The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that a diagnosis of Chronic Regional Pain Syndrome (CRPS) was not accepted and related to the September 18, 2021 injury. A hearing was held on June 23, 2026 to consider the worker's appeal.

Issue

Is a diagnosis of Chronic Regional Pain Syndrome (CRPS) accepted and related to the September 18, 2021 injury?

Decision

The diagnosis of Chronic Regional Pain Syndrome (CRPS) is accepted and related to the September 18, 2021 injury.

Background

The worker has an accepted WCB claim for injuries that were sustained as the result of an incident at work on September 18, 2021. The worker was seen at a local emergency department on September 18, 2021, where it was noted that the worker had a visible deformity to their left wrist. A diagnosis of a closed intraarticular distal radius and ulnar styloid fracture was provided, and the worker was scheduled for an open reduction and internal fixation surgery, which occurred on September 24, 2021. The worker was placed off work for 2 to 3 months during recovery from the surgery and the WCB accepted the worker’s claim on October 1, 2021.

The worker attended a follow-up appointment with their treating orthopedic surgeon on October 20, 2021, reporting pain and tightness in the fingers and wrist of their left side. After examining the worker, the surgeon noted a well-healed incision, swelling to the worker’s fingers, hand and distal forearm and reduced range of motion in the worker’s left wrist. Physiotherapy was recommended for the left wrist with the surgeon also finding early chronic regional pain syndrome symptoms.

On January 13, 2022, the worker’s file was reviewed by a WCB medical advisor. The diagnosis of a left wrist distal radius fracture was confirmed to be medically accounted for in relation to the September 18, 2021 workplace accident. The advisor noted the worker’s treating orthopedic surgeon had provided a diagnosis of chronic regional pain syndrome on December 22, 2021, referring the worker to a pain clinic for further treatment. It was recommended reports from the clinic be obtained by the WCB and forwarded to a WCB physiatrist for review. The worker’s treating physiotherapist requested the WCB refer the worker to an upper extremity physiotherapy specialist, and the worker was seen by the specialist on April 27, 202. It was reported they had reduced function of their left hand, swelling from their neck to their fingertips, pain in their neck and shoulders which radiated down the lateral region of their arm into the fingers. It was also noted they had difficulty sleeping, headaches and dizziness that caused nausea. The physiotherapy specialist examined the worker and found swelling to their entire left limb, skin deterioration, hypersensitivity, hesitation to move and guarding. It was noted they were unable to test active or passive range of motion due to reported pain. A diagnosis of chronic regional pain syndrome throughout the worker’s left upper extremity was provided.

At the request of the WCB, the worker attended a call-in examination with a WCB physiatrist on May 18, 2022. The advisor noted they were unable to complete the clinical examination of the worker due to the worker being unable to tolerate any movement or contact to their left upper extremity. The WCB advisor examined the worker’s right upper extremity and found a minor report of discomfort with palpitation of the top of the soft tissues of the shoulder. It was noted the sensitivity of the worker’s left upper extremity extended from the lateral neck region to the top of the shoulder area, down the scapular and trunk areas which also included touch sensitivity in the left upper buttock area. The WCB advised the worker by way of a formal decision letter on October 20, 2022, they were not entitled to benefits after November 2, 2022, as it had been determined their current difficulties were not related to the September 18, 2021 workplace accident. Additional medical reports from the pain clinic were received by the WCB on November 19, 2022, and reviewed by the WCB physiatrist on January 5, 2023. The physiatrist advisor that conducted the call-in examination on May 18, 2022 reviewed the new medical information provided. They provided the opinion that the injuries resulting from the September 18, 2021 workplace accident did not require the worker to restrict their movement, and it was recommended the worker resume using their left upper extremity in their activities of daily living and work duties. A further decision letter was sent to the worker on January 10, 2023, advising the previous decision remained unchanged.

On February 15, 2023, the worker requested reconsideration of the WCB’s decision to the Review Office. The worker advised they continued to experience difficulties as a result of the workplace accident, including chronic regional pain syndrome, which was supported by their treating healthcare providers. The employer provided a submission in support of the WCB’s decision on March 31, 2023, and a copy was provided to the worker. The Review Office determined on May 10, 2023 that the worker was not entitled to benefits after November 2, 2022. The Review Office accepted and agreed with the opinion of the WCB physiatrist that the worker’s diagnosis of chronic regional pain syndrome was not supported based on the May 18, 2022 call-in examination. The Review Office further found the worker’s current difficulties were due to a pre-existing condition, along with the worker not using their left upper extremity and as such, the worker was not entitled to further benefits.

A hearing was held at the Appeal Commission on October 10, 2024 to determine the issue on whether the worker is entitled to benefits after November 2, 2022. The panel did not determine what diagnosis was accepted as a result of the September 18, 2021 accident because that was not the issue before them. The panel accepted the appeal as outlined in Appeal Commission decision No. 110/24, dated December 9, 2024, and the file went back to Compensation Services for review of benefit entitlement.

The worker’s representative filed an appeal with the Appeal Commission on December 19, 2025 regarding the diagnosis of Chronic Regional Pain Syndrome (CRPS) being related to the compensable injury 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 (the “Act”), the regulations under the Act and the policies established by the WCB's Board of Directors.

Section 4(1) of the Act provides that the WCB will pay compensation when a worker has sustained personal injury by accident arising out of and in the course of employment, and Section 4(2) outlines that a worker injured in such an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident. When the WCB decides that a worker has sustained a loss of earning capacity, an impairment or requires medical aid because of an accident, compensation is payable under Section 37 of the Act. Section 39 of the Act sets out that wage loss benefits are payable until the worker's loss of earning capacity ends or the worker reaches the age of 65 years.

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, supported by their spouse and a translator. The worker also had a representative present to make submissions on their behalf. The worker’s representative relied on their written submission to the panel as well as previous submissions on the file and made an oral submission at the hearing. The worker provided testimony by way of answering questions posed by their representative and by members of the panel.

The worker’s position is that there is substantial evidence to support a diagnosis of CRPS. The worker was diagnosed with CRPS by two orthopedic surgeons and two anesthesiologists who provided evidence to support their opinions. The worker submits that the Budapest diagnostic criteria was correctly used to establish their diagnosis.

The worker submits that the mechanism of injury is the most common injury that can lead to CRPS and states that the worker’s initial presentation was consistent with CRPS. The worker states that there is no other diagnosis or basis for the pain they experienced following their workplace injury.

The worker’s position is that the claim should be accepted.

Employer’s Position

The employer did not participate in the appeal.

Analysis

The question on appeal is whether or not the worker’s diagnosis of Chronic Regional Pain Syndrome (CRPS) is causally related to the September 18, 2021 workplace accident and should therefore be accepted as part of the compensable injury. In order for the appeal to be successful, the panel must be satisfied, on a balance of probabilities, that the worker’s CRPS was the result of an accident arising out of and in the course of employment, and that the September 18, 2021 accident caused the CRPS condition. As detailed in the reasons below, the panel was able to make such a finding and therefore, the worker’s appeal is granted.

The panel is satisfied that the worker has established, on a balance of probabilities, that they developed CRPS as a consequence of the September 18, 2021 workplace accident.

The evidence before the panel is that the worker sustained a significant left wrist injury at work on September 18, 2021. The injury involved a closed intraarticular distal radius fracture and ulnar styloid fracture, with a visible deformity noted at the emergency department. The severity of the injury is further demonstrated by the need for open reduction and internal fixation surgery on September 24, 2021. There is no dispute that these injuries arose out of and in the course of the worker’s employment and were accepted as compensable by the WCB.

The evidence establishes that the worker’s symptoms developed relatively soon after the accident and were localized to the injured left upper extremity. At the October 20, 2021 orthopedic follow-up, the worker reported pain and tightness in the fingers and wrist. The treating orthopedic surgeon observed swelling of the fingers, hand and distal forearm, reduced wrist range of motion and, importantly, identified early symptoms of CRPS. Physiotherapy was recommended. By December 22, 2021, the treating orthopedic surgeon had formally diagnosed CRPS and referred the worker to a pain clinic.

The timing of these findings is significant. The symptoms did not first arise years after the workplace accident or in circumstances unrelated to the accepted injury. Rather, they appeared during the worker’s recovery from a significant fracture and surgical repair of the same limb. The evidence therefore supports a temporal and clinical connection between the workplace injury and the subsequent development of CRPS.

Further support is provided by the April 27, 2022 assessment by an upper extremity physiotherapy specialist. The specialist documented reduced function of the left hand, swelling extending from the neck to the fingertips, pain radiating through the left upper extremity, skin deterioration, hypersensitivity, hesitation to move and guarding. The specialist was unable to test active or passive range of motion because of the worker’s reported pain. Based on the clinical presentation, the specialist diagnosed CRPS throughout the worker’s left upper extremity.

The panel places considerable weight on the fact that the diagnosis was not based solely on the worker’s complaints. There were observable findings, including swelling, skin changes, hypersensitivity, guarding and reduced function. These findings were documented by treating healthcare professionals at different points in the worker’s recovery. The diagnosis was also provided by multiple healthcare professionals, including orthopedic surgeons and anesthesiologists. The panel has also noted the confident language used by the diagnosing professionals, for example: “obvious CRPS”, “severe CRPS”, and “the most severe CRPS that I have seen in the history of my practice”.

The panel has considered the contrary opinion of the WCB physiatrist. At the May 18, 2022 call-in examination, the physiatrist was unable to complete a clinical examination of the worker’s left upper extremity because the worker could not tolerate movement or contact. The physiatrist subsequently concluded that the diagnosis of CRPS was not supported and that the worker’s ongoing difficulties were not related to the workplace injury. The Review Office relied substantially upon this opinion in concluding that CRPS was not supported.

The panel accepts that the WCB physiatrist’s opinion must be considered. However, the panel does not find it sufficient to outweigh the totality of the medical evidence supporting the diagnosis.

In particular, the May 18, 2022 examination did not provide a complete examination of the affected extremity. The inability to complete the examination was itself related to the worker’s inability to tolerate movement or contact with the left upper extremity. Consequently, the absence of findings from a complete clinical examination cannot reasonably be treated as definitive evidence that the worker did not have CRPS. The panel also notes that the physiatrist’s opinion was made in the context of an examination occurring several months after the treating orthopedic surgeon had already identified early CRPS symptoms and after the subsequent physiotherapy specialist had documented findings consistent with CRPS.

The panel also considers the additional pain clinic evidence reviewed by the WCB physiatrist in January 2023. While that evidence did not change the WCB’s opinion, it must be considered alongside, rather than in isolation from, the earlier clinical findings and the opinions of the treating healthcare professionals. The evidence as a whole demonstrates a consistent history of ongoing pain, swelling, hypersensitivity, restricted movement and functional impairment involving the same upper extremity that sustained the workplace injury.

The panel has also considered the issue of the worker’s pre-existing condition and the WCB’s conclusion that the worker’s ongoing difficulties were attributable, at least in part, to that condition. Under WCB Policy 44.10.20.10, a pre-existing condition may affect entitlement where it contributes to the severity of a workplace injury or significantly prolongs recovery. However, the existence of a pre-existing condition does not, in itself, prevent a subsequent condition from being compensable. The question remains whether the workplace accident materially caused or contributed to the condition for which acceptance is sought. In this case, the panel finds that the evidence establishes a direct connection between the accepted workplace injury and the development of CRPS. The worker sustained a substantial fracture to the left wrist requiring surgical fixation. Within approximately one month, the treating orthopedic surgeon identified early CRPS symptoms. The diagnosis was subsequently made by the same orthopedic surgeon and later supported by an upper extremity physiotherapy specialist and other treating healthcare providers. The clinical findings documented during this period are consistent with the diagnosis.

The panel is tasked with determining if it is more likely than not that the condition arose from the workplace accident. On the evidence before it, the panel finds that threshold has been met. The temporal relationship, the mechanism and severity of the workplace injury, the early emergence of symptoms, the clinical findings, and the repeated diagnoses by treating healthcare professionals collectively support the conclusion that the worker’s CRPS developed as a consequence of the September 18, 2021 workplace accident.

The panel finds, based on the information available at the time of the hearing, that the worker has CRPS, and is satisfied that the condition is causally related to the workplace injury of September 18, 2021.

The worker’s appeal is granted

Panel Members

R. Lemieux Howard, Presiding Officer
M. Kernaghan, Commissioner
R. Hambley, Commissioner

Recording Secretary, J. Lee

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

Signed at Winnipeg this 13th day of August, 2026