WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100120
OBJECTION BY: Worker
PARTICIPANTS: Worker, Worker Representative, Employer Representative, Observer
HEARING DATE: May 10, 2010
ISSUES
The worker objects to the April 9, 2001; October 31, 2006; and October 14, 2009 adjudicator decisions limiting entitlement to initial health care benefits only and denying entitlement for migraines, idiopathic environmental intolerance, and environmental sensitivity.
HOW THE ISSUES AROSE
This now 57 year old worker began employment as a room attendant with the accident employer April 11, 2000. Shortly after commencing employment the worker developed a number of symptoms resulting in her leaving the workplace April 28, 2000. She has not returned to work since.
The claim was initially accepted for health care benefits resulting from fumes exposure related to a cleaning agent. Ongoing entitlement for the worker’s reported constellation of symptoms has not been accepted to result from workplace exposures.
AUTHORITY
11-01-02 – Decision Making
11-01-03 - Merits and Justice
16-01-02 – Allergic Respiratory Illness
15-05-01 - Secondary Conditions Resulting From Work-Related Disability
ASSESSMENT OF THE EVIDENCE
I have reviewed the record and considered the evidence and submissions.
Submissions
The worker representative suggests entitlement is in order for the symptoms following initial fumes exposure in April 2000. The representative suggests the claim was properly accepted based on the initial response with the subsequent respiratory, rhinitis, and IEI (Idiopathic Environmental Intolerance) symptoms, otherwise known as Environmental Illness or Multiple Chemical Sensitivity (MCS), a result of this initial exposure.
The representative suggests this is a compatibility issue and it is necessary to consider the effect on the worker following exposure. The representative notes he previously submitted a WSIAT discussion paper which confirms IEI goes beyond the organic issue. The representative suggests the discussion paper closely reflects the worker experience with the medical reporting moving from the specialist (organic) to the psychiatrist (non-organic) and the reaction “from” to “of”. The representative notes there are no other possible issues identified as the worker has no history of this response to animals, children, or smoking; and there is no history of chemical exposure. The representative suggests while it is not possible to quantify the exposure we are dealing with a severe and prolonged reaction which directly correlates with exposure. The representative notes the medical reporting began with symptom diagnosis and was ultimately identified as IEI by the treating doctors.
The representative notes the reporting begins with regular medical involvement in May 2000 and identification of sensitivity to the cleaning agent, there are continued references to symptoms, and by December 2002 CT scan confirmed inflammatory changes in the sinuses. The representative notes there are then several reports from Dr. Foell from May 2003 to August 2003 describing the symptom triggers and in September 2003 Dr. Bray diagnosed MCS. The representative suggests the theory of an ongoing impairment is that while the initial exposure appears benign, for the worker it is not, and the cognitive psychological component developed as confirmed by Dr. Kerin.
The representative suggests there is an ongoing need to reduce exposure to triggers and while the condition is manageable it requires managing and is therefore permanent.
The representative suggests it is appropriate to conclude on the balance of probability the exposure was a significant contributing factor to the ongoing health problems and continued entitlement is therefore in order.
Testimony
The worker confirmed that prior to April 2000 she had no history of environmental sensitivity. The worker reports a smoking habit of a ½ pack every 2 days from ages 10 to 29. She reports no childhood allergies, and always having had pet dogs and cats. She reports using regular household cleaners with no ill effects. In the season before working for the employer she was employed cleaning cottages where she used all types of cleaning products without effect. The worker confirmed moving to the Huntsville area from Toronto in August 1998. She confirmed operating a home based day care business in Toronto for many years before this move.
The worker relates her condition to a pink cleaning product (simplex) which was given to her by the lady who was teaching her the job. The worker reports she was later advised she was supposed to wear a mask and gloves while working with this product.
She reports a gradual onset of symptoms with stomach complaints followed by laboured breathing and as time went on she would feel lethargic after she cleaned. She reports towards the end of her employment she was quite sick and disoriented. At the end of her April 28, 2000 shift she was dropped off at Zellers by a co-worker and while very disoriented somehow walked home. She was throwing up, had diarrhea, and developed a rash. She called the employer to tell them she would not be in as she was very sick. She did not see her doctor until May 5 as she was unable to get an appointment until then. She reports while by then her symptoms were largely better the doctor said she had exposure based on her remaining symptoms.
The worker confirmed she then had a new general practitioner who provided antibiotics and although a lung capacity test was ordered this was not done. At the end of May 2000 she was admitted to hospital and diagnosed with acute sinusitis. The worker confirmed she has since attended several specialists who have diagnosed Multiple Chemical Sensitivity (MSC) and migraines. She reports she did not realize she was having migraines until she was advised of this. She reports no prior history of similar symptoms. She also reports she was unaware of MCS until being told this is what she has. She reports at the time of her acute symptoms she could not be around anything and smells would trigger her symptoms.
She confirmed having looked for work since 2000 without success although she did have a few interviews. She qualified her job search by suggesting she was not actively looking as she does not feel she could work in any event.
The worker reports continued symptoms of feeling tired with certain things triggering a reaction resulting in a loss of concentration and pain. She reports she is improved and her symptoms are less frequent as she now has her migraines under control.
File Review and Analysis
I note the operations division accepted initial entitlement for health care benefits only but did not accept ongoing entitlement on the basis of IEI or MCS. The issue in this decision is therefore limited to considering whether a causal link is accepted to be established between the initial exposure and the ongoing reported limitations.
While I do not dispute the worker representative argument as to the time correlation between the workplace exposure and symptom onset my primary concern is the lack of medical reporting which I consider to address the primary issue of a causal link. Noting the nature of the ongoing symptoms I do not consider it reasonable to presume a causal relationship between the subsequent symptoms and workplace exposure. Rather, a decision-maker must be satisfied there is sufficient subjective and objective credible evidence to support such a link.
In assessing the evidence I consider the primary evidence for accepting the relationship is subjective in nature. I note the initial symptoms were reported during and immediately following the period of employment. I note the worker related these symptoms to exposure to a specific chemical resulting in respiratory symptoms. I also note the WSIB hygienist reported he was unable to identify any literature linking the reported products to the condition being claimed. While I would accept from the worker evidence that exposure levels were in all probability higher than that recognized by the hygienist this does not in my view negate the hygienist comments regarding the available literature.
As noted by the representative the diagnosis of the worker’s symptoms progressed from a simple sinusitis (irritation / infection) to migraines (neurology) to MCS (Sunnybrook Environmental Clinic) and psychiatric treatment. I accept this pattern of diagnosis and treatment is consistent with the typical progression of the diagnostic process. I do not however consider this necessarily specific to MCS. Rather, I find the progression typical of diagnostic processes in general as a process of exclusion. Effectively, a treating doctor identifies the clinically probable diagnosis, proceeds to treatment, and should treatment not prove effective carries out additional investigation and inquiry in an attempt to assist the patient. Each practitioner of course views the condition and patient through the lens of their own experience and area of expertise.
After reviewing the various medical reports, accepting the worker reported exposure history, and accepting the IEI diagnosis as confirmed my primary difficulty with concluding entitlement is in order is that there remains no objective evidence describing the process by which the workplace exposure is shown as the, or a, causal factor in the development of the worker’s condition.
Ultimately, the worker has described a constellation of symptoms which she relates to exposure to various chemicals and scents she encounters in the general environment. These symptoms have been described by the various practitioners as similar to the effects of migraines and sinus inflammation with the neurologist reporting improvement with medication typically used to treat psychiatric conditions. Despite the confirmation of symptoms, diagnosis, and apparently reasonably effective treatment I do not find the medical reporting to establish a relationship to the workplace exposures. I am unable to identify any specific medical opinions or evidence establishing a probable connection between the initial exposure and the diagnosis of IEI.
While the OHCOW physician identified a number of limitations in the interpretation of the evidence by the WSIB hygienist and WSIB medical consultants the doctor also reported test results confirmed no evidence of an ongoing asthmatic condition. While suggesting the exposure level was greater than recognized by the hygienist and reporting these fumes are known to cause irritant type asthma the doctor also noted this type of asthma becomes quiescent when not provoked further and may not give a positive test response several months later. The June 23, 2008 OHCOW report confirmed negative pulmonary function testing (PFT) and a diagnosis of allergic rhinitis. The physician suggested the worker had a significant exposure to workplace chemicals and diagnosed allergic rhinitis. The doctor noted allergic rhinitis precedes occupational asthma in approximately 50% of cases. I interpret this reporting to suggest a possible initial diagnosis of allergic rhinitis. I also interpret this reporting to confirm that at the time of the OHCOW investigation testing did not confirm objective findings of airway limitation.
In summary, while I accept the treating doctors final diagnosis is that of IEI I do not find the evidence to support the conclusion the ongoing condition is in itself a result of the relatively brief exposure to acid based cleaning solutions in April 2000. Rather, as indicated in the description of the worker’s condition, I find the worker’s chemical sensitivity concerns idiopathic in origin.
For these reasons, entitlement for IEI (otherwise known as MCS) is not in order.
CONCLUSION
The objection is denied.
DATED June 16, 2010
M. Evans
Appeals Resolution Officer
Appeals Branch