The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that responsibility was not accepted for the worker’s neck difficulties as being a consequence of the April 15, 2021 accident. A hearing was held on November 18, 2025 to consider the worker's appeal.

Issue

Whether or not responsibility should be accepted for the worker’s neck difficulties as being a consequence of the April 15, 2021 accident.

Decision

Responsibility should not be accepted for the worker’s neck difficulties as being a consequence of the April 15, 2021 accident.

Background

The worker filed a WCB claim reporting an injury to their right elbow that occurred on April 15, 2021. The worker described installing a heavy door, which work involved a lot of overhead work and constant repetitive motion. Reports received from the worker’s treating physician for April 16, 2021 and April 20, 2021 noted the worker’s reporting of right elbow pain, and found tenderness at the medial epicondyle area. The worker was also seen by their treating physiotherapist on April 20, 2021, who provided a diagnosis of right medial epicondylitis and a suspected right ulnar nerve entrapment. The WCB accepted the worker’s claim, and the payment of various benefits started.

The worker was seen by an orthopedic specialist on May 12, 2021, reporting increased pain to their right elbow after performing overhead job duties at work. The worker noted they had been seen at a walk-in clinic and diagnosed with golfer’s elbow and referred for physiotherapy. The worker advised they were placed on light duties but was experiencing increased burning pain to the right elbow and forearm, with loss of strength and numbness to their fingertips. The treating specialist examined the worker and found no swelling or redness and tenderness was noted at the medial epicondyle. Testing found pain resisted wrist flexion and a negative Tinel test. The worker was diagnosed with severe right medial epicondylitis, and the worker was placed off work, with the specialist noting that the worker was unable to do the light duties as recommended by the WCB. A pain injection was also recommended, followed by physiotherapy. The worker underwent the injection on May 31, 2021, with the worker indicating the injection helped their elbow injury. The worker's file was reviewed by a WCB medical advisor on June 29, 2021, who confirmed the diagnosis of right medial epicondylitis and opined the worker's job duties would medically account for the diagnosis. On July 28, 2021, the worker attended for physiotherapy treatment reporting burning pain down their right medial forearm, intermittent paresthesia into ring and pinky finger, worse with heavier activity at work. The worker's diagnosis was updated to right medial epicondylitis secondary to ulnar nerve entrapment and further treatment was recommended.

On August 10, 2021, the worker contacted the WCB to advise they had sustained a new accident at work on August 9, 2021 when they dropped an object weighing approximately 30-pounds on their right arm, above their elbow brace and a new WCB claim was established. The worker later returned to work on modified duties on August 23, 2021.

A copy of a June 22, 2023 surgical report was placed to the worker's file on August 22, 2023. The report indicated the worker underwent a right ulnar nerve neurolysis and a right flexor pronator mass debridement on that date. A July 6, 2023 follow-up report from the surgeon noted that the worker was doing well, their pain was controlled and the surgical incision was healing well. It was recommended the worker could start range of motion exercises and the worker was referred to physiotherapy. The surgeon also recommended that the worker avoid heavy lifting for six weeks. The worker contacted the WCB on August 29, 2023 to discuss their claim. The worker advised the WCB that they underwent surgery on their right arm and related that surgery to their April 15, 2021 workplace accident. The worker noted they had not worked since January 15, 2022, and had been in receipt of long-term disability insurance from their employer. The worker advised that when they returned to work the employer had indicated there were light duties available but the worker noted those duties were not available. The worker further advised they had undergone surgery on July 26, 2023 for their neck and back but the surgery did not help their right arm difficulties, and they continued to experience pain and nerve damage, with pain to their pinky and other fingers and they cannot rest their elbow on a hard surface. The WCB advised the worker further medical information would be gathered. In a further discussion with the WCB on September 6, 2023, the worker advised their right arm was so bad, "…it has triggered his neck." The worker also advised they were meeting with the surgeon and would ask if they were able to return to work. The WCB advised the worker on September 8, 2023, it had been determined their current ongoing difficulties were not related to the April 15, 2021 workplace accident and they were not entitled to any further benefits.

On December 13, 2023, the worker's representative requested reconsideration of various decisions on the worker's WCB files, including whether or not the worker was entitled to benefits in relation to a neck injury on this claim to the Review Office. The representative noted the worker had reported ongoing difficulties with their right arm throughout the claim and the claim related to their August 9, 2021 accident and indicated the worker's reporting the employer had requested they work outside of their restrictions since they returned to work on full hours. In addition, a January 27, 2022 cervical spine MRI had two findings: "1. Disc extrusion at C6-C7 that contacts and likely compresses the right C7 nerve root; and 2. Congenitally narrowed cervical spinal canal." The representative argued the worker's repetitive job duties that involved overhead work and heavy lifting either caused the disc herniation found on the MRI or enhanced pre-existing conditions in the worker's cervical spine. At the request of the Review Office, the worker's file was reviewed by a WCB physiatry specialist on February 1, 2024. The specialist provided the evidence on the worker's file did not indicate the worker reported any traumatic cervical spine issues such as neck pain, C7 innervated weakness, reflex loss or sensory changes, in relation to the April 15, 2021 workplace accident. In addition, the specialist noted the medical literature did not support the physical demands of the worker's job duties would result in a cervical spine herniation. The WCB physiatry specialist's opinion was provided to all the parties for comment on February 1, 2024, with the worker's representative submitting a response on February 13, 2024.

The Review Office found on February 15, 2024, the worker was not entitled to benefits in relation to neck difficulties in relation to the April 15, 2021 accident. The Review Office was unable to medically account for the worker's neck difficulties in relation to that accident after accepting and agreeing with the opinion of the WCB's physiatrist's opinion. The Review Office found that a December 10, 2021 call-in examination identified positive testing for a possible cervical disc herniation however, a December 14, 2021 clinical examination and nerve conduction study were noted to be within normal limits and the treating physical medicine and rehabilitation specialist provided they were "…able to rule out a possible cervical radiculopathy…" based on the testing. As such, the Review Office found the worker was not entitled to benefits in relation to neck difficulties.

The worker's representative submitted further medical evidence to the Review Office on November 28, 2024 and requested reconsideration of the February 15, 2024 decision. The representative provided the Review Office with a copy of a November 16, 2024 letter from the worker's treating orthopedic surgeon received in response to questions posed by the representative. The surgeon noted their belief that the worker had a degenerative, spondylotic condition in their cervical spine that was aggravated by the physical demands of the worker's job duties. The surgeon further noted the worker's job duties involved repetitive work in an overhead fashion with arms elevated above horizontal with their neck in extension. In addition, the treating surgeon opined the worker required a laminectomy procedure in July 2022 due to the aggravation of their spondylotic condition as a result of their job duties. The representative submitted that the evidence from the surgeon supported the worker's pre-existing cervical spine condition was aggravated and enhanced by the April 15, 2021 workplace accident. The Review Office again determined the worker was not entitled to benefits for neck difficulties in relation to the April 15, 2021 workplace accident. The Review Office relied on the medical reporting in close proximity to the accident and found the worker did not report any injury to their neck or cervical spine on April 15, 2021 and did not report any immediate neck symptoms.

The representative filed an appeal with the Appeal Commission on August 7, 2025 and a hearing was arranged.

Reasons

Applicable Legislation and Policy

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act (“Act”), regulations under the Act and the policies established by the WCB's Board of Directors. The applicable provisions of the Act and policies are those in effect as of the date of the accident.

Section 4(1) of the Act provides for compensation to be paid by the WCB where a worker has sustained personal injury by accident arising out of and in the course of employment. ‘Accident’ is defined in Section 1(1) of the Act as:

"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;

The WCB has established WCB Policy 44.10.20.10, Pre-existing Conditions (the "Pre-Existing Policy"), to address eligibility for compensation in circumstances where a worker has a pre-existing condition. The Policy defines a pre-existing condition as any medical condition the worker had prior to their workplace injury, which may contribute to the severity of a workplace injury or significantly prolong a worker's recovery. Workplace injuries can impact pre-existing conditions. A temporary worsening of a worker’s pre-existing condition is considered an aggravation of the pre-existing condition and a permanent worsening of the worker’s condition because of an injury is an enhancement of the pre-existing condition.

Worker’s Position

The worker was present at the hearing, represented by an advisor and supported by their spouse. The worker’s advisor made an oral submission at the hearing and provided additional medical information for consideration prior to the hearing. The worker’s advisor also noted that they were relying on their past submissions made to the WCB and the Review Office. The worker provided testimony by answering questions posed by members of the appeal panel.

The worker’s position is that the evidence supports that the worker's neck difficulties arose out of and in the course of employment, and therefore the worker's neck difficulties should be expected as being a consequence of the accident on April 15, 2021.

It is submitted that the worker had a positive Spurling’s test on December 10, 2021 and this should be given more weight than electrophysiological studies.

The worker states that the medical evidence confirms that there is a disc extrusion at the C6-C7 level, which contacts and compresses the nerve root.

The worker relies on medical information they submitted which states that symptoms from a neck injury may be at the affected site or anywhere along the path of the nerve and note that the tingling and numbness the worker felt in their hands was due to the neck injury. The worker disagrees with the opinion of the Review Office that the absence of immediate neck pain at the time of the accident is a basis to deny responsibility for the worker’s neck injury. The evidence of the worker is that while they did not immediately experience neck pain, they had radiculopathic symptoms affecting their right arm, elbow, hand and fingers which correlates with the appropriate distal distribution for a C6-C7 disc herniation.

The worker’s position is that there is a cause-and-effect relationship between their neck difficulties and their employment. It is submitted that the repetitive job duties and employment tasks, which included heavy lifting, are sufficient to cause the cervical disc herniation or aggravate a pre-existing spondylotic condition in the worker’s spine.

The worker asks the panel to rely on the opinion of the treating surgeon, as set out in their letter dated November 16, 2024, that there is a casual connection between the worker’s physical job demands and spondylosis at the C6-C7 level secondary to repetitive working in an overhead fashion with arms elevated above horizontal and neck extension.

The worker argues that they have a genetic predisposition causing them to be more prone to spinal injury. The position of the worker is that the accident arose out of and in the course of employment.

The worker submits that their pre-existing condition was permanently worsened and therefore this constitutes an enhancement of their condition.

Employer’s Position

The employer did not participate in the appeal process.

Analysis

The question on appeal is whether or not responsibility should be accepted for the worker's neck difficulties as being a consequence of the April 15, 2021 accident. In order for the appeal to be successful, the panel must be satisfied, on a balance of probabilities, that the worker’s neck difficulties were the result of an accident arising out of and in the course of employment, or that the April 15, 2021 accident aggravated or enhanced a pre-existing cervical spine condition. As detailed in the reasons below, the panel was unable to make such a finding and therefore, the worker’s appeal is dismissed.

The panel accepts that the worker sustained a compensable injury on April 15, 2021, as the WCB accepted responsibility for the worker’s right elbow difficulties, diagnosed as right medial epicondylitis with ulnar nerve involvement. However, the acceptance of a claim for one injury does not automatically extend responsibility to other conditions unless there is sufficient medical and factual evidence to establish a causal connection. The central question before the panel is not whether the worker currently has neck pathology, but whether there is a causal relationship between the April 15, 2021 accident and the worker’s subsequent neck difficulties.

The panel places significant weight on the medical evidence contemporaneous to the April 15, 2021 accident. The initial medical reports from April 16 and April 20, 2021 document complaints exclusively related to the worker’s right elbow. Similarly, early physiotherapy and orthopedic assessments focus on elbow pain, forearm symptoms, and ulnar nerve involvement. There is no reference in these records to neck pain, cervical spine symptoms, or signs consistent with cervical radiculopathy. The absence of reported neck complaints in close temporal proximity to the accident weighs against a finding that the worker sustained an acute cervical spine injury on April 15, 2021. The panel also noted that the chart notes of the treating physician from April 20, 2021 indicate that the worker’s symptoms improved (“R elbow pain is 400% better with the topical diclofenac”) so much so that that they were requesting to return to work 5 days following the accident.

The panel acknowledges the worker’s submission that radicular symptoms may occur in the absence of neck pain and that symptoms in the arm, hand, and fingers could be consistent with a C6-C7 disc herniation. However, the evidence demonstrates that the worker’s arm symptoms were consistently assessed and treated as arising from right medial epicondylitis with ulnar nerve involvement. These diagnoses were supported by multiple treating practitioners and confirmed by a WCB medical advisor. The panel notes that the worker’s symptoms improved with treatment directed at the elbow and ulnar nerve, including injection therapy and later surgical intervention, which further supports a peripheral rather than cervical origin of the symptoms during the relevant period.

The panel also considered whether the worker’s job duties could have caused or aggravated a cervical spine condition. The panel accepts that the worker had a physical job, which involved heavy lifting and overhead repetitive work. The worker’s representative argues that the repetitive overhead work and heavy lifting either caused or enhanced a cervical disc herniation. The panel notes however that the cervical laminectomy surgery (July 2022) did not resolve the worker’s issues. The panel places greater weight on the February 1, 2024 opinion of the WCB physiatry specialist. That specialist reviewed the complete file and opined that the evidence did not demonstrate traumatic cervical spine symptoms following the accident and further noted that medical literature does not support the proposition that the worker’s job duties would result in a cervical disc herniation.

The panel considered the January 27, 2022 cervical spine MRI, which identified a disc extrusion at C6-C7 and a congenitally narrowed cervical spinal canal. However, diagnostic imaging alone does not establish causation. The panel notes that clinical examinations and nerve conduction studies in December 2021 were within normal limits, and the treating physical medicine and rehabilitation specialist indicated they were able to rule out cervical radiculopathy at that time. This evidence undermines a causal link between the April 15, 2021 accident and the worker’s later cervical spine findings.

The panel also considered the November 16, 2024 opinion of the worker’s treating orthopedic surgeon, who suggested the worker’s pre-existing spondylotic cervical condition was aggravated by the physical demands of their job duties and necessitated surgical intervention. While the panel acknowledges the surgeon’s expertise and opinion, it assigns it less weight than the WCB physiatry specialist’s opinion. The treating surgeon’s opinion was provided more than three years after the accident and is not supported by medical reporting of neck symptoms or cervical pathology in close proximity to the April 15, 2021 accident. Additionally, the treating surgeon’s opinion does not sufficiently address the absence of neck complaints or cervical findings in the period immediately following April 15, 2021. As such, the panel is not persuaded, on a balance of probabilities, that the workplace accident aggravated or enhanced a pre-existing cervical spine condition within the meaning of the Pre-Existing Policy.

The panel has also considered the worker’s own reports that neck difficulties developed later in the course of their claim, including a statement in 2023 that the right arm condition “triggered” the neck. The development of symptoms well after the accident, in the absence of contemporaneous medical evidence linking those symptoms to the workplace event, does not support a finding of causation.

After weighing all of the evidence, the panel finds it more likely than not that the worker’s neck difficulties are the result of a degenerative cervical spine condition and not a personal injury arising out of and in the course of employment on April 15, 2021. The evidence does not establish that the workplace accident caused, aggravated, or enhanced the worker’s cervical spine condition.

Accordingly, the panel finds that responsibility should not be accepted for the worker’s neck difficulties as being a consequence of the April 15, 2021 accident, and the appeal is dismissed.

Panel Members

R. Lemieux Howard, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

R. Lemieux Howard - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 9th day of January, 2026