Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20110036
Objection By: Worker
Participants: Worker, Worker Representative, Employer
Hearing: N/A
Issue
The worker objects to the January 21, 2010 case manager decision denying entitlement for fibromyalgia and psycho-traumatic disability. The worker requests a Non Economic Loss (NEL) assessment for fibromyalgia.
How the Issue Arises
On April 10, 2005 this now 62 year old data entry operator developed right shoulder symptoms she related to her work duties. The August 13, 2008 WSIAT decision concluded the worker performed repetitive keyboarding duties likely to precipitate a repetitive arm/hand shoulder strain injury and accepted the high keystroke count contributed to the onset of the right shoulder condition.
Having regard for the WSIAT decision the WSIB case manager subsequently concluded Loss of Earnings (LOE) benefits were in order until April 11, 2006 when the employer offered suitable work. The November 21, 2008 adjudicator decision concluded the most recent medical did not provide specific right shoulder findings and concluded a NEL assessment was not in order. The January 21, 2010 case manager decision concluded the fibromyalgia condition predated the compensable accident and was non-compensable. The case manager also concluded there was no entitlement for psycho-traumatic disability as this condition was more probably associated with the chronic pain disorder (fibromyalgia).
Authority
15-04-02 - Psycho traumatic Disability
15-04-03 - Chronic Pain Disability
Resolution Method and Process
The worker representative requested a decision based on the evidence and submissions on file – 60 day decision option.
Assessment of the Evidence
The worker representative suggests the WSIB erred in establishing the proper decision in this claim. The representative notes the worker’s condition has not improved and suggests there is a permanent impairment which warrants a Non Economic Loss (NEL) assessment. The representative suggests the worker should have entitlement for fibromyalgia which they believe to be related to this accident and others which may have aggravated her condition.
Analysis
As the representative has requested a decision based on the evidence on record I have proceeded to a decision based on the available evidence. Based on the available information I accept the relevant policy under which entitlement would be properly adjudicated is that of the chronic pain disability (CPD) policy rather than psycho-traumatic disability.
I note the record clearly indicates the worker suffers from a significant fibromyalgia condition with the medical reporting confirming 18 of 18 trigger points.
I also note the psychiatric report on file (March 18, 2009) confirms a DSM-IV Axis I diagnosis of major affective disorder, secondary to general medical condition with an Axis V GAF of 50. Based on this information I consider the evidence to establish a primary diagnosis of fibromyalgia. As I accept the appropriate diagnosis as fibromyalgia, entitlement for this condition is adjudicated under the CPD policy guidelines, and as there is no basis under policy for entitlement to both CPD and psycho-traumatic disability there is no entitlement for psycho-traumatic disability in this claim.
In considering fibromyalgia entitlement this review is limited by what I consider a relatively incomplete medical record.
In passing, the reports and memos on file indicate the worker has prior organic conditions including a compensable back condition (not referred as part of the appeal but from my review there is no indication of a NEL award under that claim) and a significant prior non-compensable cervical spine condition (involving multiple level fusion dating to 2000). I also note the worker apparently reported having attended the Lockwood Clinic (date uncertain) and reported fibromyalgia was diagnosed by this agency. Finally, the record indicates the worker was investigated for other health concerns prior to April 2005. The medical records indicate arthritis and fibromyalgia were referenced as early as an October 3, 2003 bone scan which confirmed activity in multiple joints and suggested this was likely age related degenerative change. I also note an October 4, 2004 specialist report noted co-morbid conditions included osteoarthritis, fibromyalgia, and hypertension.
The clinical notes on file date to March 1, 2004 with the March 1, 2004 notation indicating surgery 1 month ago. I note while this note did not confirm the nature of the surgery the worker was reporting back pain at the time. The September 25, 2006 note indicated the worker was told she had fibromyalgia by the Lockwood clinic and the December 11, 2006 note confirmed fibromyalgia with 18/18 trigger points.
The March 15, 2007 CPP application prepared by a therapist with the arthritis society noted no active joints with 18/18 fibromyalgia tender points. The therapist reported a typical fibromyalgia presentation.
Having regard for the 60 day decision request I have based my conclusions on the evidence on record. From this evidence it appears the fibromyalgia diagnosis predated the compensable shoulder injury. Noting the apparently significant prior cervical spine condition and the previous diagnosis of fibromyalgia I find the most reasonable interpretation of the evidence to suggest the fibromyalgia predated the accident under this claim and would most appropriately be attributed to other causes (including but not limited to the effects of the cervical spine impairment).
While it is possible the right shoulder injury may have resulted in a progression or deterioration in the fibromyalgia the absence of a complete medical record in my view makes such an assessment difficult. Again, having regard for the apparent prior medical history, the relatively limited specific findings associated with the right shoulder, and the prior neck condition I have significant difficulty attributing a causal link between any progression (unconfirmed) of the fibromyalgia and the compensable right shoulder injury.
Based on this assessment of the evidence I am unable to conclude the compensable right shoulder injury is established as a significant contributing factor in the worker developing fibromyalgia. Rather, the evidence suggests the appropriate conclusion is that this condition predated the compensable accident and would arise from non-compensable factors.
For these reasons I must conclude there is no entitlement under either the CPD or psycho-traumatic disability policy guidelines.
Conclusion
The objection is denied.
DATED July 22, 2011
M. Evans
Appeals Resolution Officer
Appeals Branch