WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20170004
DATE: March 7, 2017
OBJECTING PARTY: Worker
REPRESENTED by: UNION
RESPONDENT: Employer (participating)
REPRESENTED by: Lawyer
HEARING: Hearing in Writing
ISSUE
The worker is seeking ongoing entitlement for his right shoulder for a partial tear of the supraspinatus tendon and calcific tendinopathy, denied on May 19, 2015.
BACKGROUND
The worker was employed at an automotive assembly plant. He developed pain in his right shoulder as a result of closing sliding doors. The rear latch was not fully closing, resulting in him having to close some doors twice and use extra force. He was 61 years old at the accepted date of injury on June 26, 2014 and had been with the employer for approximately 18 years. The claim was initially allowed for a gradual onset right shoulder injury. He did not lose time from work.
An ultrasound on August 13, 2014 showed a partial thickness tear involving the supraspinatus tendon and calcific tendinosis. He was assessed at the WSIB Surgical Specialty Program on October 15, 2014. That assessment confirmed the diagnoses of a partial tear of the supraspinatus tendon and calcific tendonitis, but noted the calcific tendonitis was the cause of the pain. A full recovery was anticipated in four months. Ongoing entitlement for treatment was accepted in accordance with the recommendations from the Specialty Program.
On March 30, 2015, the file was referred for an opinion from a Physician Consultant. In the decision of May 19, 2015, the Case Manager rescinded entitlement for the right shoulder partial tear of the supraspinatus tendon and tendinosis. Entitlement was limited to a right shoulder soft tissue injury.
AUTHORITY
Operational Policy
11-01-01 Adjudicative Process
15-02-01 Definition of an Accident
ANALYSIS
I have considered all of the available information, legislation and relevant operational policies in reaching this decision and find the worker has entitlement for a partial tear of the supraspinatus tendon and calcific tendinopathy of his right shoulder. My reasons are explained below.
According to Operational Policy 11-01-01, an allowable claim must have the following five points:
- an employer
- a worker
- personal work-related injury
- proof of accident, and
- compatibility of diagnosis to accident or disablement history.
An accident, as defined by Operational Policy 15-02-01, does not necessarily require that a chance event be the cause of the injury. The accident may be in the form of a disablement, which would include a condition emerging gradually over time, or an unexpected result of working duties. In a disablement, the evidence must clearly show that the work made a significant contribution to the development of the injury.
Although initial entitlement was accepted in this claim, the issue before me is compatibility of the partial tear of the supraspinatus tendon and calcific tendinopathy.
The worker’s representative provided a submission dated September 26, 2016. He argued that the extra force the worker was exposed to on June 26, 2014 caused the symptoms to occur, but the worker’s job duties as a whole must also be taken into consideration.
The employer’s representative provided a Respondent Form and submission dated December 22, 2016. It is the Employer’s position that proof of accident for the diagnosed conditions has not been established and there is no evidence of any ongoing work-related injury to the right shoulder.
Although the Case Manager rescinded ongoing entitlement based on the Physician Consultant opinion of April 6, 2015, I find the opinion is supportive of ongoing entitlement. The opinion indicated that the diagnosis of calcific tendinosis was not compatible with a discrete injury on June 26, 2014, but was compatible with the worker’s general job duties, which involved repetitive (several hundred times per shift) cross body motion of the shoulder, as well as pushing/pulling with force. The opinion concluded that the worker’s job duties over time could have been a significant contributing factor in the development of the calcific tendinopathy and the supraspinatus tear.
The employer’s representative challenged the opinion of the Physician Consultant, claiming the opinion was not consistent with the accident history, was too sweeping and was made without objective knowledge of the worker’s job duties. The submission also argued the Physician Consultant had no information regarding the worker’s hobbies or non-work activities.
I have considered the arguments raised by the employer’s representative but they have not persuaded me to disregard the opinion of the Physician Consultant. The worker’s job duties and production rates were provided to the doctor as part of the claim record and the submission from the employer’s representative doesn’t dispute the specific duties accepted in the opinion from the Physician Consultant. The submission alludes to non-work-related contributors but provides no specific evidence.
The Case Manager determined entitlement was no longer in order, noting the injury was reported and accepted after a one day onset attributed to a malfunctioning door latch. While I agree those events led to the injury being reported, I also note that the initial entitlement decision accepted entitlement for the right shoulder based on a gradual onset disablement, according to the initial decision memo of July 7, 2014. Although the symptoms did not manifest until June 26, 2014 when the worker experienced problems with the sliding doors, the opinion of the Physician Consultant supported entitlement, noting the diagnosed conditions were compatible with the worker’s general job duties. I find it likely that the claimed right shoulder diagnoses developed as a result of the worker’s general job duties and became symptomatic as a result of the activities reported on June 26, 2014.
The employer’s representative made reference to the WSIAT Discussion Paper on Shoulder Injury and Disability. Their submission references the portion of the report that concludes calcific tendinitis is not associated with work. While I have considered the opinions contained in the discussion paper, I must weigh it against the opinion of the Physician Consultant, who reviewed the job duties and medical findings in this claim. I give more weight to the opinion based on the actual facts of this case than I give the discussion paper, which is based on general findings.
While I accept entitlement for the right shoulder for a partial tear of the supraspinatus tendon and calcific tendinopathy, I leave it to the Operating Area to determine the benefits flowing from this decision. The follow-up report from the Specialty Program on February 4, 2015 indicated the worker continued to have trouble with overhead activities and permanent restrictions were anticipated; however, a further follow up appointment didn’t take place in June 2015 as expected because ongoing entitlement was denied. Noting the absence of updated medical evidence, I leave it to the Operating Area to determine if the worker has a permanent impairment of his right shoulder.
CONCLUSION
I conclude the worker has entitlement for a right shoulder partial tear of the supraspinatus tendon and calcific tendinopathy. It is left to the Operating Area to determine benefits flowing from this decision, including entitlement for a permanent impairment.
The objection is allowed.
DATED March 7, 2017
H. Shaw
Appeals Resolution Officer
Appeals Services Division