The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

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

1. They are not entitled to wage loss benefits after January 5, 2018; and 

2. Their permanent partial impairment rating of 1% and the monetary award of $1,250.00 have been correctly established.

A hearing was held on September 17, 2025 to consider the worker's appeal.

Issue

1. Whether or not the worker is entitled to wage loss benefits after January 5, 2018; and 

2. Whether or not the worker’s permanent partial impairment rating of 1% and the monetary award of $1,250.00 have been correctly established.

Decision

1. The worker is not entitled to wage loss benefits after January 5, 2018; and 

2. The worker’s permanent partial impairment rating of 1% and the monetary award of $1,250.00 have been correctly established.

Background

The worker has an accepted WCB claim for diagnoses of bilateral carpal tunnel syndrome and cubital tunnel syndrome at their left elbow, after reporting a history of difficulties with their wrists and left elbow on October 1, 2014, with an accident date of March 1, 2013. The WCB reviewed the worker’s various job duties and the medical information provided and accepted the worker’s claim, and the payment of various benefits started. The worker underwent a right carpal tunnel release surgery on January 5, 2015, a left cubital tunnel release surgery on November 13, 2015, and a left carpal tunnel release surgery on April 25, 2016. It was noted the right carpal tunnel release and the left cubital tunnel surgeries were successful, but the worker reported ongoing difficulties after the left carpal tunnel surgery. Due to the ongoing complaints, a second left carpal tunnel surgery was performed on May 18, 2017.

The worker attended for an initial post-surgery physiotherapy assessment on June 20, 2017. At that time, a home exercise program, no heavy lifting and use of the left hand for light activities of daily living only were recommended. The worker’s file was reviewed by a WCB plastic surgery consultant on June 29, 2017, who agreed with the restrictions and recommended they continue for 4 weeks. A further physiotherapy assessment on August 1, 2017 noted that the worker’s reporting of improvement in symptoms after the release surgery, with intermittent numbness and tingling in their fingers, increasing with fine motor activities. Further time off work was recommended. The worker attended for a call-in examination with a WCB plastic surgery consultant on September 27, 2017. After examining the worker, the consultant provided that based on the worker’s reporting, the worker’s “…left carpal tunnel syndrome type symptoms have materially resolved in that [the worker] reported resolution of the numbness and tingling at the left thumb, index, and middle fingers.” The worker also reported resolution of the sharp pain at the volar wrist area after the May 18, 2017 surgery. The consultant noted findings from a September 12, 2017 nerve conduction study supported clinical improvement and opined the worker’s recovery had progressed well since the May 18, 2017 surgery. It was noted the worker had upcoming appointments with the treating plastic surgeon and physiotherapist and the WCB plastic surgery consultant recommended the worker’s restrictions be reviewed in 4 to 6 weeks.

On November 29, 2017, the WCB plastic surgery consultant placed a further opinion to the worker’s file. The consultant referred to the worker’s treating plastic surgeon’s November 14, 2017 report and noted the findings of excellent range of motion at the fingers and thumb, tenderness over the left wrist scar and grip strength of 40 pounds on the left and 80 pounds on the right. The treating surgeon noted the worker would not injure their left hand further, with the only limitation indicated to be strength. Continued physiotherapy exercises to regain strength were recommended. The WCB consultant also referred to the November 17, 2017 report from a 4 week physiotherapy strengthening program the worker completed, noting temporary restrictions of pushing and pulling up to 30 pounds, carrying up to 25 pounds, lifting from floor with repetition up to 25 pounds and single arm carry of approximately 25 pounds were recommended for 6 weeks, with a return to full duties anticipated by the 7th week. The WCB plastic surgery consultant agreed with the recommendations from the worker’s treating healthcare providers. The WCB provided the worker with a decision letter on December 12, 2017, advising their entitlement to benefits would end on January 5, 2018, which represented the anticipated date the worker was capable of returning to full duties.

On January 2, 2019, the worker submitted additional medical information and requested reconsideration of the WCB’s decision to end their entitlement to further benefits to the Review Office. The Review Office returned the worker’s file to the WCB’s Compensation Services for further investigation of the new medical information. The WCB’s plastic surgery consultant placed a further opinion to the worker’s file on February 27, 2019, indicating the worker’s treating physician’s July 26, 2018 opinion that the worker was not employable due to the injuries to both hands was not substantiated by the medical reports on file. The consultant noted the worker’s treating plastic surgeon recommended continued physiotherapy exercises and pushing themselves to gain more strength but did not place any restrictions on the worker returning to work. In addition, the WCB consultant noted the treating physiotherapist recommended the worker undergo a 6-week gradual return to work before a return to full duties and found there would be no change to their earlier opinion that the worker could return to full duties. On March 12, 2019, the WCB provided the worker with a further decision letter advising the new medical information was reviewed but there would be no change to the earlier decision that they were not entitled to further benefits after January 5, 2018. Additional medical reports were placed to the worker’s file and after review by the WCB plastic surgery consultant and a WCB physiatrist, a further decision letter was sent to the worker on February 14, 2020, upholding the previous decisions the worker was not entitled to further benefits.

The worker requested reconsideration of the WCB’s decision to the Review Office on August 10, 2022. In their submission, the worker noted their treating plastic surgery recommended no restrictions for their left hand but did note they would require restrictions due to loss of strength in that hand and that their treating physiotherapist reported the worker has a loss of strength in their left hand. As such, they believe they should be entitled to further benefits. On September 29, 2022, the Review Office determined the worker is not entitled to further medical aid or wage loss benefits after January 5, 2018. The Review Office accepted and agreed with the WCB medical advisors’ opinions on the worker’s file and found the worker had materially recovered from their compensable injuries and no longer had a loss of earning capacity after January 5, 2018.

At the request of the worker’s representative, the worker’s file was reviewed to determine if the worker was eligible for a permanent partial impairment rating and award. A WCB physiotherapy advisor recommended the worker attend for a call-in examination, which took place on April 26, 2023. After examining the worker, the WCB physiotherapy advisor provided the worker’s cosmetic impairment related to the compensable injuries was 1%. As well, a 5% rating for partial denervation of the left ulnar nerve based on testing, for a total permanent partial impairment rating of 6%. An addendum was placed to the worker’s file by the WCB physiotherapy advisor on May 10, 2023 noting the September 29, 2022 Review Office decision that the worker had attained a functional recovery by January 5, 2018 and their ongoing difficulties, including changes noted on electrophysiological studies, were not related to the compensable workplace accident but to the worker’s pre-existing condition. As such, the worker’s permanent partial impairment rating was reduced to the 1% cosmetic impairment rating. On May 19, 2023, the worker was advised they were entitled to a 1% permanent partial impairment rating and associated $1,250.00 monetary award.

On December 4, 2024, the worker’s representative requested reconsideration of the WCB’s decision on the worker’s permanent partial impairment rating and award to the Review Office. In their submission, the representative noted their belief the worker’s disfigurement rating had not been reviewed correctly and asked for a further review. On February 27, 2025, the Review Office found the worker’s permanent partial impairment rating of 1% and monetary award of $1,250.00 were calculated correctly. The Review Office found that the WCB physiotherapy consultant who performed the review to determine the worker’s permanent partial impairment rating had conducted many impairment examinations and was aware of the folio of images on file at the WCB and while the consultant may not have specifically mentioned reviewing the folio, the Review Office was satisfied the consultant based the rating on their appropriate recommendation. Further, the Review Office found the evidence on the worker’s file was the worker had three faint scars and as such, was provided with the appropriate 1% rating for cosmetic disfigurement.

The worker’s representative filed an appeal with the Appeal Commission on March 6, 2025, and a hearing was arranged. 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 December 3, 2025, 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 and WCB policies in effect as of the date of the worker’s accident are applicable.

A worker is entitled to benefits under Section 4(1) of the Act when it is established that a worker has been injured as a result of an accident at work. Under Section 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.

The WCB's Board of Directors has established Policy 44.90.10, Permanent Impairment Rating (the "PPI Policy") to provide a method for determining a rating that represents the percentage of impairment as it relates to the whole body. The PPI Policy provides that the degree of impairment will be established by the WCB's Healthcare Services Department in accordance with the PPI Policy, and that whenever possible, and reasonable, impairment ratings will be established strictly in accordance with Schedule A to the PPI Policy. Section 20 of Schedule A of the PPI Policy provides a step-by-step analysis.

Schedule A to the PPI Policy provides that permanent impairment from a workplace injury is evaluated for the following deficits:

• loss of a part of the body; 

• loss of mobility of a joint(s); 

• loss of function of any organ(s) of the body identified in the Schedule; and 

• cosmetic disfigurement of the body.

Worker’s Position

The worker was represented in the hearing by a worker advisor who made an oral submission on behalf of the worker and also noted that they were relying upon their past submissions made to the Review Office. The worker offered testimony through answers to the questions posed by members of the appeal panel.

The position of the worker regarding their entitlement to wage loss benefits is relating to the worker’s left ulnar nerve pain and the residual effects of the second carpal tunnel surgery.

The worker’s evidence relating to their left elbow, wrist and hand is that their symptoms were present and active, with the initial identification being in December 2016 and consistently continuing beyond January 5, 2018.

The worker disagrees with the WCB’s position that the pain, tingling and numbness in their left hand was a result of pre-existing polyneuropathy or diabetic neuropathy.

The worker submits that due to their strength and grip limitations to their left hand, they could not carry out the essential demands of their occupation and therefore had a loss of earning capacity as a result. The worker also states that their symptomatic ulnar neuropathy was caused by their work and therefore they did not have the capability of returning to the same kind of work.

The worker also argues that the WCB predetermined their recovery based on a reference by their treating physiotherapist’s report stated that six to seven weeks later the worker could return to unrestricted work but did not have subsequent conversations with the worker or their medical professionals. The worker submits that there should have been a follow up to confirm whether the goal to return to unrestricted work was actually achieved or not.

The worker’s evidence was that their job duties required the use of both of their hands and arms at full strength in order to remove and install parts in the HVAC equipment. The worker stated that they required both hands and arms to carry parts and tools up and down stairs, depending on where the equipment to be serviced was located, and required kneeling or lying down in various positions, holding tools or parts with one hand or arm, while working on another part with the other hand/arm.

The position of the worker is that the evidence supports that they had not recovered from the effects of the compensable injury and had a loss of earning capacity due to their continuing left ulnar nerve symptoms and pillar pain beyond the wage loss benefit end date.

The position of the worker regarding their permanent partial impairment (“PPI”) rating and monetary award is that the cosmetic disfigurement rating was not correctly determined.

The worker noted that they were not questioning the amount of the monetary award associated with the 1% rating but are only questioning the cosmetic disfigurement rating itself. The worker’s position is that in recommending a 5% denervation rating reference was also made to the muscle wasting in the worker’s left hand. The worker’s position is that the muscle wasting relates to a cosmetic impairment or disfigurement and therefore questions the accuracy of the 1% rating.

The worker is of the view that the 1% disfigurement rating does not properly account for all the changes in size, shape and structure of their left hand and wrist.

The worker disagrees with the medical advisor who suggests that the rating should be zero, as the medical advisor did not examine the worker or interview the worker. The worker asks the panel to rely on the physiotherapy consultant’s opinion in this regard. The worker also states that their non-compensable diabetic neuropathy ought not to be considered and ought not to reduce the PPI rating. The worker argues that surgery resolved their symptoms and therefore submits that the evidence does not support a finding that there is a major non compensable pre-existing condition that was influencing the worker’s left ulnar nerve symptoms.

The worker is seeking a finding that the 1% cosmetic rating was not correctly established.

Employer’s Position

The employer did not participate in the appeal.

Analysis

Issue 1: Whether or not the worker is entitled to wage loss benefits after January 5, 2018.

For the worker’s appeal on this issue to succeed, the panel would have to find that the worker experienced a loss of earning capacity as a result of their compensable injuries. The panel was unable to make such a finding and therefore the worker’s appeal is denied, as detailed in the reasons that follow.

The panel acknowledges the worker’s testimony that they continued to experience left hand pain, weakness, numbness and ulnar nerve symptoms beyond January 5, 2018, and that these symptoms interfered with their ability to perform the physical demands of their pre-accident occupation. The panel also accepts that the worker’s occupation required use of both hands and having strength and dexterity in both hands. However, the panel does not extend that to mean that the worker needs to have equal strength or equal dexterity in both hands.

Entitlement to wage loss benefits is determined not solely on the worker’s subjective reporting of symptoms, but on whether the medical and other evidence supports a continuing loss of earning capacity attributable to the compensable injuries. The panel reviewed the medical evidence and notes that the plastic surgery consultant who examined the worker and reviewed the file on multiple occasions, noted that the worker reported resolution of the numbness and tingling in the left thumb, index and middle fingers. The consultant also noted resolution of the sharp volar wrist pain following the May 18, 2017 surgery. The panel places weight on the opinion of the plastic surgery consultant. Furthermore, the panel has considered that nerve conduction studies performed on September 12, 2017 supported clinical improvement, and the recovery from the second left carpal tunnel release had progressed well.

The panel further notes that the worker’s treating plastic surgeon reported, on November 14, 2017, excellent range of motion in the fingers and thumb, with the only ongoing limitation being reduced strength. Notably, the treating surgeon indicated that the worker would not injure their left hand by returning to work and did not place restrictions on a return to employment, aside from strength recovery through continued exercises.

The panel also relies on the November 17, 2017 physiotherapy report following a structured strengthening program, which anticipated a return to full duties by approximately the seventh week. This anticipated recovery timeline was accepted by the WCB plastic surgery consultant, who agreed with the treating providers’ recommendations.

The panel has considered the later opinions from the worker’s treating physician and the worker’s submissions that they were not employable due to ongoing hand symptoms. However, the panel prefers the opinions of the WCB medical advisors in this case, as they are consistent with the clinical findings, the surgical outcomes, and the opinions of the treating plastic surgeon and physiotherapist at the relevant time. The panel notes that the WCB medical advisors specifically addressed and rejected the conclusion that the worker was unemployable due to the compensable injuries, finding that conclusion was not supported by the broader medical evidence.

While the panel accepts that the worker continued to experience symptoms after January 5, 2018, the panel is not satisfied, on a balance of probabilities, that these symptoms resulted in a compensable loss of earning capacity beyond that date. The evidence supports that any ongoing difficulties did not prevent the worker from returning to suitable employment.

Accordingly, the panel finds that the worker is not entitled to wage loss benefits after January 5, 2018.

Issue 2: Whether or not the worker’s permanent partial impairment rating of 1% and the monetary award of $1,250.00 have been correctly established.

For the worker's appeal on this issue to be successful, the panel must find, on a balance of probabilities, that the worker's PPI rating was not determined in accordance with the Act and the PPI Policy. The panel was unable to make this finding and therefore the worker’s appeal is denied, as detailed in the reasons that follow.

The panel notes that the worker’s PPI assessment was conducted by a WCB physiotherapy advisor following a call-in examination on April 26, 2023. The advisor initially identified a cosmetic impairment and a functional impairment related to partial denervation of the left ulnar nerve. However, in a subsequent addendum dated May 10, 2023, the advisor clarified that the functional impairment findings were not related to the compensable injury, consistent with the September 29, 2022 Review Office determination that the worker had functionally recovered from the compensable injuries by January 5, 2018.

The panel accepts that PPI ratings must reflect only permanent impairment that is causally related to the compensable injury. Based on the evidence, the panel finds that the worker’s ongoing neurological findings and strength loss were appropriately excluded from the PPI calculation as they were determined to be related to non-compensable conditions.

With respect to cosmetic disfigurement, the panel notes that Schedule A of the PPI Policy provides for a rating where there is visible and permanent disfigurement. The evidence on file, including the medical assessments and photographic documentation, supports a finding of three faint surgical scars.

The panel has considered the worker’s argument that muscle wasting should be included as a cosmetic impairment. However, the panel finds that muscle wasting relates to functional loss rather than cosmetic disfigurement as contemplated by the PPI Policy. As the functional findings were determined not to be compensable, they cannot be included in the cosmetic impairment rating.

The panel is satisfied that the WCB physiotherapy advisor was experienced in conducting impairment examinations and appropriately applied the PPI Policy. The panel finds no evidence that the assessment was incomplete or that relevant information was overlooked.

Accordingly, the panel finds, on a balance of probabilities, that the worker’s permanent partial impairment rating of 1% and the associated monetary award of $1,250.00 were correctly established.

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 12th day of January, 2026