating plastic surgeon as to whether it was probable that the compensable injury and compensable 2007 and 2018 surgical procedures resulted in the medical condition and/or resulting surgery in 2019 to the radial side of the worker's left wrist or whether the radial sided medical condition and resulting surgery was a new diagnosis. In her response dated May 10, 2022, the plastic surgeon opined, in part, that:

Given the extent of his injury in 2005 when he broke through the fence, it is certainly possible that all of the procedures performed are related to the initial injury. The force of the fall would have gone through both the radial and ulnar aspects of the wrist. The focus was mainly on the ulnar aspect of the wrist as this may have been the worse of the two, however, certainly since 2018 he has also been complaining of radial-sided wrist pain. Any type of injury can cause a ganglion cyst, increased fluid within the carpus, and traumatic arthritis as was evident on his MRI.

The panel finds that the plastic surgeon's comments are again speculative, and are not consistent with the early evidence on file which did not identify a radial-sided injury as a result of the workplace accident. The panel is therefore unable to place weight on that opinion.

Based on the foregoing, the panel finds, on a balance of probabilities, that the September 13, 2019 left wrist surgery was not causally related to the June 10, 2006 workplace accident. The panel therefore finds that responsibility should not be accepted for the September 13, 2019 left wrist surgery as being related to the June 10, 2006 accident.

The worker's appeal on this issue is dismissed.

Issue 2: Whether or not the worker is entitled to benefits effective September 13, 2019.

For the worker's appeal on this issue to be successful, the panel must find, on a balance of probabilities, that the worker sustained a loss of earning capacity and/or required medical aid as of September 13, 2019 as a result of the June 10, 2006 workplace accident. The panel is unable to make that finding.

The worker's representative confirmed at the hearing that this issue is very narrow, and concerns what benefits the worker would be entitled to as arising out of the September 13, 2019 surgery if responsibility was accepted for that surgery as being related to the June 10, 2006 accident.

Given our finding on Issue #1 above, that responsibility should not be accepted for the September 13, 2019 left wrist surgery, the panel finds that the worker did not sustain a loss of earning capacity or require medical aid as of September 13, 2019 as a result of the June 10, 2006 accident. The worker is therefore not entitled to benefits effective September 13, 2019.

The worker's appeal on this issue is dismissed.

Date of Accident - September 13, 2019

Issue: Whether or not the claim is acceptable.

For the worker's appeal on this issue to be successful, the panel must find, on a balance of probabilities, that the worker suffered a personal injury by accident arising out of and in the course of his employment. The panel is unable to make that finding.

The worker's representative has argued, as an alternative, that the worker's radial-sided difficulties are acceptable as a new accident resulting from the worker performing his work duties with a pre-existing compensable wrist instability. The panel is unable to accept that argument.

The evidence indicates that following the June 10, 2006 workplace accident and September 2007 surgery, the worker resumed his full regular duties on January 3, 2008. The worker was examined for a PPI in early 2009, at which time it was determined that he had a permanent impairment or instability. The worker continued working his regular duties after that, with limited or no contact with the WCB or need for medical attention for his wrist, through to 2018.

The worker described his duties at the hearing in response to questions from his representative and from members of the panel. The panel accepts that the worker's duties are physically demanding and challenging. The evidence also indicates that his duties vary greatly. The panel acknowledges the worker's evidence that there were some changes in his duties over this period of time. The panel is satisfied, however, that the evidence indicates that overall, the duties he was performing over this period of time were much the same. The worker also referred in his evidence to being sore after doing more forceful duties over an extended period of time or after a particularly busy shift. The panel is unable to find, based on the evidence, that the worker's duties involve the type of repetitive activity or work that would result in a repetitive injury.

In the circumstances, the panel is unable to account for the eight or nine year gap between the time after the worker resumed his full duties and the development or recognition of his radial-sided symptoms. The panel would have expected that if the worker's current radial-sided wrist difficulties were caused by the worker performing his work duties with a pre-existing compensable wrist instability, they would have emerged or manifested themselves much earlier than they did.

Based on the foregoing, the panel finds, on a balance of probabilities, that the worker did not suffer a personal injury by accident arising out of and in the course of his employment. The worker's claim is therefore not acceptable.

The worker's appeal on this issue is dismissed.

Panel Members

M. L. Harrison, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

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

Signed at Winnipeg this 29th day of July, 2022