WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100026
OBJECTION BY: Worker
EMPLOYER: Not Participating
DATE: November 26, 2009 at 10:00 a.m.
ATTENDEES: Worker, Worker Representative
ISSUE(S)
The worker objects to the denial of entitlement for bilateral carpal tunnel syndrome (CTS) as being related to:
The neck injury which occurred September 27, 2006 under Claim A or in the alternative.
To his work duties performed as an Auto Mechanic & Technician under claim B.
HOW THE ISSUE(S) ARISES
Claim A was established for the accident date of September 27, 2006. The worker who was employed as an Auto Mechanic experienced pain in his left shoulder and neck after lifting a heavy truck tire. He continued working in his regular job duties up until October 27, 2006, at which time he laid off work.
The worker was diagnosed with a large C5-6 disc herniation. He underwent a C5-6 anterior cervical discectomy with insertion of an artificial disc on June 18, 2007. A permanent impairment was accepted and the worker was seen for a non-economic loss (NEL) assessment, following which a 26 per cent NEL award was issued February 4, 2009.
The worker subsequently claimed entitlement for bilateral carpal tunnel syndrome (CTS) as being related to the accident and injury of September 27, 2006. The worker was first diagnosed with CTS in January 2008. The worker indicated that he began to experience numbness and pain in his hands approximately one month after the neck injury. He eventually underwent a bilateral CTS release May 17, 2008.
A medical opinion obtained from the Workplace Safety and Insurance Board (WSIB) medical advisor stated that the bilateral CTS was not related to the neck injury.
Entitlement for bilateral CTS on the basis of disablement was reviewed under Claim B. Entitlement was denied as it was not felt that the work duties were compatible with CTS noting the delayed onset. This is explained in the claims adjudicator’s (CA) correspondence dated
January 16, 2009.
The worker has objected to the denial of entitlement for bilateral CTS and this issue is now before the appeals resolution officer (ARO).
AUTHORITY
Workplace Safety and Insurance Act (the Act) Operational Policy Manual (OPM) Documents:
11-01-01 – Adjudicative Process
11-02-02 – Lost Time Claims
15-02-01 – Definition of an Accident
15-02-02 – Accident in the Course of Employment
ASSESSMENT OF THE EVIDENCE
The worker responded to questions and his representative also spoke on his behalf.
The worker’s representative stated that the difficulty in diagnosing the worker with CTS was due to the fact that the symptoms he was experiencing in his arms and hands were similar to the symptoms emanating from his neck injury. Initially, his attending physicians felt that the symptoms were in fact coming from the neck.
The representative also stated that the focus of attention was on the more serious injury, which was the cervical herniation. It wasn’t until after the symptoms in his hands failed to subside following the cervical surgery that further investigations were carried out to determine the cause of the hand/forearm complaints.
The worker’s representative referred to family doctor’s report of April 21, 2008 in which the doctor reported that the worker was complaining of pain and numbness in his hands the whole time while being treated for the neck injury.
The representative also pointed out that at that time, the worker didn’t have a family physician, so it was very difficult to get any medical attention and he had to keep going to see a specialist or report to the emergency department of a local hospital.
The representative referred to Dr. McCall’s report of July 17, 2008 in which the doctor felt the worker’s CTS may represent a “double crush injury.”
The representative stated that the worker’s job duties are in fact repetitive, requiring the use of vibratory equipment. He referred to the discussion paper on CTS prepared for the Workplace Safety and Insurance Appeals Tribunal (WSIAT), dated May 2001 which referred to exposure to vibratory equipment and also talked about the effects of double crush syndrome.
In summation, the worker’s representative opined that the neck injury may have precipitated the CTS and the worker’s job duties most certainly contributed to the development of CTS.
The worker responded to questions and provided the following information.
On the date of accident, he was changing tires on a truck. While lifting a tire, he experienced a sharp pain in his shoulder. He informed his service manager and asked for assistance.
He described the pain as travelling down his arm and going into his hands. His hands became numb and tingled. He continued to experience these symptoms in his hands for a month before seeing the doctor.
He worked as an Auto Mechanic for the last 19 years. He explained the job is very physical, requiring a lot of repetitive work.
In the early years of his trade, he did a lot of work with tires and also repaired engines. While performing these job tasks, he had to use pneumatic tools.
The pain in his arms grew more intense as the days went on and the pain and numbness extended into the wrists and the hands. It got to the point that he started to lose feeling in his left hand.
The symptoms in the right side emerged shortly thereafter. He explained that he is right hand dominant.
He explained that he mentioned his wrist problems to his doctors on his initial visit for medical attention, but the primary complaints pertained to his shoulder.
The doctors initially thought that he may have pinched a nerve in his shoulder.
The worker again reiterated that he definitely mentioned his wrist problems to his attending physicians at the time of the original accident.
He explained the neck surgery didn’t help his hands.
Dr. Dougall performed the surgery on his neck.
Following the surgery, he still complained about pain and numbness and tingling in his hands. He was then referred to a neurologist.
His surgeon, Dr. Dougall originally thought the hand and wrist pain was related to the neck injury, but when the symptoms never went away, that is when he referred him to the neurologist..
He was referred to see Dr. O’Dougherty. He is the doctor that performed the surgery for the CTS.
The surgery has helped the numbness in his hands, wrists and forearms, although he still feels somewhat achy after doing repetitive work.
He provided more information regarding his job duties as an auto mechanic. He indicated that he used air ratchets as well as impact guns. He used this equipment for eight hours a day, sometimes even longer.
At one time, he was working six days per week during his apprenticeship.
His attending physician believed that the problems in his hands and wrists may have been masked by the neck injury.
He indicated that he worked on a piece work basis; the faster he worked, the more money he made.
He is not involved in any extracurricular activities, hobbies or sporting activities that would cause the CTS.
He indicated that he still wears his wrist splints at night.
POST-HEARING ENQUIRY
Subsequent to the Hearing, a medical opinion was obtained from the Appeals Branch medical consultant regarding a relationship between the diagnosed CTS and the accident and injury sustained under Claim A and between the job duties performed as an Automotive Technician & Mechanic under Claim B.
The Appeals Branch medical consultant opined as follows:
“Based on review of the medical information on file as well as the information provided by you in your referral memo, I would not relate CTS as directly related to the neck injury or subsequent surgery in Claim A; however, it did probably play a role. I will probably accept that work exposure was the main culprit for the bilateral compression that was only unmasked after the cervical discectomy and may therefore represent a component of double crush.”
A copy of this medical opinion was provided to the worker’s representative and further final written submissions invited. The representative however has provided no further information.
In arriving at a decision in this case, I have carefully considered the information available on file, having regard for the worker’s testimony and the submissions made by the worker’s representative and the medical reporting.
I am guided by the expert medical opinion provided by the attending physicians in this case, that being Dr. John McCall as per his report of July 17, 2008 and family doctor as per his report dated April 21, 2008, thereby concurring with the opinion of the Appeals Branch medical consultant that this worker’s bilateral CTS is causally related to his job duties or “work exposure” as an Automotive Mechanic and Technician.
It is accepted that this worker’s job duties are repetitive and forceful in nature requiring awkward and stressed motions of the hands and wrists along with the use of vibratory equipment, all of which are risk factors for the development of carpal tunnel syndrome.
The reason for the delayed onset of symptoms with respect to the CTS has been adequately explained as per the medical reporting of Dr. John McCall and family doctor and is consistent with the worker’s testimony.
Initial entitlement is therefore accepted on a disablement basis under Claim B for the bilateral CTS and the surgical release undertaken May 17, 2008.
Entitlement to a permanent impairment for the bilateral CTS will be left to the discretion of the operating area to determine.
CONCLUSION
Initial entitlement is accepted for bilateral carpal tunnel syndrome (CTS) as arising out of and in the course of this worker’s employment duties as an Automotive Mechanic & Technician.
Entitlement is accepted for the bilateral CTS release performed May 17, 2008.
The operating area is directed to determine entitlement to a permanent impairment for bilateral CTS.
The worker’s objection is allowed.
DATED February 26, 2010
C. Rubino
Appeals Resolution Officer
Appeals Branch