SUMMARY DECISION NO. 1689/98 Carpal tunnel syndrome. The worker appealed a decision of the Appeals Officer denying entitlement for carpal tunnel syndrome. The condition was a disablement from the nature of the worker's work deburring small parts, which was repetitive work also requiring exertion of force with his hand. The appeal was allowed. [6 pages] DECIDED BY: Sutherland DATE: 10/06/99 ACT: WCA
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1689/98 [1] This appeal was heard in London on October 28, 1998, by Tribunal Vice-Chair, S.J. Sutherland. THE APPEAL PROCEEDINGS [2] The worker appealed from the decision of the Appeals Officer, N. Berman, dated September 30, 1997. In this decision, the Appeals Officer denied the worker initial entitlement to benefits for carpal tunnel syndrome that the worker related to his workplace activities. [3] The worker was present and was represented by J. Dunn, of the Canadian Autoworkers Union. The employer was present in the person of its operations director, and was represented by D. Jeffries, a lawyer. [4] After the hearing I instructed Tribunal counsel to find out from the Board whether it paid for the worker s electrodiagnostic studies and carpal tunnel release surgery. The Board s response was dated February 4, 1999. Mr. Dunn s final written submissions were dated February 24, 1999. Mr. Jeffries submissions were dated February 12, 1999. THE EVIDENCE [5] I had before me at the hearing, the Case Record and two Addenda. These were marked as Exhibits #1, #2 and #3, respectively. I also had correspondence dated September 9, and October 5, 1998, from the employer s representative. These documents were marked as Exhibits #4 and #5. [6] The worker gave evidence under oath. Messrs. Dunn and Jeffries made brief opening remarks and closing submissions. THE ISSUES [7] I am asked to determine whether the worker s carpal tunnel syndrome resulted from his workplace activities and whether he is, therefore, entitled to benefits for this condition. THE REASONS (i) Background [8] The worker was almost 53 years old at the time of the hearing. He began working for the employer, a manufacturer of valves, in 1965. He developed right carpal tunnel syndrome and a right tennis elbow. He had the right carpal tunnel released and transposition of the right unlnar nerve at the
Page: 2 elbow, in 1988. He experienced a gradual onset of pain in his left elbow and numbness in his left hand in 1995. His family physician, Dr. D. Miettinen, diagnosed a left elbow strain and possible left carpal tunnel syndrome on November 8, 1996. Following investigation, left carpal tunnel syndrome was confirmed in January 1997 and it was released on February 4, 1997. [9] The worker applied for benefits for the carpal tunnel syndrome. His claim was denied by the Claims Adjudicator on the ground that there was no proof that the injury arose out of or in the course of his employment. The Appeals Officer upheld the Claims Adjudicator s decision. [10] The worker has appealed to the Tribunal. (ii) The worker s testimony [11] The worker brought a grinder and a small part to the hearing so that he could demonstrate the actions required in his job. [12] He began his testimony by describing the job he did, deburring small parts. He said that the part was on a table. He rested his forearms on the table. He held the part in his left hand, usually at a 45 angle, and used his right hand to hold the tool and deburr. He used one of three different grinders and a small belt sander. The strength of grip that was required would depend on the part. The largest valve he worked on was about 20 pounds. He had to flex his wrist constantly to turn the valves while he deburred them. It took from 5 to 40 minutes to deburr a valve. [13] In addition to deburring, the worker ran a sand-blaster and a wash tank, and did about a half hour of janitorial work each day. He said that he might deburr 20 parts at a time. He would wash them and put them on skids. He used the sand-blaster while the parts were washing. He worked constantly, with a 20 minute lunch break and informal breaks in the morning and afternoon. He did this job between 1991 and 1996. He had the carpal tunnel release surgery in February 1997 and returned to work in March 1997. He deburred until the plant closed in the summer of 1997. [14] The worker testified that when his wrist started to hurt, he would leave the deburring and do something else for a while. [15] In response to questions from Mr. Jeffries, the worker said that he had no hobbies or sports that could account for the development of the carpal tunnel syndrome. He did not play a musical instrument. He did not ride a bicycle. [16] The worker stated that he had previously had bilateral trigger fingers, which had been repaired. This was not a workers compensation claim. He worked as a janitor and required right ulnar nerve transposition. This was followed by the right carpal tunnel release surgery. Both these conditions were covered by workers compensation. [17] The worker testified that he has no ongoing problems with either hand.
Page: 3 (iii) The medical evidence [18] The Physician s First Report was prepared by Dr. Miettinen on November 11, 1996. Dr. Miettinen diagnosed a left elbow strain and possible left carpal tunnel syndrome. He gave the worker a wrist split and referred him to Dr. B. Deathe, a specialist in physical medicine and rehabilitation. [19] Dr. Deathe examined the worker and carried out electro-physiological studies on December 17, 1996. He concluded that the worker had a moderate to moderately severe left median nerve carpal tunnel entrapment at the level of the wrist. Dr. Deathe recommended surgery to release the left carpal tunnel. [20] The worker was referred to Dr. D.W. Denton, a general surgeon. Dr. Denton examined the worker on December 30, 1996, and reported that he would be operating on the worker. His report also said work activity is precipitating numbness and tingling in the median nerve distribution. On January 24, 1997, Dr. Denton advised that the surgery would take place on February 4, 1997. After the operation, Dr. Denton reported that the surgery proceeded uneventfully and the worker was in satisfactory condition. [21] On May 29, 1997, Dr. Denton reported that the worker had pain and discomfort in the palm of his left hand. Dr. Denton opined that the discomfort was caused by scar tissue and injected the area with steroid on June 9, 1997. [22] On April 23, 1998, Dr. Denton said: Carpal tunnel syndrome results in pressure on the median nerve and work activity will precipitate symptoms of carpal tunnel syndrome. I do not have final decision in Workers Compensation matters. As you know, that rests with the Workers Compensation Board, however I do feel that carpal tunnel syndrome is a work related problem. In the office patients report work activity producing numbness and tingling and generally I feel this is a work-related injury. [23] Dr. Denton reported, on February 18, 1999, that he submitted a bill for $144.00, for the worker s left carpal tunnel release surgery which was performed on February 4, 1997, to the Board on February 5, 1997. The Board paid this bill in full on March 14, 1997. (iv) Post-hearing activities [24] During the hearing, the worker testified that although he was denied wage loss benefits, the Board paid the doctors who treated him and paid for his surgery. Therefore, after the hearing I instructed K. Hardinge-Brown of the Tribunal Counsel Office to contact the Board and determine whether it paid for the electrodiagnostic studies, surgery, and steroid injection. The Board s response was dated January 14, 1999 and said: Dr. Deathe electrodiagnostic studies 17 December 1996. Did pay $22.27 for the report only. Hospital did not bill for EMG studies. 04 February 1997 Dr. Denton s report only. Not the surgery - not billed for the surgery.
Page: 4 09 June 1997 We paid for a report from Dr. Denton and were billed for the procedure (injection) and H.C.B. [Health Care Benefits] rejected the account. [25] On February 12, 1999, Mr. Jeffries submitted that the facts outlined in the Board s report were consistent with the Board s denial of the worker s claim and asked that that denial upheld. [26] Mr. Dunn submitted, on February 24, 1999, that the worker s left carpal tunnel syndrome resulted from his employment and he ought to receive benefits for this condition. (v) Law and Board policy [27] On January 1, 1998, the Workplace Safety and Insurance Act (WSI Act) took effect. This legislation amends portions of the Workers Compensation Act, which continues to apply to injuries which occurred before January 1, 1998. All references to the Act in this decision mean the Workers Compensation Act as it read on December 31, 1997, unless otherwise indicated. [28] Section 4(1) of the pre-1997 Workers Compensation Act provides that where personal injury by accident arising out of and in the course of employment is caused to a worker, the worker is entitled to benefits in the manner and to the extent provided by the Act. Tribunal cases generally have interpreted the test for causation to be whether the work accident was a significant contributing factor to the disability. [29] The word accident is defined in section 1(1)(a) of the Act as both a chance event occasioned by a physical or natural cause and as a disablement arising out of and in the course of employment. [30] An important change that is relevant to this appeal is that the Appeals Tribunal is now required to apply Board policy in accordance with sections 112 and 126 of the WSI Act. As is required by section 126 of the WSI Act, the Board advised the Tribunal of the policies that are applicable in this appeal. (vi) Conclusions [31] The issue before me is whether the worker s left carpal tunnel syndrome was caused by his employment activities. For the reasons that are set out below, I find that it was. [32] The Claims Adjudicator did not seek an opinion from a Board Medical Advisor before denying the worker s claim. Therefore, the only medical opinions with respect to causation that I had before me were those of Dr. Denton. It will be remembered that Dr. Denton stated on April 23, 1998, that workplace activities precipitated carpal tunnel syndrome symptoms and that he generally felt that carpal tunnel syndrome was a work-related injury. I am struck by the fact that Dr. Denton did not go one step further and say that this worker s left carpal tunnel syndrome resulted from his employment. However, I note that Dr. Denton did attribute the worker s condition to his workplace activities in his report dated December 30, 1996. [33] Although the Board denied paying for the worker s carpal tunnel release surgery of February 4, 1997, it appears from Dr. Denton s records that he submitted a bill to the Board and the Board paid it.
Page: 5 [34] I note that the Board accepted the worker s claim for benefits for the release of his right carpal tunnel and the transposition of the right ulnar nerve. This injury occurred when the worker was doing a different job, but it, and the worker s bilateral trigger fingers, suggest to me that the worker was vulnerable to this kind of injury. [35] I find that the worker s employment activities, deburring parts for more than five years, likely caused the carpal tunnel syndrome to occur in the worker s non-dominant left hand. In coming to this conclusion, I note and accept the worker s testimony with respect to the angle that he held the part in his left hand in order to deburr it, the fact that this required him to work with his left wrist flexed constantly, the fact that the work was repetitive, and the fact that he was required to exert force with his left-hand. THE DECISION [36] The appeal is allowed. The worker is entitled to benefits for left carpal tunnel syndrome. I leave to the Board the determination of the nature and quantum of benefits that flow from this decision. DATED: June 10, 1999 SIGNED: S.J. Sutherland