Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20100187
Objection By: Employer
Worker: Not Participating
Representatives: Employer
Decision Without a Hearing
Issue
Entitlement to Second Injury and Enhancement Fund (SIEF) relief.
How the Issue Arises
This claim was established with an accident date of January 31, 2008. This now 41 year old employee of an auto manufacturing plant reported a gradual onset of pain in her hands, which she related to her general job duties. According to the information on file, the worker did a rotation of three jobs. The jobs required the use of air guns and torque wrenches.
The worker sought medical attention and was referred for EMG studies. The March 4, 2008 EMG results were compatible with mild right median nerve entrapment and very mild median nerve entrapment on the left. The medical documentation on file indicated the worker had thyroid disease and was on thyroid supplements. She did not have symptoms in her hands or wrists associated with her thyroid condition.
Entitlement was accepted in this claim for bilateral carpal tunnel syndrome (CTS). The worker received approximately 6 weeks of loss of earnings (LOE) benefits. According to the information on file, maximum medical recovery (MMR) was reached as of July 28, 2008 with no permanent impairment evident.
The file was reviewed for entitlement to SIEF relief. The case manager concluded that although there was a pre-existing condition, the pre-existing condition had no impact on the period of recovery or degree of impairment. As such, entitlement to SIEF relief was denied.
Authority
Workplace Safety and Insurance Act (the Act) Operational Policy Manual (OPM) Documents:
14-05-03 – Second Injury and Enhancement Fund (SIEF)
Resolution Method and Process
The employer representative elected to proceed based on the information on file and submissions made. The file was referred to the Appeals Branch Medical Consultant for an opinion on the pre-existing condition. The employer representative obtained additional medical evidence and submitted it for consideration.
Assessment of the Evidence
Policy 14-05-03 – Second Injury and Enhancement Fund (SIEF) states:
If a prior disability caused or contributed to the compensable accident, or if the period resulting from an accident becomes prolonged or enhanced due to a pre-existing condition, all or part of the compensation and health care costs may be transferred from the accident employer in Schedule 1 to the SIEF.
The SIEF policy states is that if a prior disability caused or contributed to the compensable accident, SIEF can be considered. The policy goes on to define a pre-accident disability as a condition which has produced periods of disability in the past requiring treatment and disrupting employment. Accident is plainly read as the mechanism of injury (such as a slip, twist or fall). There is no evidence that there was a pre-existing disability that contributed to the accident in this case.
The policy requires that there must be both evidence of a pre-existing condition and evidence that the pre-existing condition had an impact on the claim. An impact on the claim would include causing a greater degree of disability than would have occurred without the pre-existing, or resulting in the period of recuperation becoming prolonged.
The evidence on file indicates this worker has pre-existing thyroid disease. She was taking medication for the condition. Thyroid disease is a well known risk factor for CTS, although the condition develops in many individuals who do not have known risk factors such as diabetes or thyroid disease. The worker’s job duties had risk factors that are consistent with the development of CTS. There is no indication she had any symptoms in her hands or wrists as a result of the thyroid disease.
An opinion was obtained from The Appeals Branch Medical Consultant on the possible impact of the pre-existing condition. The consultant noted the following:
- physical examination findings were only positive in the right dominant hand (the hand with greater exposure to vibrating tools);
- although untreated thyroid disease is a risk factor for CTS, the worker’s thyroid condition was under control with thyroid medication.
- studies indicate that individuals with untreated thyroid conditions are more likely to have severe CTS and require surgery; and
- the fact the worker never developed CTS with her untreated thyroid condition or during two pregnancies points away from the thyroid disease as being a significant contributing factor.
The employer’s representative disagreed with the Appeals Branch medical consultant’s opinion and provided the following research literature:
Karpitskay Novak CB, MacKinnon SE. Evidence of smoking, obesity, diabetes, mellitus and thyroid disease in patients with carpal tunnel syndrome (CTS), annuls of plastic surgery. Volume 48, Number 3, March 2002, Pages 269-273.
Geoghegian JM, Clark DL, Bainbridge LC, Smith C, Hubbard, R. Risk Factors in carpal tunnel syndrome (CTS). The Journal of Hand Surgery: British & European Volume. Volume 29, Issue 4, August 2004, Pages 315-320.
The representative argued that both of these studies demonstrate that the incidence of CTS was significantly higher in individuals with thyroid disease. The representative noted the studies show the condition was more prevalent despite the use of thyroid replacement medication.
Although the medical literature indicates that CTS is more prevalent in individuals with thyroid disease, that is not to say that all persons with thyroid disease will develop CTS. The literature referenced in the file record did not discuss the relative contributions of other factors such as employment risk factors. Additionally, the medical literature must be reconciled with the specifics of this case. In this case, the worker had a thyroid condition that was treated with medication. Prior to the work-related onset, there is no evidence the worker had any symptoms of CTS, either with the untreated or treated thyroid condition. This would point away from the thyroid condition as being a contributing factor in this particular case. There is also no evidence that she experienced any symptoms during two pregnancies.
Also, the documentation provided by the employer representative, as well as the opinion of the Appeals Branch Medical Consultant, indicates that those with thyroid conditions are likely to develop severe CTS and more likely to require surgical intervention. This worker developed very mild CTS (symptomatic on the right) with extremely mild EMG findings on the left. The worker received 6 weeks of LOE benefits and a permanent impairment has not been accepted. Therefore, the condition cannot be seen to be prolonged or enhanced due to the presence of any pre-existing condition.
Conclusion
I find there is no evidence of a prior disability that caused or contributed to the compensable accident. Additionally, the period of disability has not been prolonged or enhanced due to a pre-existing condition. Therefore, the employer is not entitled to SIEF relief.
The employer’s objection is denied.
DATED September 21, 2010
B. Craddock Appeals Resolution Officer Appeals Branch