APPEALS RESOLUTION OFFICER DECISION
decision number:
20220010
OBJECTING PARTY:
worker
REPRESENTED by:
worker representative
RESPONDENT:
employer
REPRESENTED by:
employer representative
HEARING:
TELEphonic oral hearing – january 17, 2022
HEARD by:
c. da cunha, appeals resolution officer
January 31, 2022
ISSUES
- Claim XXXXXXXX: The worker objects to the Eligibility Adjudicator’s (EA) decisions of October 6, 2015 and November 19, 2015. She seeks:
a) Initial entitlement to bilateral carpal tunnel syndrome (CTS).
- Claim YYYYYYYY: The worker objects to the EA’s February 1, 2016 and April 7, 2016 decisions. She seeks:
a) Initial entitlement to right foot plantar fasciitis and right ankle tendonitis.
BACKGROUND
Claim XXXXXXXX
The worker sought medical attention on July 24, 2015 with her family physician, Dr. P. Salisbury. On that date, Dr. Salisbury diagnosed left rotator cuff tendonitis, left tennis elbow, and suspected bilateral CTS, providing an umbrella diagnosis of overuse syndrome of both upper limbs.
On August 5, 2015, the worker advised the EA that she had an onset of left shoulder, left elbow, and bilateral hand symptoms on or around June 4, 2015. She attributed the onset of difficulties to a faulty air gun, which increased her exposure to vibrations, and faulty dunnage, that kept catching on a mechanism as she lifted it.
At the time, the worker had worked with the employer as an Automotive Assembly Worker for over 6 ½ years, and had a 6% non-economic loss award for a right shoulder permanent impairment (PI) under a prior claim.
The employer accommodated the worker with modified duties, performing quality checks of vehicles on the assembly line. On November 27, 2015, the worker stopped working for personal reasons, applying for and receiving short-term disability benefits. She has not returned to work since that date.
The EA’s Decisions: On October 6, 2015, the EA granted initial entitlement to left forearm DeQuervain’s tenosynovitis, left lateral epicondylitis, and soft tissue injuries of the left shoulder, and trapezius and pectoral muscles, finding that the diagnoses were compatible with the two changes in the regular job duties described by the worker. However, the EA denied initial entitlement to bilateral CTS on the basis that electromyographical (EMG) and nerve conduction studies (NCS) confirming the diagnosis were not on file.
The worker underwent the EMG/NCS investigation on August 6, 2015, which confirmed the presence of bilateral CTS, and the results arrived in the case file on October 20, 2015. The EA then reconsidered initial entitlement to bilateral CTS on November 19, 2015, denying the same. The EA found, after reviewing the physical demands analyses (PDA) of the worker’s regular job duties, that the condition was not compatible with those job duties.
The Worker’s Position: In his closing arguments at the oral hearing, the worker representative put forth that initial entitlement to bilateral CTS is obvious for the following reasons:
The worker’s description of her regular duties confirms that the job entailed repetitive and forceful use of her bilateral hands and wrists. She used torque guns every shift, in awkward positions, while exposed to vibrations from the guns.
The worker is 5’2” tall and had to frequently torque bolts in an awkward position, with her upper extremities at shoulder level.
The worker used a faulty gun for over a month, which exposed her hands to significant and constant vibrations and kickback every time she torqued a bolt, which she did 6,000 times per shift.
The opinions of her family physician, Dr. Salisbury, and Dr. B. Burke, Physiatrist, confirm that the bilateral CTS came on because of repetitive overuse at work.
While the worker sought medical attention for bilateral hand complaints on June 14, 2007 with Dr. Salisbury, six months prior to her date of hire with the employer, this was so insignificant that the worker could not recall the consultation during her testimony.
The bilateral CTS has remained since 2015 and is now permanent.
The evidence shows that the work duties were, on a balance of probabilities, significant contributing factors in the development of the bilateral CTS.
The Employer’s Position: In his closing arguments at the oral hearing, the employer representative maintained that initial entitlement to bilateral CTS is not in order because:
Exposure to vibration and jerking motions does not cause CTS.
While holding the torqueing guns, the worker’s wrists were not in flexion or extension.
While she had to, at times, torque bolts at shoulder height, the PDAs confirm that she also torqued bolts below shoulder height.
The PDAs also shows that she had to perform gripping on an occasional basis only.
She rotated through various processes every shift.
With respect to Dr. Burke’s opinion, this independent medical examination was provided to the insurer in relation to long-term disability requirements and not to determine causation.
The worker’s medical record, going back to at least 2008, shows a number of non-compensable conditions, which are, on a balance of probabilities, responsible for the bilateral CTS.
Claim YYYYYYYY
On December 22, 2015, while off work, the worker reported to the employer that, on October 13, 2015, she had developed pain from the bottom of her right foot, radiating into the ankle, which she attributed to walking around the cars while performing the quality checks on modified duties.
The worker saw Dr. Salisbury on January 26, 2016. In his Health Professional’s Report (Form 8), Dr. Salisbury noted that the worker had developed right foot pain on October 13, 2015, which she attributed to continually stepping over an obstruction in the floor in her work area. Dr. Salisbury diagnosed the worker with bilateral plantar fasciitis, right greater than left.
The EA’s Decisions: On February 1, 2016, the EA denied initial entitlement to bilateral plantar fasciitis, finding that the condition was not compatible with the worker’s regular duties.
The worker objected to the EA’s decision and subsequently provided a March 3, 2016 report from Dr. T. Jevremovic. In the document, Dr. Jevremovic noted that the worker reported a one-year history of pain in the right foot, which had now radiated to her ankle, and she attributed to her job duties. Dr. Jevremovic diagnosed peroneal tendinosis, suspected sinus tarsi syndrome, and pronating arches.
Upon receipt of Dr. Jevremovic’s report, the EA denied initial entitlement to the diagnoses, finding that they were not compatible with the work duties.
The Worker’s Position: In his closing arguments at the oral hearing, the worker representative put forth that initial entitlement to right foot plantar fasciitis and right ankle tendonitis is in order because:
The worker’s sworn testimony confirms that she worked on a hard surface, covered in worn-out ergonomic mats, which were uneven due to deterioration. Furthermore, a latch on the floor required that she twist her right ankle repeatedly throughout her shift in order to carry out her duties.
The line she was working on would frequently stop, causing her feet to jerk.
She had to constantly walk in one direction, turning to the right, aggravating her right foot and ankle.
The medical opinion on record confirms compatibility between the plantar fasciitis in the right foot and the tendonitis in the right ankle.
Even with the presence of non-work-related factors, which may have potentially contributed to the conditions, the evidence shows that the work duties were, on a balance of probabilities, significant contributing factors as well.
The Employer’s Position: In his closing arguments at the oral hearing, the employer representative maintained that initial entitlement to right foot plantar fasciitis and right ankle tendonitis should remain denied because the worker’s has had bilateral foot problems, requiring orthotics, since at least 2008. This includes a bone spur in the right heel.
There is no medical evidence on record confirming that the physical demands of the work duties significantly contributed to the onset of the condition or worsened them. Working on a concrete floor is not medically recognized as an injuring process. While the mats may have had some issues, there are no documented accidents on record resulting from faulty ergonomic floor mats. Despite her description of the floor, the worker was not working in a gravel pit.
Finally, the worker only sought medical attention for the right foot and ankle well after her last day worked. If the work duties had caused her right foot and ankle issues, one would have expected her to seek medical attention while she was at work, not well after.
AUTHORITY
Section 13 of the Workplace Safety and Insurance Act, 1997 (WSIA)
Operational Policy Manual
Published
11-01-01: Adjudicative Process
15-02-01: Definition of an Accident
15-02-03: Pre-existing Conditions
November 3, 2008
October 12, 2004
November 3, 2014
Publicly Available Documents for the Record:
- WSIB Administrative Practice Document
Initial Entitlement (Disablement) – January 2005
https://www.wsib.ca/sites/default/files/2019-03/advice_initialentitlement.pdf
- Workplace Safety and Insurance Appeals Tribunal (WSIAT) Medical Discussion Paper:
CTS – Dr. B. Graham, March 2003
https://wsiat.on.ca/en/MedicalDiscussionPapers/carpal.pdf
- Canadian Centre for Occupational Health and Safety (CCOHS)
CTS Fact Sheet:
https://www.ccohs.ca/oshanswers/diseases/carpal.html
- National Institute of Neurological Disorders and Stroke (NINDS)
CTS Fact Sheet
- Merck Manual Professional Version
a) Plantar Fasciosis (Plantar Fasciitis), Dr. K.A. Whitney, November 2021
b) Obesity, Dr. A. Youdim, August 2021
- American Academy of Orthopaedic Surgeons (AAOS)
Plantar Fasciitis and Bone Spurs
https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs
- American Academy of Family Physicians (AAFP)
February 2021
https://www.aafp.org/afp/2001/0201/p467.html
TESTIMONY
The worker provided the following relevant sworn testimony at the oral hearing:
She is right-hand dominant.
She started with the employer in December 2007. Prior to that, she worked at a creamery factory. Under questioning, she denied any problems with her hands, wrists, or feet prior to starting with the employer, and attributed all her difficulties with these areas to the physical demands of her work with the employer. However, under my cross-questioning, she was not able to recall her June 14, 2007 appointment with Dr. Salisbury, where she complained of bilateral hand symptoms due to her heavy job, and was diagnosed with overuse syndrome. She stated that she was surprised that Dr. Salisbury noted that her job at the creamery was heavy because it was not.
Her bilateral hand and wrist pain and symptoms have remained unchanged since 2015. She continues to be significantly impaired, with difficulty in gripping, writing, keyboarding, and holding objects, which she drops at least once per day. She has a hard time performing her housekeeping duties because of a lack of mobility in her hands, fingers, and wrists.
Her right foot and ankle pain and symptoms are the same today as they were in 2015. The plantar fasciitis affects the middle part underneath her right foot. The tendonitis affects the outside of her right ankle. She can only stand for 10 minutes and walk for 15 minutes because of these ongoing problems.
She attributes the onset of the bilateral CTS to using a faulty torque gun for about one month in 2015. The gun would vibrate and jerk/kick back every time she torqued a bolt into a car, which she did about 6,000 times per shift. The employer never repaired or replaced the gun prior to placing her on modified duties in August 2015. The faulty gun vibrated much more than a gun in good working order, and would cause her a lot of hand and wrist pain because she had to grip the gun harder in order to stabilize it. The vibrations occurred every time she torqued a bolt, and lasted for about two seconds each time. Her four co-workers on the line had the same issues with faulty guns. She is not aware whether any of them developed hand and wrist difficulties because of this.
The torqueing guns weighed about two or three pounds. She would have to use them with her right hand, left hand, and both hands, depending on the process she was performing as well as the size of the bolts to be torqued. The gun she had to hold with both hands was about two feet long. The other guns were the size of power drills.
She would use her middle finger to pull on the trigger, which was the ergonomically correct way of doing it.
She is 5’2” tall and weighed 190 pounds in 2015. She would have to torque bolts at shoulder height, which was awkward because she had to stabilize the gun herself.
She stood for her entire shift, on a hard, concrete floor, covered in rubber ergonomic mats. However, the mats were deteriorated, full of holes and missing areas, causing them to be uneven. There were holes that were about 1 ½ to 2 inches deep, which she stepped on throughout her shift.
There were also 1 ½-inch high hard plastic latches bolted onto the floor, which were used to secure dollies. She had to be careful not to strike these latches with her feet.
She twisted her right ankle 70 to 80 times per shift because she had to be careful around the latches as well as the unevenness of the mats. She knows of one co-worker who went off because of a twisted ankle.
She had to walk around the car, torqueing the bolts, as the assembly line was moving. She had to take her time, and look down so as not to trip or twist her ankles, constantly standing and walking on the uneven, deteriorated mats, full of ruts.
Her doctors told her that the bilateral CTS, plantar fasciitis and tendonitis are work-related.
She did not have any problems with her feet prior to starting with the employer. She did not recall how many years she has had orthotics.
She performed multiple processes as part of her work duties. She would perform at least six processes per shift, and sometime more, if needed.
Her employer put her on modified duties in August 2015. She had to inspect the cars for quality control. She would walk around the cars, in a clockwise motion to do so.
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. Having done so, I find that:
Initial entitlement to bilateral CTS under claim XXXXXXXX is allowed; and,
Initial entitlement to right foot plantar fasciitis and right ankle tendonitis under claim YYYYYYYY is denied.
According to operational policy 11-01-01, Adjudicative Process, WSIB decision-makers use the “five point check system” when ruling on entitlement to benefits. An allowable claim must have the following five points:
An employer;
A worker;
A personal work-related injury;
Proof of accident; and,
Compatibility of diagnosis to accident or disablement history.
The policy adds, in part:
If it is not clear that the (injury or disablement) diagnosis provided is the result of the accident or disablement history described, a decision-maker may consult with the WSIB's clinical staff to assist in making this determination.
There is no dispute regarding the worker and employer relationship. The matters to be resolved are whether proof of accident can be established and, if so, if the worker suffered work-related injuries that are compatible with her accident history.
Operational policy 15-02-01, Definition of an Accident, categorizes three different types of accidents, including:
A wilful and intentional act, not being the act of the worker;
A chance event occasioned by a physical or natural cause; and
A disablement arising out of and in the course of employment.
A “chance event” is defined as an identifiable unintended event, which causes an injury. An injury itself is not a chance event. A “disablement” is either:
A condition that emerges gradually over time; or,
An unexpected result of working duties.
The worker’s accident history is neither a wilful and intentional act nor a chance event (i.e. an identifiable unintended event causing an injury). The accident history is that of a disablement. The worker’s claim is that she suffered bilateral CTS and right foot/ankle plantar fasciitis/tendonitis as a result of a disablement arising out of and in the course of her employment, which emerged gradually over time, due to the physical demands of her regular duties. Specifically, those described above. Therefore, initial entitlement turns on the medical compatibility of the diagnoses to the accident history.
As the worker’s claim is a disablement, she does not have the benefit of the presumption under
Section 13(2) of the WSIA, which states:
If the accident arises out of the worker’s employment, it is presumed to have occurred in the course of the employment unless the contrary is shown. If it occurs in the course of the worker’s employment, it is presumed to have arisen out of the employment unless the contrary is shown.
In other words, because the accident is neither a wilful and intentional act nor a chance event (i.e. there is no identifiable and unintended occurrence preceding the injury), while it occurred in the course of employment, it cannot be presumed that it arose out of the employment. Therefore, the onus is on the worker to prove the work-relatedness of the claimed bilateral wrist and right foot/ankle injuries.
The test for determining causation in WSIB claims is that of a significant or material contribution. A significant or material contributing factor is one of considerable effect or importance. It need not be the sole or even primary contributing factor.
The standard of proof applied is the “balance of probabilities”. A speculative possibility does not meet this standard, which requires a fact or a causal link to be “more probable than not”.
Furthermore, the January 2005 WSIB Adjudicative Document entitled “Initial Entitlement (Disablement)” states, in part:
In order to rule on whether the injury ‘arose out of the work activity’ significant detail around the work performed including the mechanics of how it was performed and the nature of the injury the worker has incurred must be secured. The primary source for this information should be the worker and the treating physician(s).
Finally, operational policy 15-02-03, Pre-existing Conditions, directs that entitlement for a work-related injury/disease will not be denied due to the existence of a pre-existing condition. Consistent with the “thin skull” doctrine, the fact that a worker may have a pre-existing condition that could increase susceptibility to injury/disease is not considered during the initial determination of entitlement in a claim. In such cases, workers are compensated for the work-related injury/disease and the claim is not denied due to the existence of a pre-existing condition.
Initial Entitlement to Bilateral CTS in Claim XXXXXXXX
The WSIAT’s March 2003 medical discussion paper entitled “CTS”, authored by Dr. Graham, Orthopaedic Surgeon, helps us to understand the causes of CTS, with sources provided. In this paper, Dr. Graham writes, in part:
The relationship between sensory symptoms and strenuous hand use is less well defined but may be prominent. The literature indicates that the hand activity must be repetitive and forceful. Activities characterized by a high frequency but low force, such as computer keypad use, have not been shown to be an important precipitating factor despite the overwhelming volume of information in the lay media to the contrary. The fact is that actual evidence of this relationship, by valid medical or epidemiological studies, is lacking. Where the relationship between exposure to repetitive hand use and CTS has been carefully studied, no significant increase in the risk of developing this condition can be identified. In rare circumstances, where a clear temporal linkage between the development of symptoms and their relief, in relation to a given exposure, can be reliably and repeatedly identified, then a major criterion for causality may be met.
Dr. Graham adds, in part:
The role of repetitive movements has been alluded to above. The data available on this subject suggests little if any relationship between this type of exposure and CTS. The exception would be in instances where the repetitive activity requires both frequent and forceful movements. Guidelines for defining a critical frequency and degree of force can be inferred from these reports.
The CCOHS’ CTS Fact Sheet is also useful in this case and it states that CTS has been associated with certain tasks including:
Repetitive hand motions.
Awkward hand positions.
Strong gripping.
Mechanical stress on the palm.
Vibration.
It adds that, people whose work-related tasks involve repetitive movements, and flexion of the fingers and wrist while performing a task, are associated with CTS. Those workers performing assembly line work, including manufacturing, finishing, cleaning, and meat/poultry/fish packaging, commonly report this injury. Cashiers, hairdressers, or knitters or sewers are examples of people whose work-related tasks involve the repetitive wrist movements associated with CTS. Bakers who flex or extend the wrist while kneading dough, and people who flex the fingers and wrist in tasks such as milking cows, using a spray paint gun, and hand-weeding are other examples. Excessive use of vibrating hand tools may also be related to CTS.
The CCOHS adds that hypothyroidism, menopause, size and shape of the wrist and median nerve, and gender (women three times more likely than men) are associated with the development of CTS.
The NINDS is another respected and useful resource and its fact sheet states that CTS is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; an overactive pituitary gland; an underactive thyroid gland; and rheumatoid arthritis. Other factors that may contribute to the compression include mechanical problems in the wrist joint, repeated use of vibrating hand tools, fluid retention during pregnancy or menopause, or the development of a cyst or tumor in the canal. Often, no single cause can be identified.
It adds that women are three times more likely than men to develop CTS. People with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. CTS usually occurs only in adults.
Workplace factors may contribute to existing pressure on or damage to the median nerve. The risk of developing CTS is not confined to people in a single industry or job, but may be more reported in those performing assembly line work, such as manufacturing, sewing, finishing, cleaning, and meatpacking, than it is among data-entry personnel.
The Merck Manual, which the WSIAT also consults, clarifies that obesity is excess body weight, defined as a body mass index of greater than 30 kilograms per square metre. It confirms a significant list of complications arising from obesity, including tendon and fascial disorders.
The worker’s medical record, which goes back to 2006, shows that the worker entered menopause in 2009, suffered from hypothyroidism for a number of years prior to the date of injury, and is obese. Therefore, she possesses a number of non-work-related risk factors associated with the development of CTS. However, this does not automatically result in a finding that the bilateral CTS is not work-related. The question that must be resolved is whether the physical demands of the work duties were, on a balance of probabilities, significant contributing factors to the development of the condition.
In reviewing the CCOHS and NINDS fact sheets on CTS, they state that there is an association between assembly line work and the development of CTS. This appears to be because these types of jobs involve repetitive movements, and flexion of the fingers, awkward hand positions, strong gripping with stress on the palms, and exposure of the hands/wrists to vibration. However, as per the WSIAT discussion paper, such exposure must be both repetitive and forceful, and there must be symptom relief when the exposures are not present.
The medical record first documents bilateral hand difficulties on June 14, 2007, approximately six months before the employer hired the worker. On that day, Dr. Salisbury diagnosed her with overuse syndrome of the hands and wrists due to heavy manual work.
There are no further hand/wrist issues documented in the medical record until March 28, 2014. On that date, A. Waanders, Registered Nurse (RN), recommended bilateral wrist and elbow braces. However, this recommendation was made on a proactive basis because the worker had a work-related right shoulder PI and had now developed left shoulder complaints. The RN likely foresaw bilateral wrist and elbow difficulties without proactive intervention.
On July 24, 2015, the worker reported to Dr. Salisbury that her left shoulder, left elbow, and both hands were bothering her. The worker complained that the left elbow pain radiated down, along the forearm, and both hands tingled and went numb, causing her to lose dexterity. Dr. Salisbury diagnosed left shoulder rotator cuff tendonitis, left tennis elbow, possible bilateral CTS, with an overall diagnosis of overuse syndrome of both upper limbs, just like on June 14, 2007.
On August 6, 2015, EMG/NCS investigations confirmed the presence of bilateral CTS.
The information on record shows that the worker had a number of pre-existing, non-work-related risk factors (i.e. female, menopausal, obesity, hypothyroidism) associated with the development of CTS. Furthermore, in his report of October 27, 2015, Dr. O. Tugalev, Physiatrist, related the worker’s difficulties to her overall lack of physical conditioning and strength. However, I find that what this evidence shows is that the worker was more vulnerable to the development of the CTS than a person without these pre-existing conditions.
In the same report, Dr. Tugalev stated that the bilateral CTS was a non-occupational diagnosis. However, Dr. Tugalev was simply following and echoing the WSIB’s position at the time, based on the original decision of October 6, 2015.
While I acknowledge the employer’s PDAs, which indicate that the regular duties do not involve forceful and repetitive use of the hands and wrists, as well as the fact that the worker did not experience relief from the bilateral CTS symptoms after she stopped working, and, in fact, required surgery, the evidence provided by the worker and Drs. Salisbury and Burke is persuasive. It shows that her regular work duties involved repetitive and forceful use of her hands, fingers, and wrists in awkward positions, often at shoulder level, while being exposed to vibrations from the torqueing guns, and that these duties caused repetitive overuse issues with her hands and wrists. I also find it reasonable to accept that someone who is 5’2” tall, who spent a full shift torqueing bolts with a gun on an automotive assembly line, with time pressure placed upon them, would have to repeatedly flex and extend their wrists to get the tasks completed on time. Therefore, her tasks involved the repetitive and forceful use of the wrists in awkward positions.
The facts and circumstances on record lead me to find that the physical demands of the regular duties were, on a balance of probabilities, a significant contributing factor in the development of the bilateral CTS. Therefore, initial entitlement to the same is in order.
Initial Entitlement to Right Foot Plantar Fasciitis and Right Ankle Tendonitis in Claim YYYYYYYY
In the articles referenced above, the AAOS and AAFP state that the plantar fascia is designed to absorb the high stresses and strains we place on our feet. However, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.
In most cases, plantar fasciitis develops without a specific, identifiable reason. Bone spurs do not cause plantar fasciitis. There are, however, many factors that can make one more prone to the condition, including:
Tighter calf muscles that make it difficult to flex the foot and bring the toes up toward the shin
Obesity
Pes planus (flat foot) and pes cavus (very high arch)
Repetitive impact activity (running/sports)
New or increased activity
Other anatomic risks include overpronation, discrepancy in leg length, excessive lateral tibial torsion and excessive femoral anteversion. Functional risk factors include tightness and weakness in the gastrocnemius, soleus, Achilles tendon and intrinsic foot muscles. However, overuse rather than anatomy is the most common cause of plantar fasciitis in athletes. A history of an increase in weight-bearing activities is common, especially those involving running, which causes microtrauma to the plantar fascia and exceeds the body's capacity to recover. Plantar fasciitis also occurs in elderly adults. In these patients, the problem is usually more biomechanical, often related to poor intrinsic muscle strength and poor force attenuation secondary to acquired flat feet and compounded by a decrease in the body's healing capacity.
The pain is usually caused by collagen degeneration (which is sometimes misnamed “chronic inflammation”) at the origin of the plantar fascia at the medial tubercle of the calcaneus. The cause of the degeneration is repetitive microtears of the plantar fascia that overcome the body's ability to repair itself.
According to the Merck Manual, recognized causes of plantar fasciosis include shortening or contracture of the calf muscles and plantar fascia. Risk factors for such shortening include a sedentary lifestyle, occupations requiring sitting, very high or low arches in the feet, and chronic wearing of high-heel shoes. The disorder is also common among runners and dancers and may occur in people whose occupations involve standing or walking on hard surfaces for prolonged periods.
Disorders that may be associated with plantar fasciosis are obesity, rheumatoid arthritis, reactive arthritis, and psoriatic arthritis.
On January 19, 2016, the worker advised the WISB that she had been using orthotics for over 30 years, since her twenties. The record shows that, on September 15, 2008, she was diagnosed with bilateral flat feet, causing pain in her hips. She was prescribed orthotics on that date.
Her foot difficulties continued, worsening in October 2011, and August 2012, when she received a cortisone shot. However, the pain did not resolve and became insidious by early 2013. On March 20, 2013, she was diagnosed with left foot plantar fasciitis. According to Dr. Salisbury, work aggravated the condition. An April 22, 2013 X-ray of the left foot showed the presence of a moderate left heel spur and mild degenerative changes in the mid-foot.
On October 23, 2015, V.R. Derita, Pedorthist, examined the worker, who complained of shooting pain in both medial longitudinal arches, right greater than left, noting that she had twisted her left knee two years earlier. The Pedorthist suspected the foot pain might be caused by a lower back issue and recommended the continuing use of orthotics at all times, with Asics running shoes, even at home.
On November 6, 2015 and December 18, 2015, Dr. Salisbury diagnosed her with bilateral plantar fasciitis, with excruciating right lateral mid-foot pain while weight bearing. A December 18, 2015 X-ray confirmed the presence of a large heel spur.
The worker saw Dr. E. Moon on February 24, 2016 and complained of pain in the right ankle, on the outside of the foot, and under the foot. Dr. Moon opined that the lateral ankle pain did not seem quite consistent with plantar fasciitis and referred the worker for a sports medicine assessment.
On March 3, 2016, the worker advised Dr. T. Jevremovic, that her pain had started in the right foot but was now in her ankle. She reported that she twisted her ankles a lot at work because the ground was uneven. On examination, Dr. Jevremovic found the worker had pronating arches, but with a full range of motion in the ankle, and diagnosed peroneal tendinosis, with a suspected small component of sinus tarsi syndrome. In summary, the worker is someone with an over 30-year history of bilateral foot difficulties. She has bilateral flat feet, overpronated arches, decreased calcaneal inversion, bilateral tightness in the gastrocnemius and soleus muscles, and is obese. These are all significant risk factors for the development of plantar fasciitis.
While the worker’s job required that she be on her feet all day, and she may have experienced increasing difficulty over the years in standing and walking for a full shift, the act of standing and walking, with intermittent breaks during a normal working day, is not reasonably considered to be an injuring process. Standing and walking is a natural human process, for which the human body is built.
With respect to the state of the floor in the plant, I do not doubt that the anti-fatigue/ergonomic mats covering the concrete floor of the automotive plant would develop areas of wear and tear over time, and that there were hard plastic latches secured into the floor, around which workers had to be careful in order to avoid injury. While I also do not doubt that, over time, the worker has genuinely developed an exaggerated picture of that floor, as the employer representative stated in his closing, the worker was not working in a gravel pit. To accept that one individual would twist and sprain her ankle 80 times per shift, every shift, because of the state of the floor, would require the suspension of disbelief. If one accepts that the state of the floor was as horrendous as described by the worker, simple math results in a finding that that it was causing thousands of twists and sprains to the ankles of workers every single day. The employer is a large, global conglomerate. If it maintained its premises in such disrepair, it would have been out of business decades ago. Therefore, respectfully, I place little evidentiary weight on the worker’s subjective and uncorroborated description of the state of the plant’s floor.
The facts and circumstances on record lead me to find that the worker’s regular duties were not, on a balance of probabilities, significant contributing factors to the development of the right foot plantar fasciitis.
In relation to the March 3, 2016 diagnosis of peroneal tendinosis, this came more than three months after the worker had stopped working, and involved a new area of injury. The worker first reported problems with her right ankle to the employer on December 22, 2015, a month after she last worked. The fact that the worker’s right foot difficulties expanded to include another area (i.e. the ankle) a month after she had last been at work, significantly buttresses a finding that her right foot/ankle difficulties in late 2015/early 2016 were not work-related, but simply a progression of the pre-existing, non-work-related problems. Therefore, I am unable to find that the right ankle tendinosis is work-related.
CONCLUSION
I find that initial entitlement to:
Bilateral carpal tunnel syndrome under claim XXXXXXXX is in order; and,
Right foot plantar fasciitis and right ankle tendinosis/tendonitis under claim YYYYYYYY is not in order.
The worker’s objections are, therefore, allowed in part.
DATED January 31, 2022.
C. da Cunha
Appeals Resolution Officer
Appeals Services Division