APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20220135
OBJECTING PARTY: WORKER
REPRESENTED BY: WORKER REPRESENTATIVE
RESPONDENT: EMPLOYER
HEARING: HEARING IN WRITING
HEARD BY: CORRADO CIRINNA, APPEALS RESOLUTION OFFICER
ISSUE
The worker objects to the case manager decision dated March 30, 2022. This decision confirms the denial of a recurrence in this claim.
BACKGROUND
The worker was employed as a mail clerk where they had worked since 2015. This claim was established for a left wrist/hand soft tissue injury they sustained while performing their job duties on February 13, 2018.
Entitlement was allowed for a left hand and wrist soft tissue injury, and after participating in a physiotherapy treatment program, they returned to their regular job duties on April 9, 2018. After working for only one week, the worker request a leave without pay starting on April 15, 2018. From that point forward, the worker was off work either on vacation or on sick leave.
On June 9, 2018, the worker claimed a recurrence of their work-related injury. When reviewing the available medical information, the case manager denied the recurrence in a decision dated December 13, 2018.
The worker objected to the denial of a recurrence, and the file was referred to the Appeals Services Division (ASD). The Appeals Resolution Officer (ARO) assigned to this case returned the file to Operations in March 2021 as a number of necessary inquiries had not been properly carried out.
Following the additional inquiries that had been requested by the ARO, in a further decision dated March 30, 2022, the case manager upheld the decision to deny a recurrence in this claim. The issue is now before me for further consideration.
AUTHORITY
Operational Policy Manual
Published
15-02-05 Recurrences April 9, 2021
ANALYSIS
In arriving at my decision I had regard for all the information contained in the file, and the applicable policy. The worker representative did not provide any additional written submission that accompanied the Appeals Readiness Form.
Operational policy 15-02-05 states in part that a worker may be entitled to benefits for a recurrence of a work-related injury, if the worker experiences a significant deterioration that does not result from a significant new incident/exposure and is clinically compatible with the original injury.
A significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings. Indicators of a significant deterioration may include; the need for active clinical treatment, a change in functional abilities, or a change in the ability to perform a job or suitable occupation.
To establish that a significant deterioration is clinically compatible with the original injury the WSIB must determine that the body part affected now is the same as, or related to, that affected by the original injury, and there is a causal link between the significant deterioration and the original injury. While a worker may take an occasional day off from work, this is generally not indicative of a significant deterioration.
Decision
There is no entitlement in this claim for a recurrence of the left hand injury as of June 9, 2018.
Reasons for the Decision
The Functional Abilities Form (FAF) dated April 5, 2018 indicates the worker could return to modified duties on a graduated basis starting at four hours per day as of April 9, 2018. Although the specifics of the modified job duties were not listed in the file at that time, there is no indication that the worker raised any concerns with the WSIB about the physical suitability of the job duties that had been offered to them.
There is no indication that during the one week that the worker did return to modified duties from April 10 to 13, 2018 that they somehow experienced a significant deterioration of their non-dominant left arm symptoms. The FAF dated April 20, 2018 continues to indicate the worker could return to modified duties avoiding heavy use of their left non-dominant arm.
The worker attended a WSIB Hand and Wrist Specialty Program on May 5, 2018. At that time, they were provided with restrictions relating to the non-dominant left upper extremity but there was no indication that they were unable to carry out the modified job duties offered by the employer.
The accepted area of injury in this claim is for the left hand and wrist. However, I note there are a number of medical investigations that were carried out in the months subsequent to the workplace injury that included ultrasounds of both shoulders, elbows, the cervical spine, and both heels. It is not clear the extent to which the worker attributes their inability to return to work to these other medical ailments.
The report from the neurologist dated April 19, 2018 indicates the worker had no features of carpal tunnel syndrome (CTS) whatsoever and EMG studies were entirely normal.
An ultrasound of the left shoulder done on April 21, 2018 (one week after they stopped working) noted the rotator cuff and bicipital tendons were normal, the AC joint was unremarkable, and impingement test was negative. An ultrasound of the left elbow was also found to be normal. The ultrasound of the left hand and wrist showed tenosynovitis of the fourth extensor compartment, but otherwise the remainder of the left hand and wrist was entirely normal. This relatively minor finding would not reflect a recurrence of the left hand and wrist condition and in my view not preclude returning to suitable work with the employer that was available.
An x-ray of the left hand, wrist and forearm done on May 4, 2018 showed no bone joint or soft tissue abnormality and the exam was entirely normal.
The report from the Hand and Wrist Specialty Clinic dated May 31, 2018 indicates the worker demonstrated full active range of motion of the elbows, forearm, and digits into both flexion and extension. They also demonstrated full opposition of both thumbs to the tips of all digits. The diagnosis at that time was repetitive strain issues of the left hand with lateral epicondylitis. In terms of recommendations for a return to work, the affected side was weak with some pain and swelling and for this reason it was recommended that they return to work at a sedentary level, while occasionally pushing their limitations as part of their rehabilitation. There was no objective medical information in this reporting that suggests the worker sustained a significant deterioration of their left hand and wrist condition as a result of returning to work for only one week in mid April 2018.
Based on information contained in the file, it seems that shortly after they stopped working on April 13, 2018, the worker underwent some sort of non-compensable medical procedure on May 22, 2018. Given the lack of objective medical information indicative of a recurrence of the compensable condition, this non-compensable issue appears to have been the primary factor preventing them from returning to work. It appears they underwent a further non-compensable medical procedure sometime in August 2018, which would have also affected their ability to return to suitable work that remained available with the employer.
The worker only returned to modified duties for one week starting on April 9, 2018. They then called in sick until April 26, 2018 at which time they began a pre scheduled three week vacation. At the conclusion of their vacation, the worker was once again on sick leave until June 9, 2018. During this timeframe the worker did not appear to raise any concerns about the physical suitability of the modified job duties that were offered to them.
As outlined in the recurrence policy, a significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings. The objective medical testing and clinical findings relating to the worker’s left hand, wrist and upper extremity around the time that they stopped working on April 13, 2018 all point to what were essentially normal findings, with no evidence of a significant deterioration in the compensable condition.
CONCLUSION
There is no entitlement in this claim for a recurrence of the left hand injury as of April 13, 2018 when the worker stopped working in the modified duties offered by the employer.
The worker’s objection is therefore denied.
DATED September 13, 2022
Corrado Cirinna
Appeals Resolution Officer Appeals Services Division