SUMMARY DECISION NO. 984/98. Delay (onset of symptoms). DECIDED BY: Sandomirsky; Rao; Howes DATE: 31/01/2001 NUMBER OF PAGES: 6 pages ACT: WCA

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1 SUMMARY DECISION NO. 984/98 Delay (onset of symptoms). DECIDED BY: Sandomirsky; Rao; Howes DATE: 31/01/2001 NUMBER OF PAGES: 6 pages ACT: WCA

2 2001 ONWSIAT 247 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 984/98 [1] This appeal was heard on June 24, 1998, by a Tribunal Panel consisting of: J. Sandomirsky : Vice-Chair, G.K. Howes : Member representative of employers, F. Rao : Member representative of workers. The post-hearing process was completed on August 28, THE APPEAL PROCEEDINGS [2] The worker appeals the decision of Appeals Officer, dated August 14, That decision denied his claim to entitlement to benefits for a low back injury arising out of an incident at work on July 24, [3] The worker appeared at the hearing with his representative M. Green, barrister and solicitor. The employer is no longer in business. THE RECORD [4] The following documents were marked as exhibits to the hearing: the Case Record, Volumes #1, #2 and #3; Addendum #1; the Scarborough General Hospital Emergency Nursing Assessment; and letters from M. Green with attached clinical notes from Dr. Ho-A-Yun. The worker provided evidence under oath and Mr. Green made submissions. [5] Subsequent to the hearing, the Panel obtained additional medical information from the worker s treating physician, Dr. P. Matzko, and a copy of the worker s Board file for his 1986 back claim. The clinical notes from Dr. Matzko were not available as he has retired, but the worker's wife was able to provide us with copies of his reports to the Ministry of Community and Social Services between July 1989, and November [6] After receiving these documents, the Panel arranged to have the case reviewed by a Tribunal Assessor. We received a medical report from Dr. H.B. Abrams. Mr. Green provided further written submissions on the post-hearing material. All of the post-hearing documents were compiled into Post-Hearing Addendum #1, #2, and #3. THE ISSUE [7] The worker suffered a fainting spell at work on July 24, He claims that he injured his back when he fell. The Board denied the claim on the basis that there was no evidence that anything in the workplace caused the fainting spell, or that the worker suffered a low back injury as a result of the fainting spell.

3 Page: 2 Decision 984/98 THE REASONS (i) Claim background [8] The worker was employed at a general labourer for the accident employer. This work involved steel fabrication. [9] The history of the worker s case is somewhat complicated by the fact that he made three compensable claims in the period between March 1989 and July Prior to his fainting spell in July 1989, the worker lost time from work due to respiratory problems. He related these problems to irritants in the workplace. The worker began to have breathing problems in 1986/87 while working as a labourer on the epoxy line. He experienced shortness of breath, dizziness, nausea and weight-loss. [10] The worker claimed entitlement to benefits for a work-related respiratory disablement. Dr. Matzko, who treated the worker s respiratory complaints starting in 1987, was of the opinion that he suffered with a chemical irritation affecting his lungs caused by exposure to fumes at work. [11] The Ministry of Labour arranged for an investigation of the work environment and further medical testing of the worker. On the basis of the information collected regarding the make-up of the epoxy and other chemicals used at the plant and the medical tests, the Board concluded that there was no evidence of chest or lung disease and denied the worker s claim. The adjudication of this exposure-related claim overlapped with the adjudication of the July 24, 1989, accident claim. [12] The worker also claimed entitlement to benefits for a chest injury on March 20, The Board allowed the claim and the worker was off work between March 20, 1989, and June 12, 1989, as a result of that injury. When he returned to work, he was placed in another part of the plant, away from the epoxy line, working on the bending machines. [13] The worker then suffered a fainting episode at work on July 24, He was treated at the Scarborough General Hospital. He claimed that he injured his back when he fell, and that he continues to have back pain related to that accident. There was no mention in the emergency report of back pain. The worker stated that there was little medical attention paid to his back complaints because the primary focus of the doctor s investigations continued to be related to his respiratory problems. The reports from Dr. Matzko to Community and Social Services first noted low back problems with pain radiating into the legs in January [14] The worker was treated by two specialists. Dr. Matzko referred him to Dr. P. Baer, a rheumatologist, because of complaints of pain in the neck, low back and upper and lower extremities. Dr. Baer also noted that the worker complained of chronic fatigue, diffuse tenderness and burning. He diagnosed diffuse myalgias and arthralgias with some elements of fibrositis syndrome. Dr. Baer wondered if these symptoms were related to toxin exposure at work. In a follow up report dated January 18, 1990, Dr. Baer noted that the worker was improving with the physiotherapy. [15] Dr. Matzko referred the worker to Dr. P.J. McGrath, an orthopaedic surgeon, in October Dr. McGrath sent the worker for a CAT scan, which showed a moderate to large disc herniation at the L5-S1. Dr. McGrath thought that the herniation may have been responsible for some of the aches and pains the worker experienced in his legs.

4 Page: 3 Decision 984/98 [16] The worker had a prior back injury in 1986 after a lifting incident at work. He lost approximately one month from work as a result of that injury. A x-ray report dated March 25, 1986, was reported to be normal. The worker testified that he did not have any further back problems when he returned to work after the compensable back strain in (ii) Post-hearing evidence [17] The Panel identified a number of issues in this case. We asked for a medical assessor to assist with our consideration of the relationship between the worker s respiratory condition and exposure to fumes at work; the likely cause of the fainting episode on July 24, 1989; and whether the fall on July 24, 1989, likely resulted in a back injury. [18] In response to the Panel s concerns, we received a medical report from Dr. Abrams noting the following answers to our questions: 1. What was the likely cause of the workers fainting episode July 24, 1989? In what way, if any, did the work environment on that day contribute to the accident? The likely cause was a vaso-vagal episode. The temperature that day was stated as hot, which could have contributed to causing this episode. There may have been some postural change preceding the event, but this has not been stated. In a computer search of the Medline database from January 1966 to May 2000, there are no articles linking fainting episodes i.e. vaso-vagal syncope, with occupational exposures or airborne pollutants. 2. What is the probable diagnosis of the workers condition? What factors may have contributed to its development? There is no specific condition related to this episode, aside from the possibility of transient vaso-vagal syncope which can occur in the absence of identifiable causes, or may contributed to by such things as heat, stress, dehydration, or postural change. 3. Is it likely that the effects of the July 24, 1989, accident produced ongoing respiratory impairment following removal from the workplace? It is extremely unlikely that this incident produce ongoing respiratory impairment. The report from Dr. Monique Forse (respirologist), August 14, 1989, states that this patient s Pulmonary Function Tests were normal, and that the methacholine challenge was negative. I agree with Dr. C.C. Gray s statement in his letter of August 29, 1990 that it is not possible to consider that this worker may have continuing impairment of pulmonary function. Also it would appear most unlikely that there is any sensitizing agent at work that has been responsible for this worker s complaints. In summary, if this worker now has respiratory problems, they are unrelated to his work environment or the incident of July 24, The worker claimed to have breathing problems related to exposures at work prior to the fainting episode. The Board denied this claim and the worker was no longer working in the epoxy area in July In what way, if any, was it likely that the worker s pre-existing difficulties contributed to the accident? There is no way in which pre-existing difficulties stated by the worker would have contributed to this incident. 5. What if any evidence is there in the medical reports on file that the worker did/did not injure his back when he fell on July 24, There are no medical reports of a back injury at the time of the incident. 6. What is the likelihood that there was a relationship between the fall in July 1989 and the findings by Dr. McGrath in October and November 1991?

5 Page: 4 Decision 984/98 (iii) There is very little likelihood that there is any relationship between the fall in July 1989 and the findings by Dr. McGrath in October and November In 1986, [the worker] had reported low back pain, preceding his fall by three years. In July, 1989, at the time of his fall, there is no medical documentation of concerns regarding low back pain, weakness, or paraesthesiae (tingling) in his legs. On November 10, 1989, an examination by Dr. Philip A. Baer did not show any signs suggestive of low back problems. [The worker s] diffuse myalgias and arthralgias, with multiple fibrositic trigger points, was more consistent with some elements of a fibrositis syndrome. On May 29, 1991, [the worker] was examined by Dr. M. Stuparyk, who found no neurological or musculoskeletal problems. In October/November 1991, Dr. McGrath documents some musculoskeletal and neurological complaints, and a CT scan shows a moderate-large disc herniation at the L5-S1 level. Dr. McGrath did not feel a myelogram was warranted at that time. Given the above history, it is more likely that the disc herniation documented in 1991 occurred at some time after May 29, 1991, if this indeed was the cause of [the worker s] symptoms. It is known that disc herniation on CT scan does not always correlate with symptomatic disease. Submissions [19] At the hearing, Mr. Green accepted that the worker was not exposed to epoxy fumes at the time of the fainting episode. He argued, however, that the worker was exposed to steel dust and fumes from the bending machine he was working on the day of the accident, which, combined with the extreme heat of the day, caused him to faint. [20] Mr. Green submitted that the worker injured his back as a result of the fainting episode. He noted that the worker had no pre-existing back problem, that he fell and landed on his back, and that the delay in reporting the onset to the doctor was explained by the dominant respiratory problems. Mr. Green argued that the worker s exposure to fumes and heat caused the fainting spell and there was no evidence of anything else causing the worker to faint. [21] In his written submissions in response to the report from Dr. Abrams, Mr. Green argued that Dr. Matzko s reports from January 19, July 27, 1990, and April 16, 1991, all indicated that the worker complained of lower back pain with spasm and radiation to the leg. He argued that these clinical findings put into doubt Dr. Abrams conclusion that the disc herniation likely occurred after May 29, 1991, when he was examined by Dr. Stuparyk. [22] Mr. Green submitted that the true issue in the appeal was whether it was likely that the disc herniation resulted from the July 1989 fall, in light of the absence of reported findings between July and November 1989, when the worker saw Dr. Baer. He argued that the symptoms of a disc herniation may take several months to appear after an accident, especially where there are other conditions overshadowing the low back and leg symptoms. In this case, Dr. Matzko s report indicated that, even after radicular symptoms were noted, the focus remained on the respiratory condition. Mr. Green submitted that Dr. Abrams report was of little assistance in addressing the issue raised by the reports of the treating doctors, and that there was sufficient evidence to conclude that the worker s disc herniation was related to his fall in July 1989.

6 Page: 5 Decision 984/98 (iv) Findings [23] After reviewing the worker s evidence, the medical reports, Dr. Abrams report and considering Mr. Green s submissions, the Panel concluded that the evidence did not support the worker s claims that the fainting episode on July 24, 1989, was causally related to the workplace, or that the disc herniation diagnosed in 1991 was a result of the fall at work. [24] In reaching this conclusion, the Panel put particular weight on the fact that there was no report of back complaints in the medical reports until January Dr. Matzko s report to social services in January 1990 notes lower lumbar pain and radicular pain in legs. This diagnosis is repeated in the July 1990 and April and November 1991 reports. The worker saw Dr. McGrath in October 1991, who diagnosed a disc herniation. None of the reports comment on what might be the cause of the worker s complaints of pain and discomfort. [25] While we accept Mr. Green s point that the worker complained of lower back pain and radiation into the leg more that a year before he was seen by Dr. McGrath, it remains that, aside from the general reference of complaints of aches and pains in Dr. Baer s reports, the report of back pain radiating into the leg were first documented by Dr. Matzko in January 1990, six months after the incident at work. [26] As a result, the Panel concluded that the balance of evidence does not support the worker s claim that he suffered an injury to his back when he fell at work on July 24, The Panel also accepts Dr. Abrams opinion, which confirmed the concluded reached by the investigators from the Ministry of Labour, that the fainting spell was not related to exposures at work. THE DECISION [27] The worker s appeal is denied. DATED: January 31, SIGNED: J. Sandomirsky, G.K. Howes, F. Rao