WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100015
OBJECTION BY: Worker
PARTICIPANTS: Worker, Worker Representative, Employer
HEARING DATE: N/A
ISSUE
The worker objects to the decision of October 21, 2008 to deny entitlement to a left rotator cuff condition and associated benefits.
HOW THE ISSUE ARISES
On June 15, 1979, this now 68 year old worker experienced pain in his left low back and hip while swinging a sledge hammer. At the time of injury, the worker was employed as a mechanic. In the month following the accident, he reported that the pain spread to his entire left side, including the neck, left upper extremity, and low back.
The worker’s complaints of low back and left lower extremity pain persisted and he was eventually found to have a permanent low back impairment. With regard to the neck and left upper extremity, the worker continued to report left-sided neck pain radiating to the left shoulder, arm, and hand. Findings pertaining to the left upper extremity included diffuse tenderness affecting all soft tissue in and around the left shoulder. Health practitioners observed a significant degree of non-organic complaint related to the neck, upper extremities, low back and lower extremities. The worker underwent numerous medical assessments during the period 1979 to 2007; however none of the attending specialists documented any complaints or findings to suggest significant rotator cuff injury.
In May 1994, the attending neurologist diagnosed the worker’s left neck, shoulder and arm complaints as thoracic outlet syndrome (TOS). Entitlement to these complaints was granted at appeal in a decision dated December 16, 1985. The worker was eventually granted a 20% permanent disability award for the low back impairment and a 10% permanent disability award for the neck, shoulder and arm impairment diagnosed as TOS.
The worker developed reactive depression due to the nature and duration of his organic impairments. He was granted a further 30% permanent disability award for psychotraumatic disability. The worker was prevented by the combined effects of his impairments from returning to his pre-injury job. He participated in a vocational rehabilitation program but did not return to remunerative employment.
In December 2007, the worker attended an orthopaedic surgeon, complaining of increased left shoulder symptoms. The shoulder condition was, for the first time, diagnosed as a rotator cuff injury. MRI revealed a moderate degree of acromioclavicular hypertrophy, rotator cuff impingement, and a full thickness tear of the supraspinatus tendon. The worker underwent surgical repair of the rotator cuff in December 2008.
The adjudicator found that the left rotator cuff tear was unrelated to the June 1979 workplace accident and denied entitlement. The worker has objected further to the denial of the rotator cuff tear, surgery and associated benefits.
AUTHORITY
11-01-01 – Adjudicative Process
15-02-01 – Definition of an Accident
RESOLUTION METHOD & PROCESS
The worker representative requested review of the issue based on the record. He had no further submissions to make in the matter. The employer submitted a participant form confirming their ongoing interest in the case.
ASSESSMENT OF THE EVIDENCE
Policy
In determining initial entitlement, it is necessary to establish five points: an employer; a worker; a personal work-related injury; proof of accident; and compatibility of diagnosis to accident or disablement history.
Consideration of proof of accident may include examining whether an accident or disablement situation exists; whether there were witnesses; whether there were discrepancies in the date of accident and the date of layoff; whether there was delay in the onset of symptoms; and whether there was delay in seeking medical attention.
The definition of accident, according to operational policy, includes a wilful and intentional act, but not an act of the worker; a chance event resulting from a physical or natural cause; and disablement arising out of and in the course of employment. Disablement includes a condition that emerges over time, or an unexpected result of working duties.
Assessment
In order to consider the worker’s request for entitlement to the left rotator cuff tear, it must be determined whether the evidence supports that the condition occurred in the course of employment in June 1979. In making this determination, I reviewed the record and considered the evidence and submissions.
The June 1979 workplace accident involved swinging a sledgehammer. While such an accident is compatible with rotator cuff injury, there is no evidence to suggest that such an injury occurred at the time.
The worker’s complaints following the accident included low back, left hip, and generalized pain affecting most of the left side of his body. The first complaint pertaining to the left shoulder was recorded in May 1980 by a doctor in Pakistan. Without providing clinical findings or a history of injury or onset, the doctor diagnosed the worker with a frozen left shoulder. On assessment by Canadian orthopaedic surgeon in July 1980, however, there were no clinical findings of the left shoulder to support rotator cuff injury.
During extensive assessment at the Downsview Rehabilitation Centre (DRC) in March 1982, the worker described low back pain radiating up into the interscapular area and, sometimes, to the neck. He also reported episodic aching of the left arm and a sensation of pins and needles in the left hand. The examining physician wrote, “When his (low) back pain is severe his neck becomes weak and he has pain radiating into the left arm and over the left scapula posteriorly.” None of these complaints was suggestive of rotator cuff injury.
In July 1983 the worker reported an increased degree of pain radiating from the thoraco-cervical junction to the left supraspinatus and left upper arm. He also reported persistent tingling in the fingers of the left hand. Examination revealed no abnormality other than slight restriction of cervical motion. During a neurological assessment in September 1983, the worker was found to have tenderness over the left levator scapular and lower rhomboid muscles, and weakness of the left triceps.
In March 1984, the neurologist re-examined the worker and, in the absence of evidence of cervical or shoulder joint pathology, diagnosed thoracic outlet syndrome (TOS). When asked about causation, the neurologist speculated that the workplace injury caused a strain of the scalene muscles which healed with fibrosis and chronic spasm, resulting in TOS.
The worker reported no alleviation of TOS symptoms following rib resection surgery carried out in May 1984; he continued to complain of pain radiating from the neck to the left shoulder, arm, and hand. In 1988, the worker returned to his neurologist due to an increase in pain and spasm. Examination revealed restriction of cervical range of motion, generalized tenderness over the neck, supraspinatus, and levator scapular muscles, and diminished sensation over the left arm. The neurologist diagnosed cervical strain but found no evidence of shoulder pathology.
The worker was granted a 20% permanent disability award for the low back impairment. He was, once entitlement was allowed, granted a 10% award for the TOS impairment. He was granted a further 30% permanent disability award for the psychotraumatic disability.
At a pension reassessment in November 1990, the worker reported no new symptoms. Examination revealed diffuse tenderness throughout the neck, shoulder, and trapezius. The worker resisted shoulder movement; however, the doctor was eventually able to obtain good range of motion. There was no suggestion of rotator cuff injury.
The worker underwent another permanent disability reassessment in September 1994. The worker reiterated his complaints of neck pain radiating to the shoulder, arm and hand. He reported the development of bilateral upper extremity symptoms and worsening of the low back condition. Examination of the shoulders revealed 50% reduction of abduction, anterior elevation, and internal rotation bilaterally. The worker was diffusely tender over the supraclavicular muscle group, scalene muscles bilaterally, and all muscles of the shoulder girdle, particularly, the trapezius ridge and rhomboids.
At a further pension reassessment in May 1996, the worker’s complaints were consistent with those reported at the 1994 assessment. With regard to the left upper extremity, the worker reported: soreness in the left shoulder girdle muscles; pain radiating to the left arm and fingers; general numbness down the left arm, and; aching in the pectoral region and left axilla. Examination revealed tenderness and restricted range of motion in the neck and all aspects of the shoulder, including the deltoid and supraspinatus; however, it was noted that there was no objective left shoulder pathology. Specifically, there was no atrophy, no scapular winging, and no signs of impingement.
There was no medical reporting pertaining to the left shoulder between 1996 and 2007. In December 2007, the worker attended an orthopaedic surgeon due to increased pain and limitation in the left shoulder. The surgeon observed findings consistent with rotator cuff pathology. In March 2008, MRI revealed a moderate degree of acromioclavicular hypertrophy, rotator cuff impingement, and full thickness tear of the supraspinatus tendon. In December 2008 the worker underwent surgery to repair the rotator cuff.
After careful review of medical documentation, I find that there is no evidence of rotator cuff injury following the workplace injury. During the period 1979 to 2007, the worker was seen by numerous specialists and, despite extensive consultation and examination, none reported any findings of rotator cuff pathology other than occasional supraspinatus tenderness. On October 3 1985, a senior WSIB medical consultant reviewed the record and concluded that there were no organic shoulder findings other than muscle tension. It is unlikely, given the circumstances, that every one of the attending and consulting specialists failed to observe or remark on rotator cuff findings. Rotator cuff conditions are common and not easily mistaken for other conditions. The worker’s complaints were, in the absence of rotator cuff pathology, diagnosed as TOS and entitlement was granted accordingly.
As the evidence supports that the rotator cuff condition did not develop until many years after the workplace accident, I cannot grant the worker’s request for a finding that it occurred in the course of employment. Entitlement to the rotator cuff condition and associated benefits is denied.
CONCLUSION
The objection is denied.
DATED March 8, 2010
D. M. Shepherd
Appeals Resolution Officer
Appeals Branch