SUMMARY DECISION NO. 2855/00 Disablement (repetitive work); Aggravation (preexisting condition) (arthritis); Sewing machine operator. DECIDED BY: Henderson; Lebert; Donaldson DATE: 09/01/2001 NUMBER OF PAGES: 7 pages ACT: WCA
2001 ONWSIAT 49 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2855/00 [1] This appeal was heard in Windsor on October 31, 2000 by a Tribunal Panel consisting of: L.J. Henderson J.J. Donaldson R.J. Lebert THE APPEAL PROCEEDINGS : Vice-Chair, : Member representative of employers, : Member representative of workers. [2] The worker appeals the decision of an Appeals Resolution Officer, dated July 29, 1999. That decision concluded that the worker was not entitled to initial entitlement for bilateral conditions in the hands and wrists arising out of her employment duties. [3] The worker appeared and was represented by Mr. Paul Laporte of the Office of the Worker Adviser. The employer was represented by Ms. T. Goff, a law clerk. THE RECORD [4] The Panel considered the following materials marked as exhibits: Exhibit #1: the Case Record prepared by the Tribunal Counsel Office dated June 19, 2000; Exhibit #2: the Hearing Certification letter dated June 23, 2000; Exhibit #3: Addendum No. 1 dated October 2000. [5] Oral evidence was heard from the worker. THE ISSUES [6] The Panel must determine whether the worker s bilateral hand and wrist conditions arose out of or were aggravated by her employment, resulting in disability. (i) Background [7] The worker, who was born on May 11, 1928, worked as a sewer for the accident employer from 1970 to 1990 when she retired. [8] The worker s claim for ongoing bilateral hand/wrist condition arising from her employment duties was made in December of 1994. As a result, the Board conducted an investigation of the work duties and medical compatibility. [9] Requests were made of the employer for the worker s medical history pertaining to the hands and wrists. The Board also requested information from all of her attending physicians.
Page: 2 Decision No. 2855/00 [10] The Case Record indicates that the Board Medical Adviser reviewed all of the medical information and the work duties and concluded that the worker had arthritis and this was not job-related. (ii) The worker s testimony [11] The worker stated that she was employed at the accident employer, a large motor vehicle company, from 1970 as a power sewer. She began noticing symptoms of pain in her fingers on a gradual basis in 1974. By 1981, she noticed more pain in her fingers and also some deformity. [12] She continued to experience pain and visited the First Aid Nurses Area in 1982. She received treatments of ice and/or wax sometimes on a daily basis and sometimes twice a week. Her evidence is supported by a copy submitted by the company of the worker s attendance at the First Aid Nurses Area for pain in her fingers, hands or wrists between 1982 and 1989, some 57 visits. [13] The worker stated that she took very little time off work. She missed a day here and there. She stated that she could not afford to miss work since she was a single mother supporting six children. [14] Between 1982 and 1987, she worked on the sun shades job which required overtime consisting of six days a week. These periods of overtime could last for as long as three months each time. [15] Over the years she attended with her family physician and medical specialists who diagnosed her condition as arthritis and provided medication and prescribed physiotherapy. [16] On October 1, 1990, the worker stated that she voluntarily stopped work. She stated that she could not do the work anymore. The work was heavier with larger pieces for the truck line. This type of work caused her more severe pain and swelling at the end of the shift. [17] When she was off work, after a few days, the pain lessened. (iii) Medical evidence [18] Dr. P. Khulman noted that: When this patient first presented in my office on the 4th May 1978, she stated that she had suffered from chronic synovitis of the left 4 th finger for several years. X-ray of the left ring finger performed on May 4, 1978 had shown: Moderately severe degenerative arthritis of the proximal interphalangeal joint with overlying soft tissue swelling. Dr. Khulman referred the worker to Dr. J. Barber, orthopedic surgeon. [19] On May 26, 1978, Dr. Khulman reviewed Dr. Barber s consultation report with the worker: The diagnosis is one of degenerative changes of the proximal joint of the left ring and left little fingers.
Page: 3 Decision No. 2855/00 Dr. Barber did question the possibility of early rheumatoid arthritis. [20] On November 12, 1981, the worker complained to Dr. Khulman of pain in the distal interphalangeal joint of the left 3 rd finger. In addition, the worker complained of a swelling above the left wrist and an examination by Dr. Khulman revealed the presence of ganglion. [21] On November 16, 1982, the worker complained of an acute severe flare-up of pain in the left ring (4 th ) finger. Dr. Khulman referred the worker to Dr. E. Fung, a rheumatologist. [22] Dr. Fung saw the worker on January 24, 1983 who assessed the worker as follows: The worker has moderately symptomatic osteoarthritis, mainly in the left hand. He prescribed Feldene along with wax baths for the hands. Dr. Fung also noted: The pain tends to be aggravated by excessive usage and she is feeling less symptoms on vacation when she was off. [23] The worker attended with a new family physician, Dr. C. Sinclair, on January 13, 1987 with complaints of pain to the right wrist area. Dr. Sinclair diagnosed DeQuervain s tenosynovitis. [24] Dr. Sinclair indicated in a report requested by the Board Investigator as follows: This is an inflammation of the tendon in the wrist likely from overuse concerning her job as a sewer. [25] Dr. Sinclair saw the worker again on March 22, 1988. At that time, she complained of pain to the hands and wrist areas bilaterally. On examination, he found the worker to be tender to all of the fingers of both hands, the dorsum of the hands and the dorsum of the wrist area. She had swelling in the DIP joints with decreased range of motion. She also had a positive Tinel sign in the wrist indicative of carpal tunnel syndrome. [26] X-rays taken on March 22, 1988 indicated that: She had diffuse degenerative arthritic change involving the radiocarpal, intercarpal MP and IP joints. She also had severe involvement of the (R) trapezium, first metacarpal and the distal IP joints. [27] On April 23, 1988, the worker had her right wrist x-rayed and this x-ray showed: Severe degenerative arthritis in the first carpal metacarpal joint. [28] On February 6, 1989, the worker complained to Dr. Sinclair of pain to the fingers particularly the left hand. On his examination, Dr. Sinclair noted that: She was found to be tender to the fingers particularly the (L) fifth finger and she seemed to have a flexion deformity from the swelling. The diagnosis of tendonitis and/or arthritis was made and she was given a prescription of Dolobid 500 mg to be taken twice a day. [29] On February 5, 1994, she attended with Dr. Sinclair complaining of pain to both hands. His examination showed diffused arthritis.
Page: 4 Decision No. 2855/00 [30] She was seen by Dr. Sinclair on July 12, 1994 with complaints of pain to hands and wrists particularly the right. [31] She was referred to Dr. Sion, a hand surgeon, on July 29, 1994, who examined the worker and ordered x-rays. Dr. Sion diagnosed right carpal, metacarpal joint arthritis. The x-rays revealed: A large osteophyte formation, subluxation of her base of the first metacarpal and collapse of the carpal-metacarpal joint. [32] The worker attended with Dr. A. Reinhartz of the Occupational and Health Clinic for Ontario workers on November 13, 1997. Dr. Reinhartz sent her for x-rays of her left hand as well as a bone scan with the hypothesis that ligament laxity at the thumb caused by repetitive work led to some bone-on-bone instability and therefore her severe bilateral osteoarthritis of the thumb. [33] Dr. Reinhartz reports on March 18, 1998 to Dr. Sinclair as follows: Stress views on the left showed widening of the lateral margin of the left first CMC joint compatible with ligamentous damage at this site and on the right on lateral stress there was lateral subluxation of the first CMC joint. This would be consistent with weakness of the ligamentous attachments. I think that it would be safe to say that the worker s osteoarthritis of both hands is secondary to repetitive work. She does have joint laxity present at the thumbs, which indicates ligamentous damage. This is more than likely on the basis of her years at [the accident employer] and repetitive use. This resulted in some instability of the thumbs which has then led to her osteoarthritis. Therefore, I think that her osteoarthritis is more than likely work-related. [34] Dr. Heckadon, Board doctor, in his memo dated January 15, 1999 states: It is probable that the injured worker had a pre-existing condition of arthritis of major extent which was aggravated by the hand sewing but there are no reports to verify circumstances of the onset of the problem. The laxity of the thumb ligaments could come from the constant inflammatory changes with swelling which may or may not be directly work-related noting that any activity with hands causes ligamentous stressing. Als o the osteoporosis noted in 1994 is probably age-related rather than job-related. Dr. Heckadon concluded: (iv) It seems that arthritis was not job-related. Relevant law and policy [35] The Board has provided the Tribunal with the applicable policies in accordance with Section 126 of the Workplace Safety and Insurance Act, 1997 (the WSIA). Policy Package #31: Policy Package #35: New Disability Related to the Original Accident Healthcare Expenses
Page: 5 Decision No. 2855/00 (v) The Panel s conclusions [36] The question before us is whether the worker s employment as a sewer aggravated or caused the bilateral hand/wrist condition such that she is entitled to compensation due to disablement arising out of and in the course of employment. [37] The Panel accepts the testimony of the worker who was straightforward and sincere. We accept that the worker began experiencing pain and soreness in 1974, a few years after beginning of her employment as a sewer. She stated that she sought treatment regularly in the Nurse s Aide Clinic at the company. The Case Record contains a copy of the First Aid records from the company dating from September 1982 to December 20, 1989. That Record contains documentation of 57 visits by the worker with complaints related to the fingers, hands and/or wrists. [38] The Panel accepts the worker s testimony that she had no pain in her fingers, hands or wrists before starting the sewing job with the accident employer. She also stated that she had no arthritis in any other parts of her body [39] The Panel has reviewed all of the medical evidence in detail and we note the progression of the worker s disease after it began in 1974. The evidence is clear that her condition continued to deteriorate over the years until she could no longer perform the heavy sewing jobs due to her hand disability. [40] The Panel notes that Dr. E. Fung, the rheumatologist who examined the worker in January of 1983, noted: The pain tends to be aggravated by excessive usage and she is feeling less symptoms on vacation when she was off. [41] Dr. Sinclair, in his March 1995 reports to the Board, provides the diagnosis of DeQuervain s tenosynovitis. He states: This is an inflammation of the tendon in the wrist likely from overuse concerning her job as a sewer. [42] Dr. Reinhartz in his report of March 1998 concluded that the condition of arthritis bilaterally would be secondary to repetitive work and that the worker has ligamentous damage on the basis of repetitive work as a sewer. [43] Dr. Heckadon in his January 1999 memo states: It is probable that the injured worker had a pre-existing condition of arthritis of major extent which was aggravated by the hand sewing [44] But Dr. Heckadon goes on to indicate that there were no reports to verify circumstances of the onset of the problem. Dr. Heckadon also states: The laxity of the thumb ligaments could come from the constant inflammatory changes with swelling which may or may not be directly work-related noting that any activity with hands causes ligamentous stressing.
Page: 6 Decision No. 2855/00 [45] Weighing all of the evidence, we are persuaded on a balance of probabilities that the worker s bilateral hand and wrist condition worsened over time due to her work duties and aggravated her pre-existing condition of arthritis. THE DECISION [46] The worker s appeal is allowed. DATED: January 9, 2001 SIGNED: L.J. Henderson, J.J. Donaldson; R.J. Lebert r