The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that he was not entitled to wage loss and medical aid benefits beyond October 13, 2021. A videoconference hearing was held on May 15, 2023 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to wage loss and medical aid benefits after October 13, 2021.

Decision

The worker is entitled to wage loss and medical aid benefits after October 13, 2021.

Background

The worker and the employer both filed incident reports with the WCB on March 31, 2021, reporting the worker injured his left arm, shoulder and neck at work on March 30, 2021. The worker described working with a scrubbing machine on stairs covered with water and chemicals, when he slipped and fell backwards, landing on his back and neck, while still holding onto the machine with his left hand, and his head and left shoulder hit the concrete.

The worker was seen by his family physician on March 30, 2021, reporting dizziness and headache, pain in his left wrist, thumb and shoulder after falling when scrubbing wet stairs. The physician noted tenderness in the worker's left thumb and wrist, and decreased range of motion in his left shoulder and cervical spine. X-rays were taken of the worker's left thumb/wrist, left shoulder and cervical spine, and were noted to be normal. The physician diagnosed the worker with a left hand/arm/shoulder strain and cervical spine strain, and recommended physiotherapy and that the worker remain off work until April 6, 2021.

The worker attended an initial assessment with his treating physiotherapist on April 3, 2021. He reported left thumb, wrist, shoulder, neck and hip to knee pain, as well as neck pain and headache. The physiotherapist indicated the worker had decreased active movement in those areas, and the examination was limited due to pain. It was further noted that the worker's left thumb was swollen. The physiotherapist diagnosed the worker with a fall on the left side affecting multiple areas, and recommended the worker begin gentle active motion at home.

The worker attended a follow-up appointment with the treating family physician on April 6, 2021, where he described ongoing neck pain, left shoulder and thumb pain, and headaches. Continued physiotherapy and time off work were recommended.

On April 6, 2021, the employer contacted the WCB to express concerns with the worker's claim. The employer requested that the WCB provide restrictions for the worker, noting the worker had a left arm injury and they had right-handed duties available. The employer advised that the worker had returned to work on full duties in November 2020, following a non-compensable motor vehicle accident which involved his right upper extremity, and had been performing those duties for over three months using his left hand more. The employer indicated the worker had declined right-handed only duties given that previous injury.

At an April 12, 2021 appointment with the treating physiotherapist, the worker reported ongoing left thumb, wrist, shoulder, neck and hip to knee pain, along with tingling to the left hand and headaches. The treating physiotherapist noted the worker was capable of modified duties, but a job demands document had not yet been provided. On April 14, 2021, the WCB advised the worker that his claim was accepted and benefits were approved.

On April 21, 2021, the WCB contacted the worker to discuss his claim. The worker confirmed he was involved in a non-compensable motor vehicle in October 2018 which resulted in a right shoulder injury, and he was still undergoing physiotherapy treatment for his right shoulder until February 20, 2021, in addition to receiving a top-up in his wage loss benefits from another benefit provider as he had moved to a less physical but lower paying position due to that injury. The worker confirmed the mechanism of the March 30, 2021 workplace accident, and noted he did not remember exactly what happened, but his co-worker told him what happened when he sat down after. He indicated that immediately after the accident, he felt pain at the back of his head, swelling in his left wrist and thumb, and he was in a "…state of confusion." The worker said he sat for ten minutes, then left work and once he got home, his spouse took him for medical treatment. The worker advised he felt dizzy but was not throwing up.

With respect to his current symptoms, the worker indicated the upper part and close to the spine part of his neck were painful off and on, there was continuous sharp pain in his left shoulder and occasional swelling in his left wrist, his left thumb was still a bit swollen and painful, and he occasionally had pain in his left hip and would limp when he woke up. The worker further described losing concentration, occasionally getting headaches, and having a hard time sleeping.

In a Progress Report of a virtual appointment on May 28, 2021, the treating family physician noted the worker's continued complaints of ongoing left shoulder and neck pain and headaches, and indicated the worker had been referred to his treating orthopedic surgeon and to a neurologist at a concussion clinic. It was noted that the worker was also being referred for an MRI of his left shoulder, which was performed on June 10, 2021, and was noted to be normal.

On June 22, 2021, the worker attended an appointment with the neurologist at a concussion clinic. The worker was noted to have sustained a concussion as a result of the fall on March 30, 2021, when he hit the back of his head on a concrete platform and lost consciousness for approximately 30 seconds. The worker reported developing headaches, memory loss, confusion and fatigue after his fall, which symptoms did not fully resolve. It was noted that current symptoms included headaches seven days a week, lasting one to three hours and described as "pressing", with light sensitivity and nausea. Other complaints included difficulty with sleep, monocular double vision, vertigo, difficulty with balance, anxiety, irritability, and cognitive symptoms. After assessing the worker, the treating neurologist noted that his neurological examination was normal, and opined the worker's headaches were likely post-traumatic headaches with migraine characteristics and his ongoing symptoms were "…likely due to Post-concussion syndrome."

On June 23, 2021, the worker underwent a nerve conduction study with a physical medicine and rehabilitation physician (physiatrist). The physiatrist recorded the worker's reporting he had "…significant pain into the right first to third digits" of his hand three weeks following the March 30, 2021 workplace accident. It was noted that initially following the fall, the worker "…had left fifth digit tingling which is now resolved." The physiatrist noted that electrodiagnostic testing indicated "There is evidence of a moderate degree of median neuropathy at both wrists. There is evidence for an acute to subacute right C7 radiculopathy." As the worker continued to report significant pain, an urgent MRI was requested for the cervical spine.

In a July 12, 2021 report from the worker's physiatrist to his treating orthopedic surgeon, the physiatrist noted that the MRI of the cervical spine performed July 3, 2021 showed "…multilevel degenerative changes with moderate right C7 foraminal narrowing at C6-C7. Specifically, at C6-C7 there is a posterior disc protrusion with slight prominence of the right paracentral foraminal region with moderate right C7 foraminal narrowing." Continued physiotherapy was recommended and a referral was sent for possible steroid injections.

At a follow-up examination on September 8, 2021, the treating neurologist noted that the worker reported forgetting things, difficulty with concentration and phonophobia. The neurologist noted that nerve block injections were performed and made further treatment recommendations.

At the request of the WCB, the worker attended a call-in examination with a WCB medical advisor on September 22, 2021. After examining the worker, the medical advisor opined that the worker's diagnosis as a result of the March 30, 2021 workplace accident was neck, left shoulder and left upper extremity strains, which was consistent with the described mechanism of injury and the medical reporting at the time of the accident. The WCB medical advisor further opined that the evidence did not support the worker sustained a concussion as a result of the workplace accident, noting an external head injury was not reported immediately after the accident, no immediate disruption of brain function was reported, and the worker continued to drive following the workplace accident and had retained his driver's licence. The advisor noted that if the worker had sustained a brain injury, he would have reported symptoms immediately following the March 30, 2021 accident, yet even though he received care from various healthcare providers, concern regarding the vestibular injury was first reported by the treating physiotherapist on July 28, 2021.

The medical advisor noted the natural history for strains included discomfort and resolution of difficulties within several weeks, and at six months since the workplace accident, recovery of these strains would have occurred and ongoing symptoms were not accounted for in relation to the workplace incident. The WCB medical advisor further noted that the cervical spine degenerative changes noted by the diagnostic imaging pre-dated the workplace incident and there was no evidence these changes were materially affected by the workplace incident.

On October 6, 2021, the WCB advised the worker that they had determined he had recovered from the workplace accident and was not entitled to further benefits effective October 13, 2021. The WCB further noted in their decision that the worker's current head symptoms and limitations, and right upper extremity symptoms, in particular right C7 radiculopathy, were not consequences of the March 30, 2021 workplace accident.

The WCB subsequently received an October 19, 2021 report from the worker's treating physiatrist indicating "…it is possible that the nerve root compromise may have been sustained in March 2021." The WCB also received a report of a follow-up appointment with the neuro-opthalmologist at the concussion clinic on October 15, 2021, where further treatment was recommended.

On October 27, 2021, the worker requested that Review Office reconsider the WCB's decision. The worker submitted his current difficulties were related to the workplace accident, which involved more than strain injuries, and he was therefore entitled to further benefits. On October 28 and 29, 2021, Review Office contacted the worker to discuss his request for reconsideration, and the worker advised that he had upcoming medical appointments and wished to have reports from those visits also considered. On October 29, 2021, Review Office advised the worker that his file would be returned to the WCB's Compensation Services for further consideration of medical information to be submitted.

Additional medical information was received by the WCB and placed on the worker's file, including chart notes from the worker's treating family physician from March 30, 2021 forward; and a January 27, 2022 follow-up report from the concussion clinic, indicating the worker underwent bilateral occipital nerve blocks with no complications. The WCB also received a January 13, 2022 report of the worker's attendance at a pain management clinic for cervical radicular pain, where the worker's "…chronic right arm electric shock pain" was said to have been discussed. It was noted in that report that the worker had bilateral carpal tunnel and was scheduled for carpal tunnel surgery the following month. On February 8, 2022, the WCB advised the worker that they had reviewed the additional medical evidence but there would be no change to their October 6, 2021 decision.

On February 9, 2022, the worker again requested that Review Office reconsider the WCB's decision. On March 9, 2022, Review Office determined the worker was not entitled to wage loss and medical aid benefits beyond October 13, 2021. Review Office found the worker had recovered from the accepted compensable left hand, arm, shoulder and cervical spine strain injuries, and was unable to determine more significant injuries occurred as a result of the workplace accident. Review Office accepted and agreed with the opinion of the WCB medical advisor that the worsening of the worker's symptoms was not related to the compensable strain injuries or accident. Review Office further found that the evidence did not support the worker sustained a concussion as a result of the workplace accident, noting the earliest that vestibular difficulties were reported was July 28, 2021. Review Office also found that they were unable to relate the worker's right upper extremity symptoms and right C7 radiculopathy and carpal tunnel syndrome to the March 2021 workplace accident. Review Office therefore concluded that the worker did not have a further loss of earning capacity or need for further medical treatment in relation to the workplace accident.

On November 16, 2022, the worker's legal counsel appealed the Review Office decision to the Appeal Commission, and a videoconference hearing was subsequently arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by 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 which were in effect as at the date of the worker's accident 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.

Subsection 4(2) provides that a worker who is 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.

Subsection 27(1) of the Act states that the WCB "…may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident."

Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such time as the worker's loss of earning capacity ends, or the worker attains the age of 65 years.

WCB Policy 44.10.20.10, Pre-existing Conditions (the "Policy"), addresses eligibility for compensation in circumstances where a worker has a pre-existing condition. The purpose of the Policy is stated, in part, as follows:

The Workers Compensation Board (WCB) will not provide benefits for disablement resulting solely from the effects of a worker's pre-existing condition as a pre-existing condition is not "personal injury by accident arising out of and in the course of the employment." The WCB is only responsible for personal injury as a result of accidents that are determined to be arising out of and in the course of employment.

The following definitions are set out in the Policy:

Pre-existing condition: A pre-existing condition is a medical condition that existed prior to the compensable injury.

Aggravation: The temporary clinical effect of a compensable injury on a pre-existing condition such that the pre-existing condition will eventually return to its pre-accident state unaffected by the compensable injury.

Enhancement: When a compensable injury permanently adversely affects a pre-existing condition.

Worker's Position

The worker was represented by legal counsel, who submitted written reports from the worker's treating physiatrist and treating neurologist/neuro-ophthalmologist in advance of the hearing, and made an oral submission to the panel.

The worker's position, as outlined by his counsel, was that the medical evidence establishes the worker has not recovered from injuries he suffered as a result of his March 30, 2021 workplace accident, and is entitled to benefits beyond October 13, 2021.

Counsel noted in the course of the hearing that the main focus on the appeal related to the diagnoses of a concussion/post-concussion syndrome and a C6/C7 radiculopathy, but that the diagnosis of carpal tunnel syndrome was also to be considered.

It was submitted that the medical evidence is clear that the worker suffered a concussion, and the real question with respect to this diagnosis was whether the worker's concussion was due to the work-related injury or to an earlier injury from an October 2018 motor vehicle accident.

Counsel argued that the evidence supported the concussion was due to the March 2021 workplace accident and the worker is entitled to further benefits in relation to that injury.

In support of their position, counsel referred to the January 13, 2023 report from the worker's treating neurologist/neuro-ophthalmologist which was filed in advance of the hearing, and called the neurologist/neuro-opthalmologist as a witness at the hearing.

The neuro-opthalmologist's evidence was that he first saw the worker for consultation on September 21, 2021. At that time, the worker described a history of falling down stairs and hitting his head at work, as a result of which he experienced dizziness, fatigue and headaches. The neuro-opthalmologist noted the worker had developed some neurological symptoms, including double vision, blurred vision, and eye strain and pain, and had been referred to him for that reason. He opined that the worker had suffered a concussion as a result of his workplace accident, and noted he diagnosed the worker with dry eye syndrome, post-concussion convergence insufficiency, monocular double vision, and post-concussion occipital neuralgia.

The neuro-opthalmologist described the treatments he had provided, noting that further concussion management was left to the other treating neurologist at the concussion clinic. He noted that the worker's condition had improved somewhat since starting treatment, but was still significantly symptomatic from his post-concussion syndrome (e.g. double vision, blurred vision, headaches, etc.), and that considering his accident was over two years ago, it seemed probable his condition would be permanent. The neuro-opthalmologist opined that the worker was not ready to return to work currently, but with the proper treatment plan as recommended by his different specialists, he might be able to gradually return to work in the future.

The neuro-opthalmologist confirmed that in his opinion, the worker's symptoms were due to the 2021 workplace accident. He said he was aware the worker had a previous motor vehicle accident, but believed it was more likely the worker's symptoms were caused by the March 2021 workplace accident, based on his understanding that while the worker may or may not have had a concussion from the previous accident, he did not have any visual symptoms for which he was referred to a neuro-opthalmologist prior to March 2021.

Continuing with his submission, counsel noted that the worker suffered an accident when he fell backwards down the stairs, slammed his head on concrete and immediately developed concussion symptoms. Counsel submitted that while the worker had a previous motor vehicle accident, he did not develop the same concussion-type symptoms at that time.

Counsel stated that they relied strongly on the evidence of the treating neuro-opthalmologist and his January 13, 2023 report. Counsel noted the neuro-opthalmologist's evidence was that the worker suffered a concussion due to the workplace accident, and the diagnosis of post-concussion convergence insufficiency was related to that accident. He had indicated that overall, the worker's condition has improved slightly but he is still significantly symptomatic from his post-concussion syndrome and, most importantly, is not ready to return to work at this time.

Counsel submitted that they also relied strongly on two reports from the worker's physiatrist, dated June 23, 2021 and July 12, 2021, respectively. Counsel submitted that the physiatrist noted in the June 23, 2021 report that the worker had concussive-type symptoms after falling off a step at work, and had developed numbness and tingling in the right first through third digits three weeks later. The physiatrist further noted that the worker may have had these symptoms closer in time to the accident but was dealing with concussive symptoms that may have masked the pain. The physiatrist noted the worker was having difficulties with fine motor tasks such as holding a pen to write, and had been attending physiotherapy with no significant change in symptoms.

Counsel noted that the physiatrist further indicated in the June 23, 2021 report, that electrodiagnostic studies demonstrated acute to subacute right C7 radiculopathy. Counsel noted that in the July 12, 2021 report, the physiatrist further wrote that the worker "…had several questions as to whether this injury was due to a remote motor vehicle collision. The findings are acute to subacute suggesting they have occurred over the last several months and not due to remote injury."

In conclusion, counsel submitted that the reports from the treating physicians all support that the worker's ongoing symptoms are due to his work-related accident. Counsel asked that the panel therefore find that the worker suffered a work-related accident, and a loss of certain wages and benefits as a result of that accident, for which he is entitled to be compensated.

Employer's Position

The employer did not participate in the appeal.

Analysis

The issue before the panel is whether or not the worker is entitled to wage loss and medical aid benefits after October 13, 2021. For the worker's appeal to be successful, the panel must find, on a balance of probabilities, that the worker suffered a loss of earning capacity and/or required medical aid or treatment beyond October 13, 2021 as a result of his March 30, 2021 workplace incident.

Based on our review and consideration of all of the evidence and submissions on file and as presented at the hearing, the panel is satisfied, on a balance of probabilities, that the worker suffered a head injury, diagnosed as a concussion/post-concussion syndrome, which had not resolved as of October 13, 2021, and that the worker continued to suffer a loss of earning capacity and to require medical aid with respect to that injury beyond that date.

In the Worker Incident Report which was filed on March 31, 2021, the day after the accident, the worker described the mechanism of injury as slipping and falling backwards, landing on his back and neck, and his head and left shoulder hitting the concrete. The panel is satisfied that the mechanism of injury as reported has been generally consistent throughout the claim where the worker indicated he slipped while operating a scrubbing machine on wet stairs, fell backwards and landed on his back and neck, and hit his head and left shoulder on the concrete platform which was behind him.

The panel reviewed the mechanism of injury with the worker in detail, and is of the view that the worker suffered a severe fall. The evidence on file and at the hearing indicates the worker was standing on the stairs, with one foot on the first step from the platform or landing, operating an automatic scrubbing machine. The step was covered in water and cleaning materials and very slippery, and the worker fell backwards and hit his head on the platform or landing which was behind him.

The panel is further satisfied that the evidence supports that the worker's symptomatology with respect to his headaches and visual difficulties was consistent from the Incident Report through the medical reports to the diagnosis of a concussion and post-concussion syndrome by the treating neurologist on June 22, 2021.

The panel notes that there are repeated references in the initial and ongoing medical reports to the worker experiencing headaches after his fall, and other symptoms which are consistent with a concussion type of injury, including dizziness, confusion, fatigue and poor concentration. The worker's spouse took him to see his family physician on March 30, 2021, the same day as the accident, and the first two entries on the physician's Doctor First Report under the heading of subjective complaints are "Dizziness. Headache…"

Less than one month later, chart notes of a follow-up visit with the treating family physician on April 28, 2021, appear to indicate a diagnosis of concussion, and it was noted that the worker was being referred to a neurologist at a concussion clinic. The worker was seen by the neurologist at the concussion clinic on June 22, 2021, and based on her assessment of the worker, the neurologist diagnosed the worker with a concussion and post-concussion syndrome and referred him to the neuro-opthalmologist at the concussion clinic for consultation with respect to visual difficulties and symptoms.

The panel acknowledges that the reference on the file to the family physician not having documented blunt trauma to the head or altered brain function on March 30, 2021. Information on file indicates, however, that in the initial contact with the worker on April 21, 2021, the adjudicator noted the worker confirmed the mechanism of injury as reported, and that "He really doesn't remember exactly what happened, but his co-worker told him what happened when he sat down after. It was slippery." It was further noted, in terms of immediate symptoms, that the worker reported he "…does not remember that moment for about 5 or 10 seconds after he fell," that after he started walking, "…contractors saw him and asked him if he was okay and he told them he fell", that his "co-worker told him he saw him hit his head", that he "…tried to fill out the sheet and he wasn't concentrating, make (sic) mistakes with some spelling…and his job title", that he "…was in a state of confusion", and that he "…felt dizziness, but not throwing up." It was further noted that the worker indicated his "physio and his physician said it could be a mild concussion." Similar information is indicated on the Worker Assessment memorandum on file, dated April 26, 2021.

The panel notes that in spite of references on the file to the co-worker having seen the accident and having not only told the worker what happened but also having accompanied him to the custodian's room following the accident, and to contractors having also been present, the WCB does not appear to have attempted to follow-up with or contact these individuals.

In his evidence at the hearing, the worker again indicated that he fell and hit his head and "couldn't remember for about half a minute." The worker noted that there was also "another contractors there. They walked me out to the custodian's room." The worker further indicated that while his writing is generally good, he could not even write or spell words when he went to the custodian's room, and asked his co-worker to write for him.

Based on our review of all of the medical and other evidence which is before us, the panel is satisfied that the worker suffered a disruption of brain function and a concussion as a result of the March 30, 2021 workplace accident.

The panel notes that the evidence supports that the worker had not recovered from his concussion or post-concussion symptoms as at October 13, 2021, when his benefits ended, and that he continued to require treatment with respect to his concussion symptoms and was not fit to return to work at that time. The panel is therefore satisfied that the worker suffered a loss of earning capacity and required medical aid with respect to his concussion injury after that date.

Counsel also argued that the worker's diagnosis of C6/C7 radiculopathy was related to the March 30, 2021 workplace accident and the worker is entitled to ongoing benefits as a result of that injury. The panel is unable to accept that argument.

In advancing this argument, counsel relies on the June 23, 2021 and July 12, 2021 reports from the treating physiatrist. The panel notes that in her June 23, 2021 report, the physiatrist acknowledges that the symptoms of tingling and numbness into the right first through third digits did not develop immediately, but three weeks after the workplace accident. The physiatrist's only explanation as to why these symptoms would not have been there previously is her suggestion that the worker "…may have had these symptoms prior to the three weeks but found he was dealing with the concussive symptoms which may have masked the pain." The panel notes that the physiatrist herself did not assess the worker until June 23, 2021, or 12 weeks after the workplace accident.

The panel notes that the findings of the July 3, 2021 MRI of the cervical spine are summarized by the radiologist as being:

IMPRESSION:

Multilevel degenerative changes as described above. Moderate right C7 foraminal narrowing at C6-C7.

In her July 12, 2021 report, the treating physiatrist acknowledged the degenerative findings, but noted that the MRI demonstrated a posterior disc protrusion at C6-C7 and moderate C7 foraminal narrowing and stated that the MRI changes at C7 correlated with the electrodiagnostic findings. The physiatrist went on to indicate that the electrodiagnostic findings were acute to subacute suggesting they occurred over the last several months and not due to remote injury.

The panel finds the physiatrist's comments in this regard to be vague, and notes the physiatrist provides no detail with respect to this reference to "remote injury", whether she is referring to the worker's October 2018 motor vehicle accident, or what knowledge she may have with respect to the nature or date of that accident.

The evidence on file also indicates that the worker's left shoulder hit the ground when he fell and that his reported injuries at that time were to the left side. The panel notes that the reference in the MRI is to "a posterior disc protrusion with slight prominence in the right paracentral/foraminal region…" The panel is unclear as to how such a fall on the left side would have resulted in a right-sided protrusion. Further, the panel is unclear as to how such a protrusion on the right would have affected the worker's left side. In any event, with respect to the worker's left-sided difficulties or symptoms, the panel finds that there is little reporting of ongoing symptoms on that side.

Counsel has argued that the worker's right side symptoms, including his ongoing right shoulder difficulties, were causally related to or aggravated by the March 30, 2021 workplace accident, and in particular the C6/C7 radiculopathy. In this regard, the worker stated that the right-sided pain is different from the pain he suffered as a result of the 2018 motor vehicle accident. It was argued that the degenerative findings and the finding of a disc protrusion were two different things, and that the worker's right-sided condition was aggravated by the workplace accident to the point that it resulted in a disc protrusion, such that there is a direct correlation to the workplace accident. The panel is unable to accept that argument. The panel finds that there is a lack of clinical evidence to support that the worker's right-sided conditions were aggravated or enhanced by the workplace accident.

The panel further notes that the physiatrist stated in an October 19, 2021 note "To Whom it May Concern", that the worker contacted their clinic with respect to the electrodiagnostic findings and concerns regarding the timing of the onset of his symptoms in relation to his fall at work. The physiatrist went on to note that while the June 23, 2021 electrodiagnostic finding "suggests an injury to the C7 nerve root occurred in the previous several months", the testing "is not sensitive enough to determine the exact date of onset of the nerve root compromise," and concluded that:

As per his report he was asymptomatic prior to the injury that he sustained in March 2021. As a result, it is possible that the nerve root compromise may have been sustained in March 2021. (Emphasis added)

In the circumstances, the panel is unable to find that the worker's C6/C7 radiculopathy was causally related to the March 30, 2021 workplace accident. The panel is also unable to find the worker's C6/C7 radiculopathy or pre-existing right shoulder injury was aggravated by the March 30, 2021 workplace accident. 

Finally, counsel indicated that the panel should also consider the worker's diagnosis of carpal tunnel syndrome as being related to the March 30, 2021 workplace accident. The worker indicated that he did not have symptoms of carpal tunnel syndrome before the accident, and that both his wrists were swollen following the accident. The worker noted that the treating physiatrist had indicated verbally in a telephone conversation with him, that this condition would therefore be related to the accident. The panel is unable to accept that conclusion.

The panel notes that there is limited medical information on file with respect to the diagnosis of bilateral carpal tunnel syndrome.

In the physiatrist's June 23, 2021 report, the physiatrist reported that electrodiagnostic investigations indicated there was evidence of a moderate degree of median neuropathy or moderate degree carpal tunnel syndrome at both wrists.

An operative report from the treating orthopedic surgeon noted that the worker underwent right carpal tunnel release surgery on January 26, 2022, and the worker indicated at the hearing that he underwent similar surgery on his left wrist about three months later.

The panel understands that common factors associated with the development of carpal tunnel syndrome include a combination of repetitive and forceful motions for prolonged periods of time. Occupationally-related carpal tunnel syndrome is therefore found where the job duties involve high force and high repetition. Bilateral carpal tunnel syndrome presents another challenge in that it is often associated with non work-related factors, but can be found to be caused by work if the evidence shows both hands and wrists were exposed to the types of occupational hazards that could lead to the development of carpal tunnel syndrome in each hand.

When this was put to the worker, he noted that he was using the scrubbing machine at the time of the injury, which involved the type of repetitive movement that causes carpal tunnel syndrome to flare up. The panel acknowledges the worker would use the scrubbing machine in his work and was using it on March 30, 2021, but notes that the claim is not for a repetitive injury, but with respect to a traumatic incident where the worker fell on a stairway.

In conclusion, and based on the foregoing, the panel finds, on a balance of probabilities, that the worker suffered a concussion injury as a result of the March 30, 2021 workplace accident. The panel further finds that the worker suffered a loss of earning capacity and required medical treatment beyond October 13, 2021 based on that injury, and is entitled to wage loss and medical aid benefits after that date.

The worker's appeal is allowed, in part.

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 14th day of July, 2023