WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20090006
OBJECTION BY: Worker
EMPLOYER: Not Participating
HEARING DATE: N/A
ISSUE
The amount of the non-economic loss award.
HOW THE ISSUE ARISES
The worker, an assembler employed since August 8, 2006 experienced bilateral finger discomfort installing engines. Entitlement was accepted for bilateral trigger thumb with an accident date of October 25, 2006.
The worker was assessed at a regional evaluation centre (REC) in April 2007 where he was diagnosed with a repetitive strain injury to the forearms and hands. Temporary restrictions were recommended for four months.
X-ray, bone scan and EMG were reported as normal.
The worker was referred to the Hand and Upper Limb Clinic (HULC) in July 2007. In September 2007, he continued to have tingling and numbness in the ulnar aspect of both hands and continued to have symptoms of triggering of both thumbs. It was recommended that the left flexor pollicis longus tendon sheath be injected. The worker preferred not to proceed with this.
A permanent impairment was accepted in December 2007 for bilateral trigger thumb. Maximum medical recovery was identified as of July 4, 2007 when the worker saw Dr. Roth at the HULC. Restrictions were identified for repetitive gripping, grasping and pinching; heavy lifting. Further chiropractic treatment was not approved.
The worker was assessed for a non-economic loss (NEL) award on February 22, 2008 and this was rated on April 14, 2008 resulting in a 9 percent NEL award.
AUTHORITY
11-01-05 Determining Maximum Medical Recovery (MMR)
18-05-03 Assessing Permanent Impairment
18-05-04 Calculating NEL Benefits
18-05-05 Effect of a Pre-existing Impairment
18-05-09 Redeterminations and Recalculations
RESOLUTION METHOD & PROCESS
This appeal was resolved using the information contained on the claim record.
ASSESSMENT OF THE EVIDENCE
The NEL award is calculated according the Guides to Evaluation of Permanent Impairment, 3rd Edition, Revised (AMA guides).
The AMA guides direct that range of motion be used to assess hand impairments unless this underestimates the impairment and then other measures can be used. For example, where range of motion is normal, other measures can be used to assess the impairment.
When there is neurological impairment, this would also be assessed and included in the award. In this case, there is no evidence of a neurological impairment. The EMG was normal and the NEL doctor did not identify any neurological impairment.
The worker does have loss of range of motion and the non-economic loss award was calculated based on the loss of range of motion. The loss of range of motion of both thumbs was measured and recorded at the time of the NEL assessment on the Hand Recording Form. I double checked that the measures were correctly entered onto the NEL Evaluation and that the ratings for each measure were assigned correctly.
I am satisfied that measuring the reduced range of motion across a number of movements reflects the impairment. I considered that if the worker was rated instead for the persistent joint subluxation and dislocation of the thumb, the rating would be less.
Range of motion was assessed in both thumbs for adduction, radial abduction, opposition retained, flexion and extension of the joints in the thumb. The ratings are outlined on page 2 of the NEL Evaluation. The ratings were calculated using figures 10, 13 and tables 5, 6, 7 on pages 21, 21, 23, 24 of the AMA guides, respectively.
The values for loss of range of motion for the left thumb were added for a total of 26 percent for the loss of range of motion of the left thumb. This was converted to an impairment of the left hand using table 1 on page 15 of the AMA guides. The rating reduced to 10 percent. The left hand rating was then converted to a left arm impairment using table 2 on page 16 of the AMA guides. The rating reduced to 9 percent. The left arm impairment was converted to a whole person impairment using table 3 on page 16. The rating reduced to 5 percent.
The values for loss of range of motion for the right thumb were added for a total of 18 percent for the loss of range of motion of the left thumb. This was converted to an impairment of the left hand using table 1 on page 15 of the AMA guides. The rating reduced to 7 percent. The left hand rating was then converted to a left arm impairment using table 2 on page 16 of the AMA guides. The rating reduced to 6 percent. The right arm impairment was converted to a whole person impairment using table 3 on page 16. The rating reduced to 4 percent.
The whole person rating for the left hand was combined with the whole person rating for the right hand using the combined values chart on page 254 of the AMA guides. The result was 9 percent.
The NEL award was correctly calculated.
CONCLUSION
The NEL award is confirmed at 9 percent.
The objection is denied.
DATED September 21, 2009
J. Cantwell
Appeals Resolution Officer
Appeals Branch