WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
claim: 20172034
objecting party: Worker, self-represented
respondent: Employer
hearing: Hearing in Writing
heard by: L. Diaz, Appeals Resolution Officer
DATED: september 1, 2017
ISSUE
The worker requests initial entitlement to a right shoulder injury under the claim.
BACKGROUND
On January 3, 2017, while employed as an Excavator, the worker reported a gradual onset right shoulder injury as a result of operating an excavator for 30 years. He was 59 years old at the time of the reporting of the injury and had been with his employer since 1985.
The worker reported seeking initial medical attention for his shoulder condition in late 2016. As a result of a November 22, 2016 MRI confirming a large central tear of the supraspinatus tendon, the adjudicator requested that an Occupational Medical Consultant (OMC) review the file to provide an opinion as to whether the worker’s right shoulder condition was occupationally related.
Adjudicator’s decision
Further to the January 13, 2017 decision and April 21, 2017 reconsideration, it was noted that the worker had not reported any changes to his regular job duties and had not reported a specific injury. As a result, it was concluded that entitlement to a right shoulder injury was denied on the basis it could not be established that his injury arose out of and in the course of his employment.
Worker’s position
In his completed Appeals Readiness Form (ARF), the worker indicated that his regular work involves more than excavating. He stated that in the winter he performs snow removal with a caterpillar and also removes some snow manually. In the spring, he indicated he performs firewood work for approximately three weeks, which involves cutting firewood, piling it, and driving a front end loader to load the logs into a truck. In addition to the above duties, the worker also advised he is required to perform machine maintenance which involves doing oil and tire changes. In the summertime, the worker indicated they install septic systems, which entails a lot of hand shovelling to dig trenches for the pipes. In summary, he was of the view that all of the above tasks are hard on the shoulders and believes that performing his job duties has led to his right shoulder condition.
AUTHORITY
The following Operational Policies apply:
11-01-01 Adjudicative Process
11-01-02 Decision-Making
ANALYSIS
I find the worker does not have entitlement to a right shoulder injury under the claim. In arriving at this decision, I have had regard for the worker’s arguments, the relevant file and medical reports, and for the applicable Policy.
Policy 11-01-01, records the following with respect to the criteria that must be established for an allowable claim:
All decision-makers use the same criteria for ruling on initial entitlement to WSIB benefits. This system is known as the "five point check system."
An allowable claim must have the following five points:
an employer (see 12-01-01, Who is an Employer?)
a worker (see 12-02-01, Workers and Independent Operators)
personal work-related injury
proof of accident, and
compatibility of diagnosis to accident or disablement history.
In reviewing the above criteria, I find the point which requires further scrutiny is that of ‘compatibility of diagnosis to accident or disablement history’.
With respect to the earliest medical documentation of right shoulder difficulties, chart notes from March 3, 2016 confirm the worker woke up with a sore right shoulder in late 2015, with no specific injury occurring. The worker reported it had been sore all day. A cortisone injection was administered. Range of movement (ROM) was normal, though there was pain with impingement testing. Additional cortisone injections were administered in May and August 2016.
An MRI conducted on November 22, 2016 confirmed the following impression: large central tear of the supraspinatus tendon with marked degree of retraction and superior subluxation of the humeral head as a result. There was also a small subacromial spur noted, and the acromioclavicular (AC) joint showed fluid within the joint, suggestive of arthritis.
The worker underwent surgical intervention on February 27, 2017 for the rotator cuff tear and for AC joint arthritis. Postoperative diagnosis was the same. The procedure performed was complex rotator cuff repair, AC resection, and installation of pain pump. The rotator cuff was repaired, and the outer 4 to 5 mm of clavicle was excised.
The worker’s file was reviewed by Dr. Castiglione, OMC, who recorded the following, in part, with respect to the compatibility of the worker’s diagnosis to his accident history:
Rotator cuff tendinosis and tears are typically due to intrinsic degenerative processes and wear and tear over time and are a natural correlation of aging. Extrinsic factors include repetitive overhead activity, AC joint degenerative changes, acromion morphology, and impingement. There is evidence of AC joint degenerative changes and clinically positive impingement tests. This worker is nearly in his 7th decade of life and a 1995 study of 90 asymptomatic adults found that over 50% of those tested who were in the 7th decade of life had ultrasound evidence of rotator cuff lesions. …
Considering the worker’s right shoulder conditions are in keeping with natural degenerative processes, and there is no objective quantification of work related physical demands, in my opinion, the worker’s right shoulder large central tear of the supraspinatus tendon is not compatible with the worker’s job duties as reported in this claim file.
With respect to the worker’s job duties, although the worker indicated in his completed ARF that his regular job duties involved more than simply excavating, he nonetheless reported to the adjudicator on April 21, 2017 in memo 12, that he was attributing his right shoulder condition to operating heavy equipment and loaders, specifically from using the excavator. He further indicated that he was unable to identify any change in job duties/hours and that no specific incident had occurred to cause his right shoulder injury.
Nonetheless, even if I were to accept that the worker’s job duties are as described in his completed ARF, i.e. snow removal, firewood work, machine maintenance, septic system installation and excavator use, in my view, the worker’s regular job duties still would not involve constant at or above shoulder level activity which might cause significant stress on the AC joint.
Furthermore, the diagnosis of complex rotator cuff tear, as described would be more in keeping with a specific significant incident or AC joint arthritis and, in my view, would not be attributable to the job duties the worker described in his ARF. In the absence of a specific work-related injury, and having regard for the job duties described by the worker in his ARF, I concur with Dr. Castigilione’s opinion and find the worker’s diagnosed right rotator cuff tear and AC joint arthritis is not compatible with his accident history.
Consequently, in light of the fact that I have concluded the worker’s accident history is not compatible with his diagnosis, I find the worker has not met all five points for an allowable claim, as noted in Policy 11-01-01. As a result, I conclude the worker does not have entitlement to a right shoulder injury under the claim.
CONCLUSION
I conclude the worker does not have entitlement to a right shoulder injury under the claim.
The worker’s objection is therefore denied.
DATED September 1, 2017
L. Diaz
Appeals Resolution Officer
Appeals Services Division