WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
Decision Number: 20100087
OBJECTION BY: Worker
EMPLOYER: Not Participating
REPRESENTATIVES: Worker
HEARING DATE: N/A
ISSUE
Initial entitlement for bilateral hand osteoarthritis.
HOW THE ISSUE ARISES
A claim was established and allowed for a bruised left hand, when a part fell on the worker January 13, 2005. Following diagnostic testing, it was discovered the worker had bilateral osteoarthritis. The worker’s osteoarthritis was not considered related to the part falling on the worker’s hand. Further enquiries led to information that the worker developed bilateral hand problems approximately one year prior to reporting on January 13, 2005. The diagnosis of osteoarthritis was considered non-compatible with the work duties performed. As a result, entitlement was denied. This is the issue now before the appeals resolution officer (ARO) for determination.
AUTHORITY REFERENCE
Operational Policy Manual (OPM) Document(s):
15-02-02 – Accident in the Course of Employment
15-05-03 – Non-Work-Related - Second Accidents
15-05-04 – Non-Work Related Conditions
ASSESSMENT OF EVIDENCE AND SUBMISSIONS
I have reviewed the claim record and noted the evidence and submissions. The worker’s representative provided a written submission dated September 15, 2009 requesting entitlement for bilateral osteoarthritis. In his submission, the worker’s representative referred to medical reporting which supported that the worker’s osteoarthritis was connected to his work duties. As such, entitlement was requested including all entitlement flowing from such.
On January 12, 2005 this worker a machinist employed with the employer had a part fall on his left thumb. The part weighed approximately one pound. The worker finished his shift but sought medical attention January 14, 2005 when a report from an Urgent Care Clinic diagnosed a soft tissue (STI) left thumb. Entitlement for the left thumb was granted.
Subsequent medical documentation indicated the worker was diagnosed with osteoarthritis of both hands. The worker requested entitlement for osteoarthritis as a result of his work duties as a machinist. A review by the operating level determined entitlement was not in order.
Work Performed
The employer is an automotive parts manufacturer. The worker was working in automotive parts machining. He maintained that the repetitive type duties of a machinist contributed to the development of the osteoarthritis. The worker claimed a gradual onset approximately occurring one year prior to reporting in January 2005. He had been working for the employer with a date of hire, November 12, 1996.
The work as a machine operator involved in repetitive use of his hands to load small steel parts. Again, the worker worked for the accident employer for approximately eight years.
Interestingly, although the worker worked for the employer since November 12, 1996, according to the Employer’s Report of Injury/Disease (Form 7), the doctor indicated in his report of July 26, 2006 that the worker developed the osteoarthritis over a period of one year.
Medical Information
The worker was first seen for his left thumb January 14, 2005 and was diagnosed with an STI of the left thumb.
He then requested entitlement for bilateral osteoarthritis of the hands.
He was referred to a rheumatologist for further assessment. In a report dated March 2, 2005 outlined the worker’s chief complaint was pain and stiffness of the DIP and PIP joints of both hands. This had been present with variable severity for a few months. It explained the worker had a physical demanding job which was dependent on repetitive motion of both hands. He also complained of intermittent pain in both knees. He reported no other joint symptoms. On physical examination of the musculoskeletal system, Heberden’s Nodes were noted on the DIP joints of both hands. The nodes were tender. There was no evidence of active synovitis on the MCP or PIP joints. The rest of the joint examination was unremarkable. It was the doctor’s impression that the worker had primary osteoarthritis. He was placed on Mobicox, 15 milligrams a day. No further intervention was required. The report concluded that the nature of the job required repetitive motion of both hands and this might be difficult. As a result, the worker may consider job modification.
A report dated March 21, 2005 from the family physician provided a diagnosis of osteoarthritis.
A further report dated July 26, 2006 from the family practitioner indicated the worker’s osteoarthritis appears to have fully developed over a period of one year. The doctor felt certain it was related to the type of work he was doing for the past seven years.
A December 11, 2006 report from the family physician again outlined the worker had been referred to a rheumatologist who made a diagnosis of primary osteoarthritis which was in the family doctor’s opinion definitely had been made worse by the kind of work performed. Since the worker stopped working his osteoarthritis improved.
An October 9, 2008 report from the family physician outlined in part that the worker’s diagnosis was primary osteoarthritis and that again this was definitely made worse by the kind of work he did.
This worker’s case was referred initially by operations to their medical consultant. In February 2009 the medical consultant determined from reviewing the medical documentation the primary diagnosis was osteoarthritis which was not work-related.
The ARO referred the matter for a further opinion to the appeals medical consultant. The appeals medical consultant responded after consideration of all medical documentation available that due to the multifactorial etiology of primary hand osteoarthritis one can’t single out work exposures being the etiologic factor. Age is a primary factor in osteoarthritis development associated with other probable genetic and biomechanical factors. Therefore based on the reasonable degree of probability compatibility could not be confirmed between the onset described by the worker and the diagnosis of bilateral osteoarthritis of the hands.
This worker was employed as a machinist with the accident employer for approximately eight years. Approximately one year before reporting the matter in June 2005, he started to develop bilateral hand symptoms. There is no question the worker’s job duties are repetitive in nature. Again, however the worker was performing such work for a lengthy period with no noted problems or complaints. It was not until approximately one year prior to reporting that the worker started to develop symptoms. There were no job changes noted or reported in conjunction with the onset.
The medical opinion of both the section medical consultant and the appeals medical consultant concluded the osteoarthritis was not compatible with the onset described; that is the job duties performed. The medical documentation provided by the worker’s family practitioner supported the worker’s job duties contributed to the worker’s condition. However, the reporting from the specialist, also noted complaints of intermittent pain in both knees and that the nature of the job required repetitive motion of both hands which might be difficult. The specialist did not indicate the osteoarthritis was connected to the worker’s job duties.
Osteoarthritis has been categorized as a slowly evolving degenerative disease affecting cartilage and bone with a multi-factorial etiology depending on the joint site.
Primary osteoarthritis is commonly in the hands, particularly in the distal interphalangeal joints, proximal interphalangeal and first carpal metacarpal joints.
Clinicians who include involvement of other joints in the definition of primary osteoarthritis also see the disease in the hip joints, knee joints, first metasophalangeal joints and lower lumbar and cervical regions of the spine. Primary osteoarthritis in other joints, such as the shoulder, elbow, wrist and ankle is less common.
A variety of factors most notably age lead to the development of primary osteoarthritis. Certain diseases are often categorized as subset of primary osteoarthritis. These disorders include primary generalized osteoarthritis (PGOA), erosive inflammatory osteoarthritis and chondromalacia patellae.
Although the family practitioner has opined that the work duties performed contributed to the worker’s osteoarthritis, the weight of evidence, including the opinion of not one but two of the WSIB medical consultants concluded the osteoarthritis is non-compensable and not related to the job duties described. Again, osteoarthritis has a multifactorial etiology with age being the primary factor. This coupled with the fact that there were no changes to the work duties,the worker was performing the same work for a significant number of years prior to developing osteoarthritis leads me to find the osteoarthritis is indeed not compensable in nature.
CONCLUSION
Entitlement for the bilateral hand osteoarthritis is not in order for the reasons outlined.
The objection is denied.
Dated: March 12, 2010
A. D'Ambrosio
Appeals Resolution Officer
Appeals Branch