WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
Decision number: 20170007
DATE: March 3, 2017
OBJECTING PARTY: Worker
REPRESENTED by: Worker Representative
RESPONDENT: Employer
REPRESENTED by: Employer Representative
HEARING: Hearing in Writing
HEARD by: P. Luck, Appeals Resolution Officer
PRELIMINARY ISSUE
The submission from the worker representative speaks to the worker’s general work duties and risk factors that the representative submits are compatible to a shoulder injury. There has been no determination on compatibility based on the job duties in general. I must limit my deliberations to the issue of continuing entitlement based on the disablement, unexpected result of work duties occurring on January 15, 2015. The worker representative was informed and confirmed his understanding.
ISSUES
The worker objects to the decision dated July 8, 2015 and May 13, 2016 and seeks:
Ongoing entitlement to a right shoulder impairment.
Secondary entitlement to a Superior Labrum Anterior and Posterior (SLAP) tear and surgery of December 2, 2015.
BACKGROUND
On January 15, 2015, this then 54 year old automotive assembly worker reported right shoulder pain while lifting a box from waist level to place on a rack at shoulder level. The claim was accepted for health care benefits for a right rotator cuff strain.
The worker and physiotherapist reported symptoms reflective of a brachial plexus injury and entitlement was reviewed and extended to include a brachial plexus injury. Treatment concluded on May 9, 2015.
Diagnostic investigations revealed right acromioclavicular (AC) joint osteoarthritis and tendinosis of the supraspinatus tendons. Following review by a medical consultant, entitlement was limited to a strain and ongoing entitlement was denied. The worker was informed of this decision in a letter dated July 8, 2015.
The worker representative, on behalf of the worker, requested a reconsideration of this decision and provided a submission that included an operative report of December 2, 2015 and the orthopaedic surgeon provided additional information regarding the newly diagnosed SLAP tear in the right labrum. This information was reviewed and entitlement to the SLAP tear was denied as outlined in the letter of May 13, 2016.
AUTHORITY
The following operational policies apply:
11-01-01 Adjudicative Process
11-02-02 Lost Time Claims
15-05-01 Resulting from Work-Related Disability/Impairment
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
ANALYSIS
1. Ongoing Entitlement
Policy 11-02-02 states that decision-makers must monitor, assess and weigh the health care information in the worker’s claim file to determine whether the worker has recovered from his/her work related injury/disease. The policy recognizes that periods of impairment can be prolonged by factors such as age and/or pre-existing conditions. The decision maker must determine through the review of clinical information, when a worker is fit to go back to his/her pre-injury work, or suitable and available work.
Based on the evidence before me, I conclude there is no ongoing entitlement based on the allowance of a right shoulder rotator cuff tear.
In my decision, I have considered the following evidence in particular:
As outlined in memorandum #1 there was a previous acromioclavicular (AC) joint repair in the early 1980’s and x-rays revealed arthritic changes and type 1 acromion/impingement syndrome. A prior claim for a right shoulder injury was accepted for an aggravation of a moderate pre-existing right shoulder rotator cuff tear. The aggravation ceased on November 19, 2003.
On November 15, 2000 Orthopaedic Surgeon, Dr Stecko noted impingement syndrome and AC arthritis and surgery.
The initial diagnosis was right rotator cuff strain as per the Health Professional’s Report (Form 8).
An x-ray taken one day post-injury revealed advanced AC joint osteoarthritis with large osteophytes. No acute fracture or dislocation was seen.
An ultrasound of January 20, 2015 revealed tendinosis of the subscapularis and supraspinatus tendons without evidence of rotator cuff tear and acromioclavicular joint osteoarthritis.
In a report dated March 6, 2015, the family doctor provided the results of the diagnostic testing and amended his diagnosis to osteoarthritis of the shoulder joint and rotator cuff tendonitis.
The family doctor noted that due to the worker’s extensive degeneration of his AC joint and tendon conditions he would likely have future problems.
The March 25, 2015 Program of Care (POC) Care & Outcomes Summary noted nerve type pain.
The May 6, 2015 Physiotherapist’s Treatment Extension Request form provided a diagnosis of rotator cuff tendonitis with brachial plexus limitations/injury.
The Physician Case File Review of June 19, 2015 noted that rotator cuff tendinosis and tears are typically due to intrinsic degenerative processes and wear and tear over time and the ultrasound and x-ray findings are not compatible with the mechanism of injury.
The ongoing right shoulder symptoms were seen to be related to the pre-existing history of chronic right shoulder pain and the pre-existing AC joint osteoarthritis and rotator cuff tendinosis
In a report of July 22, 2015, Orthopaedic Surgeon, Dr Elashaal noted a little bit of weakness, limited range of motion, and apprehension. The worker was referred for an MRI arthrogram but the report is not on file.
The SLAP tear was repaired on December 2, 2015.
Having regard for the medical evidence on file, I find that the accepted strain has fully resolved. The worker’s ongoing symptomology and need for ongoing treatment was found to be related to AC joint osteoarthritis and tendinosis, which would not be compatible with a right rotator cuff strain. The evidence supports the ongoing impairment, need for investigation and treatment is not injury related.
2. Secondary Entitlement
Workers sustaining secondary conditions that are causally linked to the work-related injury will derive benefits to compensate for the further aggravation of the work-related impairment or for new injuries. When I assess the evidence I find there is no entitlement for a SLAP tear and surgery of December 2, 2015 as a secondary condition.
On December 2, 2015 the worker underwent right shoulder arthroscopy, capsular release and repair of the Superior Labrum Anterior and Posterior (SLAP) tear. The operative report noted significant scarring on the anterior labral from the area of previous surgery and the labrum showed signs of tear of the superior part. There were articular surface changes and loss of cartilage on both the glenoid and the humeral head. The scar tissue was resected and the capsule was released. There was suggested wear and tear on the articular surface of the rotator cuff. The SLAP tear was localized and anchored and a subacromial bursectomy and acromioplasty were performed.
In a report of February 2016 Dr Elashaal provided his opinion that the tear was a direct result of the recent injury. However, he described the injury as lifting a heavy box above shoulder level. The box has been described as weighing 29 pounds by the worker and 15 pounds by the employer. Neither would be classified as heavy as the National Occupational Classification (NOC) defines heavy as over 20 kg (44 pounds). Also, the worker lifted the box from waist to shoulder height. I considered this discrepancy with the weighing of this medical opinion.
The Physician Case File Review of May 3, 2016 noted prior surgery at the site of the current labral tear. He noted evidence of scar tissue, which in his opinion likened the new labral tear to degenerative changes in the shoulder over time as opposed to lifting incident of
January 15, 2015.
It is noted the SLAP tear did not show up on the ultrasound of January 20, 2015. I assume it did appear on the MRI arthrogram ordered by Dr Elashaal in light of the pre-operative diagnosis. However, the first evidence in the claim file of the tear is the operative report of
December 2, 2015, 11 months post-injury.
I have considered the opinion of Dr. Elashaal. In determining what weight to place on this opinion, I considered whether the workplace injury would be compatible with the impairment for which benefits are being claimed. I conclude a relationship has not been established. A lift of insignificant weight to shoulder level only, would not result in a Slap Tear.
I am not satisfied that the SLAP tear is compatible to the history of injury. There was no acute injury that would be compatible to the diagnosis. When I consider the worker’s age and history I submit the SLAP tear was as a result of wearing down of the labrum due to the normal aging process and the degenerative state of the worker’s right shoulder.
The medical evidence fails to establish entitlement to the SLAP tear as a secondary condition arising from the work-related right rotator cuff strain.
On this basis, the worker’s claim for entitlement to the SLAP tear and subsequent surgery is denied.
CONCLUSION
I conclude:
There is no ongoing entitlement for a right rotator cuff strain.
Entitlement to a right SLAP tear is denied.
The worker’s objection is denied.
DATED March 2, 2017
P. Luck
Appeals Resolution Officer
Appeals Services Division