DECISION NUMBER:

20220113

OBJECTING PARTY:

WORKER

REPRESENTED by:

WORKER REPRESENTATIVE

RESPONDENT:

EMPLOYER

REPRESENTED by:

EMPLOYER REPRESENTATIVE

HEARING:

VIDEOCONFERENCE – SEPTEMBER 7, 2022

HEARD by:

K. MACMILLAN, APPEALS RESOLUTION OFFICER

ADDITIONAL ATTENDEES:

EMPLOYER RESOURCE

DATED: SEPTEMBER 23, 2022

ISSUES

The worker, through their representative, is objecting to the following:

1. The Case Manager’s decision of November 16, 2018 denying entitlement to chronic mental stress (CMS); and,

2. The Case Manager’s decision of April 30, 2021 denying initial entitlement to an organic (physical) injury for a chest wall strain.

BACKGROUND

On August 23, 2018 the worker was assigned to manually change the retail store’s outside reader board. The worker had previously started a graduated return-to-work on April 20, 2018 after undergoing treatment for a non-work-related condition. The worker made three attempts to change the board and requested help or for the task to be assigned to someone else. A medical note dated August 25, 2018 stated that there was an inability to work from August 27, 2018 to September 10, 2018 due to medical reasons. The worker met with the Payroll Coordinator and the Health, Safety, and Wellness Coordinator on September 4, 2018 to discuss difficulties with co-managers and the store manager, as well as to report the incident of August 23, 2018. A letter from the worker to the employer dated September 4, 2018 summarized incidents of alleged harassment.

A Health Professional’s Report dated September 5, 2018 diagnosed a possible chest muscle strain. A Health Professional’s Report for Occupational Mental Stress completed on the same date stated that the worker was unable to work due to a psychological condition. The employer notified the worker of a pending investigation on September 13, 2018 and completed the investigation on October 1, 2018. The Case Manager’s decision letter dated November 16, 2018 denied entitlement to CMS on the basis that the diagnosed anxiety and depression was a stress reaction in response to interpersonal conflict in the workplace.

Correspondence from the worker representative dated February 4, 2021 suggested that an aggravation of a pre-existing condition on either a temporary or permanent basis had not been considered. The worker representative pointed out that there had been no investigation to determine if the accident exacerbated the previous surgical procedures. The Case Manager’s decision letter dated April 30, 2021 denied entitlement to a muscle strain as the worker did not specifically report seeking medical attention relating to a left rib/chest injury until two weeks after August 23, 2018. The Case Manager determined that the majority of information on file relates to conflict with management and co-workers, and that the mechanics of the task performed is not compatible with the diagnosis of a possible muscle strain. The decision letter denied entitlement to health care benefits and loss of earnings benefits as the updated medical information of March 2020 indicates ongoing left chest pain that is not compatible with the diagnosis of a sprain/strain injury.

The Appeal Readiness Form signed February 24, 2022 requested that the worker’s objections be resolved by an oral hearing. The Respondent form of June 3, 2022 requested a hearing in writing. The administrative decision of June 23, 2021 authorized an oral hearing as the method of resolution. The worker’s objections to the decisions of November 16, 2018 and April 30, 2021 are now before me.

AUTHORITY

Operational Policy Manual

Published

11-01-01

Adjudicative Process

November 3, 2008

11-01-05

Determining Permanent Impairment

November 3, 2014

15-02-01

Definition of an Accident

October 12, 2004

15-02-03

Pre-existing Conditions

November 3, 2014

15-02-04

Aggravation Basis

November 3, 2014

15-03-14

Chronic Mental Stress

January 2, 2018

ANALYSIS

I find that entitlement to CMS is not appropriate. In addition, I accept that there is a permanent aggravation of a pre-accident impairment involving the left-sided intercostal neuralgia. My reasons for these findings are outlined below. I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision.

Jurisdiction

I acknowledge the worker representative’s submission that the worker’s doctor seems to indicate that the depression and anxiety are related to a significant injury involving the pre-existing medication port from the non-work-related surgery. However, as discussed during the oral hearing, there is general agreement that the issues of psychotraumatic disability entitlement or loss of earnings benefits are not properly before me. Therefore, the focus of my review remains limited to entitlement to CMS and to a physical injury involving the left side of the chest.

Worker representative’s position

It is the worker’s position that there has been a permanent aggravation of the portal site as the worker required different treatment after the reader board incident of August 23, 2018. The worker representative

points out that the policy threshold for harassment may still be met even if it does not meet the standard used by the employer. In the view of the worker representative, the employer’s investigation suggests that the witness statements not on the side of the store are less credible.

Employer representative’s position

It is the employer representative’s position that the worker was not harassed or bullied in the workplace. Instead, it is suggested that the workplace environment falls within the policy guidelines and that any stress seems to be caused by employment issues and constructive criticism. The employer representative submits that there is no work-related aggravation of a physical injury relating to the reader board incident given that the condition had worsened by March 2020.

Worker’s testimony

According to the worker’s testimony, the atmosphere upon returning to work on a graduated basis to alternative duties in April 2018 was not very welcoming. The worker identifies having problems with the store manager and sales manager. During testimony, the worker clarifies that they did not resign or quit, never received severance, and is in receipt of Canada Pension Plan Disability (CPP-D) benefits as they are unable to work due to chronic pain.

The worker describes being harassed by the sales manager who was degrading towards them, suggested that they should step down, and assigned them the reader board task even after being informed that they could not do it. It is the worker’s testimony that the most offensive comment by the sales manager involves the suggestion that their treatment for the non-work-related condition “fried” their brain. The sales manager also indicated that they should not have to work as their father was selling a farm. The worker describes an incident involving the store manager belittling them, stating that everyone hates them and no one wants them to be back.

The worker explains that the left chest area had partially recovered prior to the workplace incident and has not recovered since. The worker indicates that the reader board incident of August 23, 2018 resulted in nerve endings becoming caught on bone which is why they are now receiving intercostal injections.

1) Entitlement to chronic mental stress

I am not persuaded that the criteria for entitlement to CMS is established as it is my view that the required criteria of a substantial work-related stressor are not met.

Policy 15-03-14, Chronic Mental Stress, states that entitlement to CMS requires there to be an appropriately diagnosed mental stress injury that is caused by a substantial work-related stressor arising out of and in the course of employment. It must be shown on a balance of probabilities that the substantial work-related stressor was the predominant cause of an appropriately diagnosed mental stress injury. The term predominant cause means that the substantial work-related stressor is the primary or main cause of the diagnosed mental stress injury.

Policy 11-01-01, Adjudicative Process, requires the injury to be work-related. I recognize that Policy 15-03-14 defines work-related stressor as including a cumulative series of work-related stressors. In order to consider entitlement to CMS, policy requires decision-makers to be able to identify the events

that are alleged to have caused the CMS. Policy defines the term substantial work-related stressor in part as a work-related stressor that is excessive in intensity and/or duration in comparison with the normal pressures and tensions experienced by workers in similar circumstances. In order to consider entitlement

to CMS, policy requires decision-makers to be able to identify the events which are alleged to have caused the CMS.

Policy 15-03-14 outlines that interpersonal conflicts between workers and their co-workers or supervisors are generally considered to be a typical feature of normal employment. Policy documents that such interpersonal conflicts are consequently not generally considered to be a substantial work-related stressor, unless the conflict amounts to workplace harassment or results in conduct that a reasonable person would perceive as egregious or abusive.

Similarly, Policy 15-03-14 verifies that a worker is not entitled to benefits for CMS caused by decisions or actions of the employer relating to the worker’s employment. That being said, policy confirms that entitlement to CMS may be in order if the employer’s actions are not part of the employment function, such as workplace harassment or conduct that a reasonable person would perceive as egregious or abusive. Policy 15-03-14 confirms that workplace harassment will generally be considered a substantial work-related stressor. Policy states that workplace harassment occurs when a person or persons, while in the course of employment, engage in a course of vexatious comment or conduct against a worker, including bullying, that is known or ought reasonably to be known to be unwelcome.

The worker representative suggests that the sales manager’s comment that the worker’s brain was fried from treatment is not a common comment from one manager to another. In the view of the worker representative, the degrading and belittling comments and the posting of a sign advising staff not to talk to the worker does not represent common workplace communication. The argument is presented that if the sales manager’s comments are viewed to be degrading and uncommon, then entitlement to CMS can be considered.

In contrast, the employer representative argues that the employer performed a very thorough investigation, noting that the written notice of September 13, 2018 informed the worker of the details of the proposed investigation to look into the complaints of harassment. The employer representative highlights that the resulting investigation report of October 1, 2018 includes notes indicating the

co-worker’s suggestion that the worker was the problem. In any event, the employer representative submits that this information is not evidence of harassment towards the worker.

Review of the evidence

I acknowledge the worker representative’s argument that the investigation report appears to consider individuals as more credible if their statements are in favour of the employer. Even so, it is the worker’s testimony that their annual performance review in 2016 resulted in the worker disagreeing with the store manager’s review “big time” as it suggested that the worker started rumours and was causing trouble.

The worker verifies that the store manager stated that the worker was very good at their job with customers. However, the worker explains that this annual review made them look like a terrible person prior to even going off for the non-work-related diagnosis in March 2017. Therefore, I afford significant weight to the investigation report’s documentation of the majority of witnesses suggesting that the worker creates rumours and has always behaved this way but seems worse upon their return to work.

I appreciate that the worker has provided written statements from former employees and a customer regarding the sale’s manager’s behaviour. Nevertheless, I must also consider that the worker’s testimony indicates having at least some arguments with the prior sales manager. According to the worker, the difference with the current sales manager was that they would raise their voice, yell, and be very rude.

The worker indicates that the sales manager would call them names and indicate being tired of the worker’s sickness. Yet, the worker confirms that no one was around when the sales manager made the

most offensive comment suggesting that the treatment had fried their brain. Further, I note that the employer investigator’s documentation of October 24, 2018 describes a call from the worker that was very accusatory and hostile.

I am aware of the staff announcement sign contained in the case record that the worker refers to within testimony. I note that the sign informs staff that the worker is on medical leave until further notice and that no store information/communication is to be discussed with the worker until they return. I also observe that the case record contains a staff memo from the sales manager clarifying that the worker is a key holder/manager and that it was expected for staff to show them the same respect and consideration that they would show the sales manager. In my opinion, neither of these documents represent anything that a reasonable person would perceive to be egregious or abusive.

Overall, I am not persuaded that the worker’s job falls within Policy 15-03-14’s definition of a job with a high degree of routine stress as it does not involve the responsibility over matters of life and death or routine work in extremely dangerous circumstances. I find that the circumstances are not excessive in intensity and/or duration in comparison with the normal pressures and tensions experienced by workers in similar circumstances. Instead, I find that the situation before me fits within the policy definitions of the employer’s decisions or actions relating to employment, and of interpersonal conflicts.

In reaching this determination I find that there is insufficient corroborating evidence of the sales manager commenting to the worker that the non-work-related treatment has fried their brain. The investigation report of October 1, 2018 documents the worker’s allegation of the sales manager calling them into the lunchroom and making the comments about stepping down from their position and the treatment affecting their brain. According to the investigation report, the sales manager alleges that the worker approached them and denies ever calling the worker into the office, lunchroom or anywhere else where they would be alone. The sales manager goes on to allege that any time that they have been alone with the worker was because the worker approached or cornered them.

When weighing the evidence I observe that an employee describes the sales manager as being overly nice when talking to the worker and suggests that perhaps this is so the worker does not feel threatened. The sales manager states that after the worker’s return to the store they have chosen their words very carefully and have said nothing that could be potentially used against them. A different manager maintains that they have never witnessed anything inappropriate between the worker and the sales manager. Therefore, it is my view that there is insufficient evidence that either the store manager or sales manager acted in a way that amounts to harassment or conduct that a reasonable person would perceive to be egregious or abusive. Instead, I accept that the situations represent interpersonal conflict. As a result, I find that the criterion of a substantial work-related stressor required by Policy 15-03-14 is not established. Therefore, it is my opinion that entitlement to CMS is not in order, including on a cumulative basis.

2) Is entitlement to a physical injury in order for the chest?

I accept that the worker is claiming a disablement injury to the same left-sided rib area where the

non-work-related medication port was located. The employer representative submits that there was no aggravation of the pre-existing medication port site. Rather, the employer representative highlights that the investigation report of October 1, 2018 documents that an employee and the sales manager both confirm the worker referencing the neck and not the port site immediately after the incident.

There is general agreement that the worker had non-work-related surgery on April 19, 2017 involving a medication port being placed on the left-sided rib area for the administration of treatment. The device was

removed on August 8, 2017. The worker indicates that the port was attached to the ribs as they received treatment through a vein as well as the medication port. The worker states that their body did not like the port which was the reason for its removal. Although the removal of the port decreased the level of pain, the worker was referred to physiotherapy to rebuild the muscles which were very sore.

A physiotherapist began treating the worker for the medication port injury January 22, 2018. The worker describes this pre-accident physiotherapy treatment as rebuilding the muscle, increasing mobility, and involving ultrasound treatment and certain exercises. Upon questioning, the worker describes being very weak and sore but also being excited during their gradual return to work. The worker’s testimony explains that after the reader board incident on August 23, 2018 the physiotherapy treatment involved different exercises and that it felt like they were starting all over.

I am aware that Policy 15-02-03, Pre-existing Conditions, states that the thin skull and crumbling skull doctrines are well-established legal principles that are components of decision-making at the WSIB. Consistent with the thin skull doctrine, the fact that a worker may have a pre-existing condition that could increase susceptibility to injury is not considered during the initial determination of entitlement. Policy states that in such cases, workers are compensated for the work-related injury and the claim is not denied due to the existence of a pre-existing condition. However, I find that there must still be sufficient evidence that the work duties made a significant contribution to the claimed physical injury.

Policy 15-02-04, Aggravation Basis, requires decision-makers to first determine entitlement by applying Policy 11-01-01 prior to considering entitlement to benefits on an aggravation basis. Policy 15-02-03 similarly requires decision-makers to determine entitlement by applying Policy 11-01-01 before considering the impact, if any, of the pre-existing condition.

Policy 11-01-01, Adjudicative Process, sets out five factors that must be present in order to allow a claim:

• Is there an employer?

• Is there a worker?

• Was there a personal work-related injury?

• Is there proof of accident?

• Is there compatibility of diagnosis to accident or disablement history?

There is no dispute that the first two criteria are met. I accept that this third criterion listed under Policy 11-01-01 is satisfied as the Employer’s Report of Injury signed September 7, 2018 does not provide any evidence contesting the factors of time, activity, or place. Therefore, my review will focus on the two remaining criteria for initial entitlement.

i) Proof of accident

I accept that proof of accident is established.

When reviewing the fourth policy criterion, Policy 11-01-01 provides the authority for decision-makers to consider factors that may be relevant to establishing proof of accident including examining if an accident or disablement situation exists, if there are any witnesses, or if there were any delays in the onset of symptoms or in seeking health care attention. Policy 15-02-01, Definition of an Accident, outlines that the term accident includes both a chance event and a disablement. Policy outlines that a disablement includes both a condition that emerges over time and an unexpected result of working duties. Importantly, Policy 15-02-01 requires the disablement to arise out of and in the course of employment.

Again, the employer representative argues that the worker’s immediate discussion upon re-entering the store relates the reader board incident to the neck. It is submitted that the first medical documentation two days later does not state the cause for requiring time off work other than for medical reasons. The employer representative argues that the covering doctor not completing a Health Professional’s Report (Form 8) on August 25, 2018 suggests that the condition is not work-related. The employer representative stresses that the first mention of the reader board was 13 days later when the family doctor completes a Form 8 on September 5, 2018 which still does not reference the port area or an aggravation.

I acknowledge the employer representative’s position that the medical report of November 14, 2018 outlines improvement in the worker’s floor to waist lifting tolerance to 30 pounds while the new Form 8 dated March 2, 2020 provides a lifting limit of 10 pounds. The employer representative maintains that there is a 12-day delay in reporting the injury to the employer. It is also presented that the reader board task was not outside of the worker’s restrictions.

All the same, I find that a disablement situation exists based on the worker’s testimony that they had not performed the reader board task for years due to head/neck issues that had started in approximately 2003 to 2005. The worker denies indicating that the reader board incident of 2018 injured their neck. I observe that the Employer’s Report of Injury signed September 7, 2018 confirms that there were no direct witnesses. However, the investigation report documents the store manager’s statement that the worker called them on August 23, 2018 and were instructed to stop doing the reader board if it was a problem.

I must additionally consider that the doctor who completed the off work note dated August 25, 2018 was covering for the family doctor. The family doctor’s subsequent Form 8 dated September 5, 2018 clearly identifies the date of injury as August 23, 2018 and lists the incident as using a long pole overhead to change a sign at work. The case record further contains documentation of the sales manager verifying that the worker came to them a total of three times to report being unable to complete the reader board task. The employer’s investigation report documents an employee’s statement that the worker came back inside in tears after being sent out to change the reader board.

To summarize, I accept that the worker clearly reported having difficulty changing the reader board on August 23, 2018 to the point of being in tears and complaining about a physical injury. Therefore, I find that there is no delay in reporting a work-related physical injury relating to a change in duties. I accept on a balance of probabilities that the medical note of August 25, 2018 is related to this claimed physical injury given the information provided on the family doctor’s subsequent Form 8 dated September 5, 2018. The Form 8 identifies the injury as involving the chest, not the neck. Accordingly, it is my view that proof of accident is evident for an injury occurring in the course of employment as there is a disablement situation with no unreasonable delays in reporting or medical attention.

ii) Clinical compatibility and permanent aggravation

I find that the policy criterion of clinical compatibility is met for initial entitlement to a muscle strain of the left-sided chest. The employer representative submits that the incident of August 23, 2018 would not be outside of the worker’s physical restrictions.

Policy 11-01-01 requires clinical compatibility of diagnosis with accident history. To put it another way, the medical diagnosis must be shown to have resulted from, or been caused by, the worker’s job duties. By establishing this factor, the disablement can be shown to have arisen out of the course of employment.

The doctor’s graduated return-to-work plan of March 28, 2018 indicates limited lifting up to 10 pounds. The graduated return-to-work on April 20, 2018 consisted of mostly Cashier duties as the worker is unable to perform full duties as a Certified Receiver. The physiotherapist’s return-to-work plan dated June 18, 2018 suggests the ability to lift of up to 25 pounds but with the ability to take breaks at the worker’s discretion. The worker’s testimony describes their functional abilities being increased to five hours per day by August 23, 2018 while still remaining limited to lifting up to 25 pounds.

Briefly, I accept that the evidence within the case record and the worker’s testimony establish that the task of changing the reader board involved standing and raising an approximately seven to eight foot pole overhead to reach the reader board. The worker describes the bottom of the reader board as being 15 feet off of the ground while their own height is 5’4”. According to the worker, the pole must be gripped with both hands overhead while standing on their toes and moving in a back-and-forth motion. The worker states that the sales manager did not assign a helper to them. As the worker was not successful and the pole cannot be extended, they went back into the store and were required by the sales manager to bring a ladder back out.

I observe that the claimed injury to the left-chest (rib or intercostal) area is on the worker’s non-dominant side. The worker states that there was immediate pain and that they dropped the pole. The worker describes the thin pole as weighing at least 15 pounds and being wobbly when raised overhead. As previously mentioned, the worker describes having to constantly move back-and-forth to try to change the reader board’s lettering. The employer’s investigation report documents the store manager’s confirmation that another employee ended up changing the reader board the next day and also had problems with getting the letters down and the new ones to stick.

Based on these factors, I accept that the September 5, 2018 diagnosis of a possible chest muscle strain reasonably resulted from the disablement incident on August 23, 2018 even if the task did not involve lifting more than 25 pounds. Accordingly, I find that all five criteria required under Policy 11-01-01 are met and that initial entitlement for a muscle strain of the chest is in order as a disablement that arose out of and in the course of employment

Permanent aggravation

In my view, entitlement is in order for a permanent aggravation of the left-sided intercostal (rib or chest) area. The employer representative notes that the worker’s lifting limitations decreased between November 2018 and March 2020. While the employer representative does not dispute the worker’s ongoing port site pain, it is argued that the reader board incident did not aggravate this area.

Policy 15-02-04 states that entitlement is considered on an aggravation basis in cases where the worker has a pre-accident impairment and suffers a minor work-related accident/injury. Policy defines a minor accident as one that would be expected to cause a non-disabling or minor disabling injury in the absence of a pre-accident impairment. Policy 15-02-04 defines a pre-accident impairment as a condition that has produced periods of impairment requiring health care and has caused a disruption in employment (either lost time or modified work). Although a period of time cannot be defined, the decision-maker may use a one to two year timeframe as a guide.

With respect to this specific case, there is general agreement that the worker went off work in

March 2017 due to the non-work-related diagnosis, had surgery in 2017, and participated in a graduated return to work prior to August 23, 2018. I observe that this period represents a timeframe of less than two years. Additionally, I accept that the worker was near recovery at the time of injury. The physiotherapy report of October 11, 2018 states that the worker had nearly recovered from the chest wall injury from the

medication port prior to re-aggravating it on August 23, 2018 and returning to therapy. I afford significant weight to the opinion of the physiotherapist as they started treating the worker for the non-work-related chest wall injury on January 22, 2018.

I find that the disablement history of August 23, 2018 represents a minor work-related accident. Therefore, I accept that entitlement to a left-sided chest wall injury is in order on an aggravation basis as there is both a pre-accident impairment and a minor work-related accident/injury. Policy 15-02-04 provides the authority for decision-makers to determine that the work-related injury has permanently aggravated the pre-accident impairment if the worker never returns to the pre-accident state. The worker may be entitled to a non-economic loss (NEL) benefit if the clinical evidence confirms that the

work-related injury permanently increased the worker’s pre-accident impairment.

Policy 11-01-05, Determining Permanent Impairment, defines the term maximum medical recovery (MMR) as a plateau in recovery at which point it is not likely that there will be any further significant improvement in the work-related injury. Policy 15-02-03 confirms that the work-related injury does not need to be the sole cause of the impairment for the degree of the work-related impairment to be assessed.

The Musculoskeletal Program of Care Outcomes Report dated November 14, 2018 suggests that the worker’s condition worsened after August 23, 2018. I recognize that the family doctor’s notes dated November 26, 2018 and March 19, 2019 do not explain the medical reasons for the worker’s inability to work. Regardless, the family doctor’s Form 8 of March 2, 2020 describes ongoing left chest pain for the last two years after using a long pole overhead to change a sign at work. The Form 8 identifies the prior condition as a chest wall injury dated August 23, 2018 and provides the updated diagnosis of left anterolateral chest wall pain. As pointed out by the employer representative, the family doctor provides the limitation of lifting no greater than 10 pounds.

An anesthesiologist’s report dated January 12, 2022 identifies the major pain complaint as arising from the former port site entry and representing intercostal neuralgia. The CT scan of the chest performed on February 24, 2022 shows no significant changes compared to a study dated October 22, 2021. The clinical chart note of March 9, 2022 describes chronic pain in the left side of the chest/upper abdomen that is long-standing. The specialist report dated March 10, 2022 documents a recurrence of the

non-work-related condition occurring in 2020. The report explains that left upper quadrant pain prompted investigations which identified a left upper quadrant mass. A history of chronic pain associated with the port site is confirmed for which the worker was receiving intercostal blocks.

The anesthesiology report dated April 6, 2022 documents the intercostal nerve blocks and a trial of pulsed radiofrequency therapy (RF). A third-party insurer medical report dated April 29, 2022 states that the primary diagnosis relates to a recurrence of the non-work-related condition. The report identifies the additional condition of chronic pain secondary to the port site.

Based on the above-noted evidence, I accept that there is a work-related permanent aggravation involving left-sided intercostal neuralgia as a result of the incident dated August 23, 2018. I afford significant weight to the family doctor’s Form 8 of March 2, 2020 given the continuity of care both before and after the workplace incident of August 23, 2018. I appreciate the employer representative’s argument that the worker’s lifting abilities have decreased between November 2018 and March 2020. However, I note that there is a recurrence of the non-work-related condition in 2020 as well. Therefore, I am not persuaded that this change in lifting abilities is sufficient to determine that there is not a work-related permanent aggravation relating to the left-sided chest.

I am aware of the worker’s scheduled intercostal injection for October 2022 which is to be repeated every six months. Policy 11-01-05 defines the term significant improvement as a marked degree of improvement that is demonstrated by a measureable change in clinical findings. In this case, the worker indicates that the intercostal injection lasts for approximately 4.5 months. The anesthesiology report of April 6, 2022 confirms that the worker may have eight to 10 weeks of improvement with the block. As a result, I accept that there is a permanent work-related aggravation for the diagnosis of left-sided intercostal neuralgia as of the MMR date of March 2, 2020 since a significant improvement in the

work-related permanent aggravation is not likely.

CONCLUSION

I conclude the following:

1. There is no entitlement to chronic mental stress (CMS).

2. Entitlement is in order for a permanent aggravation of a pre-accident impairment involving left-sided intercostal neuralgia (left-sided chest).

Maximum medical recovery (MMR) was reached March 2, 2020.

A non-economic loss (NEL) determination is in order for the work-related permanent aggravation.

The Case Manager is requested to determine the extent and duration of any resulting benefits flowing from this decision.

The worker’s objection is allowed in part.

DATED September 23, 2022

K. MacMillan

Appeals Resolution Officer Appeals Services Division