Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20100085
Objection By: Worker
Employer: Not Participating
Participants: Worker, Worker’s Representative
Hearing Location: N/A
Issue
The worker claimed entitlement in this claim for hearing loss and for tinnitus.
The decision letter is dated June 4, 2009.
How the Issue Arises
On November 22, 1977, the worker was struck on the right side of his chin with a handle. Emergency treatment was sought which confirmed the accident. The worker sustained a three‑centimetre laceration of the right chin and there was indication of slight pain in the left temporomandibular joint area on opening his mouth. X-rays of the jaw did not show any fracture or other evidence of trauma.
One day lost time was paid.
The worker claims entitlement to hearing loss and tinnitus related to the November 22, 1977 accident.
Entitlement was reviewed by the Operating Area and hearing loss and tinnitus were denied.
The worker objects to the denial of hearing loss and tinnitus in this claim.
Authority
Operational Policy Manual Documents (OPM)
- 15-04-01 – Traumatic Hearing Loss
- 16-01-07 – Tinnitus, Pre-January 2, 1990
- 11-01-01 – Adjudicative Process
Assessment of the Evidence and Submissions
In arriving at a decision in this claim, I have reviewed and considered the file evidence as well as the further written submission made by the worker representative.
In a further discussion with the worker representative, the issues of temporomandibular joint dysfunction and facial disfigurement were removed from the issue agenda at this time.
The only issue for review in this claim at this time is that of entitlement to hearing loss and entitlement to tinnitus related to the November 22, 1977 accident.
The accident of November 22, 1977 is confirmed and the initial medical attention was also confirmed. There was no complaint initially or after of hearing loss or tinnitus. There was then a significant gap in medical attention with the next medical report dated December 10, 1985, indicating that the worker reports tinnitus in both ears for the past six months. This report was from the ear, nose, and throat (ENT) specialist relating the onset of tinnitus over the preceding six months in 1985. There is no indication of the hearing loss and tinnitus being related to the 1977 accident. The examination was normal. A hearing test showed low-frequency hearing loss. The follow up in 1986 confirmed that the worker had normal hearing.
The next report indicating tinnitus was dated August 20, 1993. This was a health examination report and the report outlines the worker’s family history and other conditions. The remarks made by the examining physician in 1993 indicated that the worker had a history of tinnitus for 10 years, no vertigo and no known hearing loss.
The further reports submitted then indicated that the worker had several industrial audiometric tests done beginning with 1993. At that time, there was no indication of a hearing loss but ringing in the ears was indicated. The next examination was in December 2004 and still no indication of a hearing loss but the report indicates that the worker has had ringing in his ears for 15 years which would be from approximately the late 1980’s.
The April 12, 1995 report, again from the same ear, nose, and throat (ENT) specialist, was an unrelated non compensable assessment of the worker, indicating that he could not breathe, he had complaints of burning and rawness in his throat all of the time and the worker had heartburn, especially with food or beer. The worker was taking no medication. The family history was again reviewed. The diagnosis made was reflux and a barium swallow was to be arranged. The worker was advised to raise the head of his bed, avoid acidy food, spicy foods, carbonated beverages and he was advised to lose weight.
The further audiograms submitted were in 1995 and the hearing loss was indicated to be minimal. The further audiogram report was submitted indicating the audiograms done in 1999, 2000, 2001, 2003, and a final one in 2005. All of the audiograms do not indicate a significant hearing loss. The reference made in these audiogram assessments was that the worker had a history of tinnitus in both ears, for many years.
The further report was then received from the worker’s dentist dated October 8, 2008 referencing the worker’s issues, which included the temporomandibular joint (this issue is not reviewed at this time), and continual ringing in his ears since the accident.
A review of the file evidence confirms that the worker sustained a striking injury to his right-chin area in November 1977. There were then many significant gaps in this claim regarding medical attention. The medical reports that were received did not relate the hearing loss or tinnitus to the 1977 accident; however, the hearing loss is indicated to have started some time in the mid 1980’s according to the first reports.
The policy on traumatic hearing loss notes that:
“Workers are entitled to benefits for traumatic hearing loss that results from a work-related accident.
Traumatic hearing loss (THL) is hearing loss of sudden onset experienced after an acute trauma such as
- exposure to noise from an explosion (acoustic trauma)
- direct trauma to the ear causing damage
- trauma to the head resulting in a severe concussion, or
- exposure to an ototoxic (toxic to the ear) drug or chemical.”
The worker representative submission of April 6, 2010 and the WSIAT decisions 1909/04 and 1782/06 were reviewed and considered. The significant difference between the worker’s claim and the two WSIAT decisions was that the WSIAT decisions centred around claims made for noise induced hearing loss (NIHL) and tinnitus. Both WSIAT decisions went on to accept occupational noise exposure and some hearing loss related to the occupational noise exposures but confirmed that the worker’s hearing loss was insufficient to meet the criteria set out in the Board’s policy for heath care or NEL entitlement. The WSIAT decisions then went on to accept the tinnitus in the two claims and indicated that, although below the WSIB criteria, it accepted that the tinnitus was occupational tinnitus.
However, the worker’s claim is not for NIHL but for a hearing loss and tinnitus claimed as related to a blow to the chin in 1977, not noise exposure.
The worker’s claim for hearing loss and tinnitus related to the 1977 accident has significant medical attention delays specifically from 1977 to 1985 when the worker first complained of tinnitus. Also, the documented history in the subsequent medical reports appears to indicate that the onset history was early to the mid 1980’s and no reference was made in the early reports to a relationship between the claim of hearing loss and tinnitus and the 1977 accident.
The worker’s claim for entitlement to hearing loss and tinnitus related to the accident of November 22, 1977 is denied. I highlight the following reasons for the denial:
- the worker made no initial complaints in 1977 of a hearing loss of tinnitus
- the onset of hearing loss and tinnitus did not occur until approximately 1985.
- the first ear, nose, and throat (ENT) specialist’s assessment of 1985 was the first indication of a minimal hearing loss and complaints of tinnitus. There is a lack of medical attention continuity in the years following the accident of 1977, with the first mention of hearing loss and tinnitis made in 1985
- the medical report dated January 23, 1986 following the audiometric and other testing indicated that the worker’s hearing was “essentially normal in both ears”
- the medical report of 1990 indicated no hearing loss
- the last ENT report on file in 1995 indicated that the worker was seen for other problems including respiratory and throat problems and heartburn. There was no indication of hearing loss or tinnitus complaints and no reference made to the 1977 accident.
- no accident history was provided to the ENT’s seen to draw a relationship between the 1977 accident and the onset of the hearing loss (very mild) and tinnitus anytime from 1985 to 1995 , and continuing to the present day
There is no relationship established between the onset of a very-mild hearing loss and tinnitus in 1985 and the blow to the right chin, which occurred in 1977. Entitlement for these conditions is therefore confirmed as denied.
Conclusion
The worker’s request for hearing loss and tinnitus entitlement in this claim is denied.
The worker’s objection is denied.
Dated: April 20, 2010
N. Grunenko
Appeals Resolution Officer
Appeals Branch