The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

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

1. Date of Accident: November 6, 2017 – they are not entitled to further benefits in relation to the November 6, 2017 accident; and 

2. Date of Accident: October 31, 2018 – they are not entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident.

A videoconference hearing was held on November 16, 2021 to consider the worker's appeals.

Issue

1. Date of Accident: November 6, 2017 – Whether or not the worker is entitled to further benefits in relation to the November 6, 2017 accident; and 

2. Date of Accident: October 31, 2018 – Whether or not the worker is entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident.

Decision

1. Date of Accident: November 6, 2017 – The worker is entitled to further benefits in relation to the November 6, 2017 accident; and 

2. Date of Accident: October 31, 2018 – The worker is entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident.

Background

Date of Accident: November 6, 2017

The employer provided an Employer’s Report to the WCB on December 13, 2017, reporting the worker injured their left shoulder in an incident at work on November 6, 2017. The employer described the incident as occurring “While the employee was removing a portable sign off the truck, he felt pain around his left shoulder.”

The WCB received a Physiotherapy Initial Assessment report on December 11, 2017 for the worker’s assessment on December 5, 2017. The worker reported to the physiotherapist that they were “Holding a sign, wind caught it and pulled the shoulder back (into horizontal abduction)”, injuring their left shoulder. The worker reported they felt pain immediately afterward through the front of their chest, which continued to tighten up over time. The physiotherapist recorded that the worker had a positive Speeds test, with pain noted on palpation of the upper trapezius, pectoral and biceps areas, and diagnosed left biceps strain/tendonitis, rotator cuff, pectoral and upper trapezius strain. The physiotherapist noted the worker was on a seasonal layoff and that no problems were anticipated on the return to work.

The worker submitted their Worker Incident Report to the WCB on December 20, 2017, confirming the employer’s reporting of the incident and noting the delay in reporting their injury occurred as they initially treated their injury with massage therapy until recommended to obtain further treatment from a physiotherapist. When the WCB spoke with the worker on January 16, 2018, the worker confirmed they were a seasonal employee and had been laid off on November 18, 2017, with a possible re-hire date at the beginning of April 2018. The worker further advised that on attending a regularly scheduled appointment with their massage therapist approximately two weeks after the workplace accident, the therapist advised the worker to seek further treatment for their shoulder, and the worker then made an appointment for physiotherapy, which took place on December 5, 2017. The worker advised the WCB their shoulder was better and “loosening up”.

On January 16, 2018, the WCB advised the worker the claim was accepted for an incident occurring on November 6, 2017; however, due to the delay in seeking medical treatment, the worker was not entitled to wage loss or medical aid benefits.

Date of Accident: October 31, 2018

On November 8, 2018, the employer filed an Employer's Incident Report with the WCB indicating the worker injured their left shoulder in an incident at work on October 31, 2018 described as "While the employee was loading a stencil onto the truck, the wind caught the stencil and he sprained his left shoulder as a result."

In a Doctor's First Report arising out of an appointment on November 1, 2018, the treating family physician noted the worker’s report of injury to their left arm/shoulder at work the previous day when the wind caught a sheet they were holding and stretched their left arm. The worker reported pain in their left arm and shoulder with movement. The physician noted tenderness over the worker's left arm, reduced range of motion and pain, and diagnosed left shoulder and arm strain. At a follow-up appointment on November 8, 2018, the physician referred the worker to physiotherapy and recommended an MRI of the worker’s left shoulder.

The worker attended for initial physiotherapy assessment on November 12, 2018, reporting pain with lifting their left arm over shoulder height and overhead. The physiotherapist noted testing indicating pain in the worker's left anterior shoulder/pectoralis and diagnosed grade 1 pectoralis strain.

When the WCB discussed the claim with the worker on November 16, 2018, the worker confirmed the mechanism of injury, advised they had not missed any time from work, and that they felt their shoulder had improved since the injury occurred. The worker also confirmed their treating family physician recommended an MRI to determine the extent of damage in their shoulder.

On November 16, 2018, the employer advised the WCB the worker would be subject to a seasonal layoff after their shift that day.

The findings from the MRI study of the worker's left shoulder conducted on January 10, 2019 indicated "Full-thickness tear of the supraspinatus tendon and anterior fibers of the infraspinatus tendon. There is mild atrophy of these muscles", and "[t]endinosis of the subscapularis and long head of biceps tendons".

A WCB medical advisor reviewed the worker's file, including the January 10, 2019 MRI findings on January 23, 2019 and provided an opinion that the indication of tendinosis "…implies that injury had occurred to the tendon in the past" and further that "Fatty infiltration on the advanced imaging is seen in ruptures or tears of the rotator cuff that are remote. Fatty infiltration would typically occur over a period of 6 months to 1 year". Noting that the MRI was conducted 2 months following the workplace accident, the medical advisor was of the view that the rotator cuff tear indicated on the MRI "…likely occurred remote from the workplace accident" and concluded that the workplace injury was a shoulder strain in the environment of a pre-existing rotator cuff tear. At a follow-up appointment on January 23, 2019, the treating family physician referred the worker to an orthopedic surgeon.

On January 25, 2019, the WCB advised the worker it accepted responsibility for the left shoulder strain within the environment of a pre-existing condition but would not accept responsibility for the full-thickness tear indicated on the recent MRI study.

On assessment by the orthopedic surgeon on January 29, 2019, the surgeon noted positive testing and tenderness over the bicipital groove anteriorly, with the diagnostic imaging indicating a large tear of the supraspinatus and infraspinatus. The orthopedic surgeon opined the worker had an acute traumatic rotator cuff tear and based on their evaluation of the retraction and fatty infiltration, recommended surgical repair of the tear.

On February 28, 2019, the worker requested Review Office reconsider the WCB's decision that the worker was not entitled to benefits in relation to the rotator cuff tear, noting their treating orthopedic surgeon related the tear to the workplace accident.

On March 5, 2019, a WCB orthopedic consultant reviewed the worker's file and concluded the January 10, 2019 MRI findings were "…not concordant with an injury some two months prior…."

On March 12, 2019, the WCB advised the worker it did not accept responsibility for the proposed surgery.

On April 11, 2019, Review Office determined the worker was not entitled to benefits in relation to the left shoulder rotator cuff tear. Review Office relied upon the opinions of the WCB medical advisor and the WCB orthopedic consultant that the rotator cuff injury indicated in the diagnostic imaging pre-dated the workplace injury of October 31, 2018 and as such, the worker was not entitled to benefits relating to the rotator cuff tear.

Both Claims:

On June 17, 2020, the worker’s representative requested Review Office reconsider the WCB’s decisions, noting the worker self-modified their work in order to continue working until they were to be laid off on November 18, 2017. The representative submitted a statement from a co-worker confirming the worker self-modified their duties. In addition, the representative also provided an opinion from the worker’s treating orthopedic surgeon indicating the worker’s ongoing difficulties from the October 31, 2018 workplace accident may relate to the initial injury in November 2017 which was never fully investigated as the WCB had determined the worker was not entitled to benefits in relation to that incident. The worker’s representative argued that the worker should be entitled to further benefits related to the November 6, 2017 workplace accident and should also be entitled to benefits in relation to the October 31, 2018 workplace accident. The employer provided a submission in support of the WCB's decisions on July 30, 2020, a copy of which was provided to the worker's representative on August 4, 2020, with a further response received by the representative on August 19, 2020.

Date of Accident: November 6, 2017

Review Office found on August 21, 2020 that the worker was entitled to a limited course of physiotherapy benefits in relation to their strain/sprain injury sustained on November 6, 2017. Review Office noted the worker's reporting to the WCB of improvement in their shoulder from physiotherapy in January 2018 and further, their reporting of no prior left shoulder problems and that their shoulder was fine prior to the October 31, 2018 workplace accident.

Date of Accident: October 31, 2018

On August 21, 2020, Review Office found the worker was not entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident. Review Office accepted the opinions on file from the WCB medical advisor and orthopedic consultant that the worker's rotator cuff tear predated the date of the workplace accident and occurred approximately four months' prior. Review Office noted the evidence that the worker reported their shoulder was fine when they returned to work in the spring of 2018 after a seasonal lay off and that they did not sustain any other workplace accident prior to the October 31, 2018 workplace accident. As such, Review Office determined the worker was not entitled to medical aid, and in particular, the proposed surgical repair of the left rotator cuff tear, as that injury could not be causally related to the workplace accident.

Both Claims

The worker's representative filed an appeal with the Appeal Commission on February 1, 2021 and a videoconference hearing was arranged for November 16, 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 November 9, 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 provisions of The Workers Compensation Act ("the Act"), regulations under the Act and the policies established by the WCB's Board of Directors. The provisions of the Act in effect as of the date of the worker’s accidents are applicable.

A worker is entitled to benefits under s 4(1) of the Act when it is established that a worker has been injured as a result of an accident at work. Under s 4(2), a worker injured in an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident, but no wage loss benefits are payable where the injury does not result in a loss of earning capacity during any period after the day on which the accident happens.

When the WCB determines that a worker has sustained a loss of earning capacity, an impairment or requires medical aid because of an accident, compensation is payable under s 37 of the Act. Section 39(2) of the Act sets out that wage loss benefits are payable until the worker's loss of earning capacity ends or the worker attains the age of 65 years. Section 27 allows the WCB to provide a worker with such medical aid as the board considers necessary to cure or provide relief from an injury resulting from an accident.

Worker’s Position

The worker appeared in the hearing represented by a worker advisor, who made submissions on behalf of the worker in the hearing and provided further written submissions following the hearing, upon review of the additional information obtained by the hearing panel. The worker provided testimony in the hearing through answers to questions posed by their representative and by members of the appeal panel.

The worker’s position as outlined by the worker advisor is that the worker is entitled to further benefits in relation to the November 6, 2017 accident as the evidence supports a finding that the worker was not fully recovered from that injury at the time of the WCB’s termination of benefits but required further medical treatment. With respect to the accident of October 31, 2018, the worker’s position is that they are entitled to benefits for a left shoulder rotator cuff tear as the evidence supports that this tearing was more likely than not caused by the 2017 accident and enhanced as a result of the 2018 accident, or was entirely caused by the 2018 accident. In either case, as a result, the surgical repair ultimately became necessary.

The worker’s representative noted that the physiotherapist’s report as of January 24, 2018 does not indicate recovery and that treatment was discontinued only because the WCB terminated coverage for physiotherapy. The worker’s evidence is that they continued with home exercises, including use of a home ultrasound machine, stretches and using heat and cold to maintain and increase function in their shoulder after they discontinued physiotherapy. The worker further testified that on returning to work in April 2018, they moved to new job duties that required less upper body strength and involved more walking. As a result, the worker was able to successfully manage their return to work, although their shoulder was not fully recovered to its pre-accident condition. The worker confirmed in their testimony that they did not sustain any other injuries between November 6, 2017 and October 31, 2018.

The worker’s representative noted that both the WCB orthopedic advisor and the worker’s treating physiotherapist stated their opinion that the mechanism of injury on November 6, 2017 was consistent with a tearing in the rotator cuff. The worker confirmed an acute onset of pain with that injury and the evidence of a coworker, on file, confirms that the worker continued to work afterward making modifications to how they did their work and noting weakness in the shoulder.

The worker’s representative submitted that the 2018 injury caused greater disability than the 2017 injury, comparing the physiotherapy clinical reports following each injury. The worker’s representative submitted that the MRI findings from January 2019 are consistent with a finding that the tearing was caused by both accidents, noting that in areas of secondary tearing, there is no evidence of fatty infiltration suggesting that this occurred more recent to the imaging, whereas the areas of fatty infiltration support a more remote injury. The worker’s representative further submitted that the worker’s November 6, 2017 injury left the worker susceptible to further injury with lesser forces applied and that the October 31, 2018 injury enhanced the 2017 injury.

The worker’s representative noted the WCB medical advisor on January 23, 2019 stated that the mechanism of injury on October 31, 2018 accident was consistent with findings of rotator cuff tearing, although concluding that the presence of the fatty infiltration indicated a more remote date of injury. The treating orthopedic surgeon also outlined in their August 27, 2019 report that the mechanism of injury on October 31, 2018 “is consistent with the pathology identified” in the MRI study and clinical examination. The orthopedic surgeon further noted that the fact the fatty infiltration is grade 1 indicated “that this is in fact an acute traumatic injury” and that the injury occurred within 6 months of the MRI study.

The worker provided testimony describing their job duties at the time of the November 6, 2017 injury, noting that their work required upper body strength and was quite physical. Following the accident, the worker indicated they felt tender and sore in the left shoulder region, noting that they participated in physiotherapy until the WCB discontinued coverage for the treatment. The worker testified that on returning to work in April 2018, they chose to move to a less physically strenuous job that entailed more walking and required less upper body strength, so as to allow more time for their shoulder to heal. At the time of the accident on October 31, 2018, the worker did not have any continuing symptoms in their left shoulder. The worker noted that the injury sustained in the accident of October 31, 2018 was very similar to their 2017 injury, although the weight of the object caught by the wind resulting in the injury was greater in 2017.

The worker also noted an increase in symptoms and a new symptom of “clicking” that developed following the January 2019 MRI study.

In sum, the worker’s position is that the evidence supports a finding that the worker’s left shoulder rotator cuff injuries are related to the workplace accidents of either November 6, 2017 or October 31, 2018 or a combination of these accidents and as such, the WCB is responsible for benefits in relation to the rotator cuff tears and the worker’s appeal should be granted.

Employer’s Position

The employer was represented in the hearing by its workers compensation coordinator, who made submissions on behalf of the employer in the hearing and provided a further written submission following the hearing, upon review of the additional information obtained by the appeal panel.

The employer’s position is that the worker is not entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident and that the worker is not entitled to further benefits in relation to the November 6, 2017 accident.

The employer’s representative noted the worker did not seek medical treatment until more than one month following the 2017 accident and did not miss any work as a result of that injury or report any significant issues arising from the injury. The representative further noted that the worker was capable of a return to work without restrictions and without complaint, working from April through October 2018. Furthermore, the medical reporting from December 2017 and January 2018 indicates improvement in the worker’s symptoms over that period.

The employer does not agree that the 2018 accident caused the rotator cuff tearing evident on the January 2019 MRI study, nor that the tearing was caused by the 2017 accident and enhanced by the 2018 injury, noting there is no evidence the tearing was caused in 2017.

With respect to the accident of November 7, 2017, the employer’s representative noted that the worker was able to continue with their regular duties until layoff on November 18, 2017. While it may be the case that a coworker assisted the worker with those duties, that does not establish that the 2017 accident caused a rotator cuff tear. The employer’s representative also noted there is no evidence the worker sought any medical attention for their left shoulder between the end of January 2018 and the injury on October 31, 2018.

With respect to the accident of October 31, 2018, the employer’s representative noted the WCB medical advisor’s January 23, 2019 opinion makes no mention of this accident enhancing or aggravating a pre-existing injury, although the medical advisor did comment that the compensable diagnosis arising out of this accident was a sprain/strain type of injury in the environment of a pre-existing rotator cuff tear.

The employer’s representative noted as well that the MRI findings indicated some degenerative findings in addition to the rotator cuff tearing.

The employer submits that if the 2017 accident had caused rotator cuff tearing, it would be expected that the worker would have had some continuing symptoms and difficulties with their return to work in 2018 but there is no evidence of that. Further, the employer’s submission of October 13, 2022 notes that the November 2018 medical reporting received from the treating family physician documents that the worker sustained an injury on October 31, 2018 that was no more serious than a shoulder strain.

As such, the worker should not be entitled to further benefits in relation to the compensable accident of November 6, 2017 and should not be entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident. The worker’s appeal on both questions should be dismissed and the decisions of the Review Office upheld.

Analysis

The questions on appeal are whether the worker is entitled to further benefits in relation to the compensable accident of November 6, 2017, and whether the worker is entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident. For the worker’s appeal to be granted the panel would have to determine, in respect of the accident of November 6, 2017, that as a result of the injury the worker sustained in the compensable accident, the worker requires further medical aid to cure and provide relief from that injury and/or that the worker experienced a further loss of earning capacity as a result of that injury. In respect of the accident of October 31, 2018, for the worker’s appeal to succeed, the panel would have to determine that the left shoulder rotator cuff tear occurred arising out of that compensable workplace accident and therefore the worker is entitled to benefits relating to that tear. As noted above and set out in the reasons that follow, the panel was able to make such findings and therefore the worker’s appeal is granted on both questions.

The panel reviewed and considered the evidence relating to each accident. There is evidence that the accident of November 6, 2017 occurred late in the worker’s annual season of employment; in fact, it occurred just 10 days prior to the annual layoff. The worker injured their left shoulder when wind caught hold of a sign the worker was holding, causing the worker’s left arm to pull back putting the worker’s shoulder into horizontal abduction. The worker did not seek medical care until one month later, explaining that they were able to perform their duties with self-modifications and support of co-workers until the layoff took place. The worker was treated with physiotherapy from December 5, 2017 to January 24, 2018 when the WCB determined the worker did not require more treatment, and the worker therefore did not continue with that therapy.

The panel noted the worker did not seek treatment relating to that injury other than from the physiotherapist. On initial assessment by the treating physiotherapist, the worker reported that at the time of injury they felt pain immediately through the front of their chest that continued to tighten up over time, noting the shoulder would get very stiff after activity such as shoveling and that there was pain at rest even if the worker had not been active. On testing, the physiotherapist recorded findings indicating reduction in the worker’s left shoulder flexion, abduction, external rotation and internal rotation as compared to their right shoulder, as well as a positive Speed’s test and pain on palpation of the pectoral, bicep and upper trapezius muscles. The diagnosis noted at that time was of left “biceps strain/tendonitis, rotator cuff, pecs and UFT strain.” The physiotherapy chart notes indicate the worker continued to attend treatments following the initial assessment until late January 2018 and that the worker reported some improvement in shoulder stiffness and overall symptoms over that period, but do not indicate a complete recovery or no need for further treatment.

The worker testified that they discontinued the physiotherapy only because the WCB did not authorize further treatment and that they were able to rest their shoulder as they did not return to work until April 2018 when their seasonal employment resumed. The worker also described doing a home-based stretching program as provided by the physiotherapist, using an ultrasound machine and applying heat/cold for pain relief during this period. The panel noted that the worker also testified to choosing to take on different job duties in the 2018 season that was less demanding upon their upper body, using wheeled equipment that they could maneuver on the ground. The worker confirmed they did not experience any further injuries until October 31, 2018.

The panel noted the similarity of the mechanism of injury on October 31, 2018 to that of November 6, 2017, in that injury again occurred when wind caught an item the worker was holding while moving it from the ground to truck. The worker described this injury as worse than the previous injury, noting that afterward, they iced their shoulder and saw their physician the next day. The treating physician offered a diagnosis of left shoulder and arm strain based on findings of tenderness over the worker’s left arm and reduced range of motion with pain and prescribed for pain relief medication. At follow up one week later, the physician noted ongoing reduction in range of motion and pain with extension, rotation and abduction, recommended physiotherapy and ordered an MRI. Physiotherapy findings from the assessment on December 11, 2018 indicate reduced left shoulder range of motion, even from the initial findings post-injury in 2017, with reduced strength, pain and positive empty can testing. The physiotherapist initially diagnosed pectoralis strain and on further assessment, added strain of the upper fibres of the trapezius.

The panel also considered the January 10, 2019 MRI study findings that indicated:

“There is a full thickness, full width tear involving supraspinatus tendon with failure near the footprint. The tear also extends into the anterior fibers of the infraspinatus tendon and measures 3.0 cm anteroposterior with 2.3 cm tendon retraction.

There is tendinosis of the cephalad subscapularis tendon. Teres minor tendon is intact. There is mild atrophy with fatty infiltration of the supraspinatus and infraspinatus bellies. The acromioclavicular joint is normal. There is tendinosis of the long head of the biceps tendon….”

The panel noted that there are differing opinions as to the interpretation of these diagnostic findings. The treating orthopedic surgeon set out in their opinion of August 27, 2019 that the grade 1 fatty deposits indicated in the MRI support that the injury is acute and not chronic, going on to note that “…the size of the tear and [the worker’s] young age with no previous shoulder symptoms suggest that this MRI has been performed within six months of the time of injury.” The surgeon also noted that the mechanism of injury described in relation to the 2018 accident is consistent with the identified pathology. The WCB orthopedic consultant, however, stated in their March 5, 2019 opinion that the presence of “fatty infiltration” is “not concordant with an injury some two months prior, but possibly explainable as seen in relation to the November 6, 2017 injury, which was never fully investigated, but which from the provided therapy notes appears to incriminate the rotator cuff pathologically.” The panel also noted the January 23, 2019 opinion of the WCB medical advisor that fatty infiltration is typically seen in remote, not recent injuries, over a period of 6 months to 1 year.

When asked whether the October 31, 2018 accident could have caused the rotator cuff tear, the WCB medical advisor stated on January 23, 2019 that “Although the forces applied to the shoulder given the described mechanism of injury would satisfy the typical forces to result in injury to the shoulder, the presence of fatty infiltration would suggest that the January 10, 2019 rotator cuff tear likely occurred remote from the workplace accident.” They went on to conclude that “The likely diagnosis supported by the opinion of the treating physiotherapist is a shoulder strain in the environment of a preexisting rotator cuff tear.”

The panel considered the worker’s position that either accident or a combination of both accidents, could have caused a rotator cuff tear injury rather than just the WCB accepted diagnoses of left shoulder sprain/strain injury. We find that the evidence does not indicate that the worker was fully recovered from the initial injury when the WCB discontinued the worker’s benefit entitlement in January 2018. Although the worker returned to work and did not seek further medical treatment or therapy for their left shoulder between January 2018 and the October 2018 injury, this does not necessarily indicate complete recovery. The panel noted that while improvements were documented to the end of January 2018, the worker’s evidence is they continued with their home program following discontinuance of the therapy and managed their return to work in April 2018 by taking on a less physically demanding job. Further, the panel also noted that the evidence that this worker demonstrated an ability to function even with a rotator cuff tear, as evident from the reports in late 2018 of shoveling snow, assisting with drywalling and other activities following their October 31, 2018 injury and leading up to the MRI study of January 2019.

The panel also considered the opinion of the treating physiotherapist who provided care to the worker following each injury. The physiotherapist stated on December 30, 2019 that “…the mechanism of injury of both incidents would be consistent with that which would cause a rotator cuff tear, and that [the worker’s] objective finding[s] on both occasions could be attributed to this injury.” The panel noted as well the WCB medical advisor’s January 23, 2019 opinion that the worker’s rotator cuff tear was a pre-existing injury given the presence of fatty infiltrations, noting that the “…forces applied to the [worker’s] shoulder given the described mechanism of injury would satisfy the typical forces to result in injury to the shoulder.” The medical advisor also remarked that “The rotator cuff naturally degenerate[s] in individuals over the age of 40 which requires less force to result in injury.” Although this opinion was given in the context of the 2018 accident, the panel noted that the similar mechanism of injury in the 2017 accident, as was also noted by the WCB orthopedic consultant in their March 5, 2019 opinion. While noting the MRI findings “are not concordant” with a recent injury given the findings of fatty infiltration, the orthopedic consultant went on to speculate that the findings were “possibly explainable as seen in relation to the November 6, 2017 injury, which was never fully investigated, but which from the provided therapy notes appears to incriminate the rotator cuff pathologically.”

While it is impossible to go back in time and definitively determine whether and to what extent the accident of November 6, 2017 caused tearing to the worker’s left rotator cuff, the panel is satisfied on the basis of all the evidence before us, that it is more likely than not that the worker sustained a partial tear injury to their left rotator cuff on November 6, 2017. The nature and extent of that injury was such that the worker was able to continue working with self-modifications until the end of the season in 2017 and able return to a less physically demanding job several months later, until October 31, 2018 when the second workplace accident occurred.

On the basis of the totality of the evidence before the panel in relation to both claims, the panel is further satisfied that it is more likely than not that the October 31, 2018 accident caused further injury to the worker’s already vulnerable left shoulder rotator cuff, further injuring or enhancing the tearing first sustained on November 6, 2017.

The panel therefore concludes that the worker is entitled to further benefits arising from the November 6, 2017 accident and that the worker is entitled to benefits for a left shoulder rotator cuff tear in relation to the October 31, 2018 accident. The worker’s appeal is granted.

Panel Members

K. Dyck, Presiding Officer
R. Hambley, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

K. Dyck - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 2nd day of December, 2022