The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker appealed the Workers Compensation Board ("WCB") decision that their claim is not acceptable and on October 22, 2025, a hearing took place to consider the appeal.

Issue

Is the claim acceptable?

Decision

The claim is not acceptable.

Background

On October 1, 2024, the worker filed a Worker Incident Report with the WCB reporting they developed bilateral carpal tunnel syndrome ("CTS") due to repetitive use of their hands at work, indicating they first noticed symptoms in December 2023. The worker described symptoms of swelling and numbness in their hands which they treated with anti-inflammatory medication and a topical cream. The worker also confirmed they had been off work since July 2024 due to an unrelated health concern.

The WCB received reports from the treating family physician, including a March 29, 2023 report indicating the worker reported onset that day of left-hand pain, which the worker described as constant, of mild intensity and non-radiating. The physician also recorded a history of swelling in the worker's left hand and diagnosed mechanical hand pain, with a query as to osteoarthritis or sprain. An x-ray of March 29, 2023 indicated no acute bone or joint abnormality. The WCB received a further report dated November 6, 2023 in which the treating family physician outlined the worker's report of constant, non-radiating pain to both wrists. The physician noted the absence of swelling, redness, deformity and atrophy, with mild tenderness bilaterally. X-rays taken the same date indicated no acute bone or joint abnormalities in either wrist. In a further report from the treating family physician dated May 13, 2024, the physician recorded that the worker had complained of bilateral wrist pain "for the past few years" and was right-hand dominant. At that time, the worker noted the pain was sharp, constant and moderate in intensity, and increased with movement and bending. The physician also noted a history of numbness in the worker's index, middle fingers and thumb. On examination, the physician recorded no redness, deformity or atrophy, tenderness at the lateral aspect of the right wrist and a positive Phalen test. They noted a likely diagnosis of CTS, but also provided a differential diagnosis of tenosynovitis and arthritis.

The WCB received an August 12, 2024 report from the treating neurologist who recorded the worker's report of intermittent numbness and tingling in both hands for the past 9 months, mostly affecting the first, second and third fingers, as well as swelling of the knuckles of those fingers. The neurologist concluded the worker's symptoms could be a result of CTS and ulnar neuropathy and referred the worker for a nerve conduction study of their hands. The nerve conduction study on September 12, 2024 supported diagnosis of bilateral CTS, severe on the left and moderate-severe on the right. The treating neurologist noted the worker was using wrist braces, which were somewhat helpful and discussed carpal tunnel release surgery with the worker.

A second family physician outlined in an October 9, 2024 report that the worker reported bilateral hand pain, numbness and weakness, with the right slightly worse than the left. The physician noted decreased sensation to the median nerve bilaterally and diagnosed a chronic overuse injury. The physician noted the worker was referred to a surgeon for treatment of CTS and should avoid repetitive work until the surgery, following which, they require rehabilitation.

The employer advised the WCB on October 9, 2024 that the worker had recently returned to work after being off work many years, and on October 10, 2024, set out concerns they had with the worker's claim in an email to the WCB. The employer noted the worker was first employed in June 2014 but was away on medical leave for an unrelated health issue from June 2015 until March 2023 when they returned to an accommodated position. The worker then worked until July 2024, when they took another unrelated medical leave, returning in October 2024. When the worker returned to work in October 2024, they worked 2 hours of their shift before advising the employer they could not continue due to medical issues. The employer further noted the worker advised on October 7, 2024 that they would make a WCB claim.

On October 21, 2024, the worker told the WCB they first noticed numbness and swelling to the first two fingers of both hands 9 - 10 months previous, beginning with the swelling in their right hand. The worker provided a detailed description of their various job duties and noted their hand symptoms progressed with swelling and tingling throughout the day. The worker stated they told their supervisor of their symptoms and were placed in different positions, but they returned to their original job duties as needed to help out. The worker advised that they first sought medical attention for their hands in October 2023 as both hands were "numb" and they were referred for a nerve conduction study. The worker stated they returned to work in October 2024 after being away since July 2024, but only worked two hours before leaving work. The worker advised they were scheduled for left carpal tunnel surgery on October 31, 2024.

A WCB plastic surgery consultant reviewed the worker's file on January 7, 2025. On January 9, 2025, the WCB advised the worker that the claim was not acceptable as it could not establish that they sustained an injury arising out of their employment.

On February 18, 2025, the worker requested Review Office reconsider the WCB's decision, submitting that their repetitive job duties caused their hands to swell and their fingers to go numb and as such, they believed their claim was acceptable. Review Office requested and received additional information from the employer, and the worker provided a submission in response on May 2, 2025. On May 12, 2025, Review Office determined the worker's claim was not acceptable.

The worker appealed to the Appeal Commission on May 22, 2025 and a hearing was arranged.

Reasons

Applicable Legislation

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act (the "Act"), regulations under that 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 accident are applicable.

The Act sets out the definition of an accident in s 1(1) as including: 

(a) a chance event occasioned by a physical or natural cause, 

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

(c) an event or condition, or a combination of events or conditions, related to the worker's work or workplace, 

that results in personal injury to a worker, including an occupational disease, post-traumatic stress disorder or an acute reaction to a traumatic event.

A worker who is injured as a result of an accident at work is entitled to benefits under s 4(1) of the Act.

Worker's Position

The worker appeared in the hearing on their own behalf and outlined their position that because of the repetitive nature of their job duties, they developed bilateral CTS which was diagnosed in 2024 and resulted in two surgeries. The worker provided testimony in support of their appeal and in answer to questions posed by the appeal panel. They outlined in detail the nature of their various job duties, with reference to the file information including photographs of the job site provided by the employer. The worker described that their symptoms developed at first in their left hand in spring of 2023 and by later that year they had swelling and numbness in both hands.

The worker confirmed their symptoms were consistent from day to day and even on days when they were not at work. The worker described using wrist braces beginning in April 2024 and noted these interfered with how they moved their hands at work. The worker submitted that their bilateral CTS is the result of these job duties, noting that in their previous work as a meat cutter, over many years, they did not have any such issues with their hands.

Employer's Position

The employer was represented in the hearing by a human resources officer who provided an oral submission outlining that the employer did not dispute the medical information in relation to the worker's claim and confirming that the information provided to the WCB by the employer was correct. The employer representative also provided testimony through answers to questions posed by the panel.

Analysis

The issue for the panel to determine is whether the worker’s claim is acceptable. For the worker’s appeal to succeed, the panel would have to determine on the standard of a balance of probabilities that the worker was injured as a result of an accident as defined by the Act, arising out of and in the course of their employment. In other words, we must find that it is more likely than not that the worker developed CTS because of an event or condition, or a combination of events or conditions, related to the worker's work or workplace to find the claim is acceptable. The panel was not able to make such a finding for the reasons detailed below and therefore the worker's appeal is denied.

The panel accepts and relies upon the medical reports that confirm the worker's diagnosis of bilateral CTS. This is not in dispute; however, there must also be evidence to support a finding, on a balance of probabilities, that this diagnosis is causally related to events or conditions related to the workplace or the worker's job duties. The worker's position is that the cause of their

developing this condition is their job duties which they describe as repetitive and requiring constant use of their hands and wrists and they rely on the fact that they did not have such symptoms or develop this condition until after they began this job.

The panel therefore considered whether the job duties as described by the worker in the hearing and in the information provided to the WCB, as well as in the information provided by the employer, support the worker's position in this regard. The worker's job duties involve several different tasks undertaken as needed based on weekly product orders, and include cutting with a paper cutter, placing labels on product with a scraping tool, stacking empty bags into storage containers, holding bags as they are filled with up to 20 pounds of product, flipping bags on a conveyer, and clipping bags onto a machine. Some tasks are repeated daily whereas others are undertaken weekly or as needed. The worker's job takes place in any of four different production areas, depending on the nature of the task at hand on a given day. While each task could be described as repetitive of itself, the evidence indicates that the worker takes breaks as scheduled and that they may be doing different tasks from day to day, or even within the same day.

The file contains an opinion from a WCB plastic surgery consultant that outlines the requirements for development of CTS because of an occupational cause. In this opinion of January 7, 2025, the WCB consultant sets out information from the American Medical Association Guides to the Evaluation of Disease and Injury Causation (2014) (the "Guides") which provide an evidence-based review of medical literature regarding various conditions, including CTS. The Guides provide that there is very strong evidence that work duties involving a combination of force and repetition, or force and awkward postures represent risk factors for CTS, but that there is conflicting evidence as to the risk associated with highly repetitive work alone and low risk for awkward postures alone. High force is defined in this context as more than 4 kg of force per hand. High repetition in this context means a cycle time of less than 30 seconds or more than 50% of the cycle time performing fundamentally the same activity. Awkward postures in this context mean more than 45 degrees of wrist flexion or extension without excess radial or ulnar deviation. The panel accepts and relies upon these definitions and criteria in reviewing the evidence in this appeal.

The panel considered whether the job duties described by the worker meet the criteria of a combination of force and repetition or force and awkward positioning. We note the worker first sought medical attention in relation to left hand symptoms within weeks following their return to work from a lengthy unrelated absence and over the subsequent six months, reported symptoms in both hands which they described as relatively stable and consistent regardless of whether they were working or away from work. We note that some of the worker's job duties require more effort from the worker's dominant hand while other duties rely on both hands equally. While we agree the worker's job duties do involve wrist and hand movements that include gripping objects of varying weights and repetitive activities, as well as some awkward wrist positions, we find that the evidence does not establish that these activities involved sufficient force, repetition, or awkward positioning as defined in the AMA Guide relied upon by the WCB plastic surgery consultant. In other words, the evidence does not lead the panel to conclude there is a causal relationship between the worker's job duties beginning in March 2023 and their later development and diagnosis of bilateral CTS.

Based on the evidence before us and applying the standard of a balance of probabilities, the panel is not able to find that the worker sustained an injury arising out of and in the course of their employment. Therefore, the worker’s claim is not acceptable. The appeal is denied.

Panel Members

K. Dyck, Presiding Officer
J. MacKay, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

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

Signed at Winnipeg this 30th day of October, 2025