APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER:
20250056
OBJECTING PARTY:
WORKER
REPRESENTED by:
SELF
RESPONDENT PARTY:
EMPLOYER
REPRESENTED by:
EMPLOYER REPRESENTATIVE
HEARING:
HEARING IN WRITING – AUGUST 25, 2025
HEARD by:
C. DA CUNHA, APPEALS RESOLUTION OFFICER
DATED:
AUGUST 25, 2025
ISSUES
The worker objects to the July 20, 2023, November 8, 2024, and March 19, 2025 decisions of the Occupational Disease & Survivor Benefits Program (ODBSP) Adjudicators.
The worker seeks:
Initial entitlement to non-ischemic dilated cardiomyopathy (NIDC), caused by myocarditis arising from the occupationally compulsory COVID-19 vaccine; and,
Loss of earnings (LOE) benefits from June 4, 2022 to sometime in October 2023.
BACKGROUND
In December 2021, the worker received his first occupationally compulsory COVID-19 vaccination, followed by the second dose on January 22, 2022. He was able to return to work after the vaccinations but started to develop shortness of breath about a week or two following the second one. On
April 11, 2022, he visited his family physician, Dr. T. Bacher, who assessed and referred him for a pulmonary function test, which came back essentially normal. He was subsequently referred to a cardiologist, Dr. R. Vijayaraghavan, who assessed him on May 20, 2022 and diagnosed severe cardiac failure, with a 19% cardiac function. Dr. Vijayaraghavan opined that a possible cause was COVID-19 vaccine myocarditis, amongst others. The worker’s symptoms worsened and he stopped working as of June 4, 2022. He returned to work sometime in October 2023. He had worked with the employer as a Courier Driver for over 31 years on June 4, 2022.
The Decisions under Appeal: The ODSBP Adjudicator obtained statements from the workplace parties, confirmed the compulsory nature of the COVID-19 vaccine at work, and received the outstanding medical documentation. Upon doing so, the ODSBP Adjudicator secured the expert opinion of Dr. V. Spilchuk,
Occupational Medicine Consultant on July 17, 2023. The ODSBP Adjudicator reviewed and considered Dr. Spilchuk’s opinion and denied initial entitlement to a work-related adverse reaction to the mandatory COVID-19 vaccination on July 20, 2023. The ODSBP Adjudicator found that the evidence on record did not meet the Centers for Disease Control and Prevention’s (CDC) diagnostic criteria for myocarditis, accepting the appropriate diagnosis solely as NIDC.
The worker objected to the decision and, on August 23, 2024, participated in a virtual consultation with Dr. P. Jugnundan, General Practitioner (GP), Clinic A. The worker submitted Dr. Jugnundan’s report to the case file to support his request for a reconsideration of the July 20, 2023 decision.
On November 8, 2024, another ODSBP Adjudicator reconsidered and upheld the original decision, for essentially the same reasons.
The worker then submitted his Appeal Readiness Form (ARF) to the case file on February 24, 2025. Upon receiving, reviewing, and considering the ARF, the ODSBP Adjudicator reconsidered and upheld the original decision, for essentially the same reasons.
The Worker’s Position: The worker argues that initial entitlement to work-related myocarditis arising from the occupationally mandatory COVID-19 vaccination is in order, for the following reasons:
Dr. Vijayaraghavan and Dr. Jugnundan have both opined that he sustained COVID-19 vaccine related myocarditis. The only contradictory opinion is that of Dr. Spilchuk’s, who is paid by the WSIB;
In WSIB cases, scientific certainty is not required to find compatibility. Rather, causality is determined based on the balance of probabilities. Furthermore, the benefit of the doubt is to be given to the worker when the evidence is equal in weight. In this case, more evidentiary weight should be given to Dr. Jugnundan’s opinion because he provided a detailed and thorough analysis of all the evidence, including Dr. Spilchuk’s opinion, and concluded that he had suffered myocarditis as an adverse reaction to the compulsory, work-related COVID-19 vaccine; and,
There are no other identified, non-occupational risk factors for the development of the myocarditis.
Noting the above, initial entitlement to NIDC, arising from myocarditis, caused by the occupationally compulsory COVID-19 vaccine, is in order. Furthermore, he is also entitled to LOE benefits from June 4, 2022 to sometime in October 2023, when he returned to work, because the employer did not provide him with suitable work during this period.
The Employer’s Position: The employer representative contends that the worker’s appeal should be dismissed, for the following reasons:
Dr. Spilchuk carefully analyzed and applied the CDC’s criteria and found that the medical evidence lacked the necessary objective markers (i.e., histopathological confirmation, diagnostic imaging confirming the presence of myocarditis, and elevated troponin levels) to confirm a diagnosis of myocarditis. Contrary to the worker’s position, Dr. Spilchuk’s opinion is thorough, direct, and unbiased, contrary to Dr. Jugnundan of Clinic A, which specifically advocates for workers when a claim is denied;
Dr. Jugnundan’s report suggests a probable diagnosis of myocarditis. However, this is not supported by any diagnostic or other indicative testing. Rather, it is largely based on a retrospective interpretation of symptoms and temporality. This is a speculative opinion, lacking the testing rigor demanded by WSIB policy, which lowers the diagnostic bar, inconsistent with both CDC standards and the WSIB’s adjudicative approach. Regardless, a probable diagnosis is not sufficient to accept entitlement to the same under WSIB policy. A diagnosis must be confirmed, which is not the case here;
The timing and clinical course of the worker’s symptoms do not support a COVID-19
vaccine-related reaction. The onset of shortness of breath occurred about two weeks after the second dose and the worker remained at work for another five months. Acute myocarditis following immunization typically presents with more immediate and pronounced symptoms; and,
- The diagnosed NIDC is chronic and often idiopathic, with multiple non-occupational causes. In this case, there is no identifiable occupational hazard or direct physiological mechanics present to account for this condition.
In summary, while there is a temporal connection, a direct and clear causal connection, supported by objective clinical evidence, is not present in this case. Therefore, initial entitlement to NIDC, arising from myocarditis as an adverse reaction to the COVID-19 vaccination is not in order.
AUTHORITY
Operational Policy Manual Published
15-04-10: Immunization Against Infectious Disease October 12, 2004
ANALYSIS
I have carefully considered all of the available information and relevant operational policy in reaching this decision. Having done so, I find that:
- Initial entitlement to NIDC, caused by myocarditis arising from the occupationally compulsory COVID-19 vaccine, is not in order.
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 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”.
Operational policy 15-04-10, Immunization Against Infectious Diseases, prescribes that entitlement will be awarded for any adverse reaction arising from compulsory immunization procedures as a
pre-employment requirement, or as a compulsory part of the employment, providing the immunization is for the prevention of work-related disease or infection.
In this specific case, there is no dispute that the worker underwent immunization against the COVID-19 virus in December 2021 and January 2022 as a compulsory part of his employment and that he subsequently developed NIDC. The two questions at the very centre of this appeal, which are best answered by medical professionals, are:
a) Whether he suffered myocarditis following that mandatory vaccination; and, if so,
b) Whether, on a balance of probabilities, the myocarditis arose secondarily to that mandatory vaccination.
On May 30, 2022, upon assessing the worker, Dr. Vijayaraghavan, Cardiologist, opined that the worker had evidence of NIDC, noting that they still had to rule out coronary diseases. He listed as “other causes” the COVID-19 vaccination, myocarditis, autoimmune, endocrine, and metabolic. He recommended that he continue to work but not lift anything over 25 pounds.
On June 9, 2023, Dr. J.G. Duero, Cardiologist, assessed the worker. In his clinical notes, Dr. Duero wrote, in part:
[The worker] asked in several occasions whether his cardiomyopathy is a consequence of having received a booster against the COVID vaccine [emphasis added] (mRNA-Pfizer), I explained that it is impossible for me to know that. I also explained that the majority of systolic dysfunction cases that have been attributed to the mRNA vaccines have been in the context of myocarditis, I explained that the persistence of systolic dysfunction in the absence of Late Gadolinium Enhancement would argue strongly against that consideration. [emphasis added] I also reminded [the worker] of our first conversation when I indicated that the cause of systolic dysfunction remains unknown among a significant proportion of patients. Lastly, I reiterated that a more complete picture could be obtained with genetic testing as a cause we have yet to rule out, [the worker] continued to decline this for the time being. [emphasis added]
The record shows that Dr. Vijayaraghavan’s last report is from June 20, 2023. On that date, Dr. Vijayaraghavan opined that the worker had probable vaccine-associated myocarditis.
Dr. Spilchuk then reviewed and considered all the evidence on record on July 17, 2023. Upon doing so, he wrote:
Although the timing of onset of symptoms is somewhat suggestive of a temporal link (reported to be approximately 2-3 weeks after receipt of the second dose of the Pfizer mRNA COVID-19 vaccine), the medical provided makes it impossible to confidently ascribe the NIDC to
COVID vaccine-related myocarditis, and in fact certain key elements provided argue against it.
Using the CDC case definition for the diagnosis of myocarditis, a confirmed case requires both new onset clinical symptoms suggestive of heart failure, plus either histopathologic confirmation of myocarditis, or MRI findings consistent with myocarditis in the presence of elevated troponin level, with no other identifiable cause. The attached medical did not indicate evidence for histopathologic testing, elevated troponin (the only included level was normal), or MRI findings consistent with the diagnosis (Lake Louise Criteria). Therefore this case does not meet the CDC case definition for the diagnosis of myocarditis, and the only confirmed diagnosis is NICD, as per hospital notes.
In particular, in his note dated June 9 2023, Dr. Duero notes that the cardiac MRI (dated
June 15 2022) did not find Late Gadolinium Enhancement, which is an expected finding in myocarditis, using the Updated Lake Louise Criteria. Additionally, reported cases of
mRNA vaccine-related myocarditis also note Late Gadolinium Enhancement confirmation in all reported cases. Elements of the case were also inconsistent with reported mRNA vaccine-related myocarditis: The patient's age at the time of diagnosis was 56, which is significantly older than the typical age for mRNA vaccine-related myocarditis (peaking at age 16-17); symptoms generally start within 1 week post-vaccination (his were reported to be 2-3 weeks after); and symptoms are generally mild and resolve quickly with conservative therapy (his was severe and only partially resolved).
This evidence, provided by two Cardiologists who assessed and treated the worker, as well as an OMC, does not confirm a diagnosis of myocarditis, arising from the COVID-19 vaccination. While
Dr. Vijayaraghavan opined that the worker “probably” had myocarditis, he did not state that the condition/diagnosis had been confirmed. In other words, his opinion was speculative. In fact, both
Dr. Duero and Dr. Spilchuk categorically opined that the diagnosis has not been confirmed and noted that the evidence argued strongly against that diagnosis. Therefore, I find that the evidentiary weight of these expert medical opinions does not show that the worker suffered from myocarditis, caused by the occupationally compulsory COVID-19 vaccination.
On August 23, 2024, Dr. Jugnundan assessed the worker and reviewed and considered the evidence on record, including Dr. Spilchuk’s opinion. As Dr. Jugnundan is a GP, I place less evidentiary weight on his medical opinion in comparison to those of Drs. Vijayaraghavan, Duero, and Spilchuk, noting their areas of expertise. Upon considering all the evidence, Dr. Jugnundan provided the following opinion:
[The worker], up until the time of his second immunization (which was mandated by his workplace), was a healthy gentleman with a history of hypertension and no known cardiac risk factors. His previous cardiac investigations one year prior was normal. He was physically active up until he was required to take his covid immunization.
Following his second covid immunization, he became symptomatic about two weeks later. Many months later he was assessed by a cardiologist and diagnosed with dilated cardiomyopathy due to myocarditis. There were no lifestyle risk factors and there was no family history of note. The treating cardiologist was of the opinion that the myocarditis was as a result of the COVID vaccine.
The quoted literature supports the diagnosis of myocarditis following the mRNA COVID vaccine. Although the incidence is higher in the younger adult, it is not exclusive to them, and it can occur in older populations as demonstrated in the above reference.
The WSIB based their rejection on the fact that the diagnosis of myocarditis was not confirmed. The attached literature notes that this is not a one test diagnosis. The entire clinical picture needs to be taken into account and there are various variances and methods to diagnose myocarditis.
[The worker] met the "probable" diagnostic criteria based on the CDC criteria. [emphasis added] Although his [cardiovascular magnetic resonance] was not reported as being positive, there is various reasons quoted above for this, also noting the limitations related to specific ethnic populations and/or people of color.
Therefore, taken in totality, it is my medical opinion that Mr. John, noting the absence of any other risk factors, developed his myocarditis as a result of his COVID vaccine.
Like Dr. Vijayaraghavan’s opinion, Dr. Jugnundan speculated that the worker probably had myocarditis following the COVID-19 vaccination. However, like Dr. Vijayaraghavan, he does not confirm that he had myocarditis and does not provide any objective confirmation of the same. While WSIB adjudication is
based on the “balance of probabilities” in determining whether the probative standard has been met, the diagnosis being considered when determining work-related causality on the “balance of probabilities” must be an objectively confirmed one. In this case, that confirmation, for the reasons provided by Dr. Duero and Dr. Spilchuk, is not evident.
While there is no dispute that there is a temporal relationship between the onset of the worker’s cardiac issues in May 2022 and the January 2022 COVID-19 vaccination, a temporal relationship is not necessarily a causative one. Furthermore, the objective evidence and subjective medical opinions on record do not confirm a diagnosis of myocarditis related to the COVID-19 vaccination. As such, I am not able to find that he suffered myocarditis arising from the occupationally mandated COVID-19 vaccination.
The facts and circumstances on record lead me to find that initial entitlement to NIDC, caused by myocarditis arising from the occupationally compulsory COVID-19 vaccine, is not in order.
CONCLUSION
I find that:
- Initial entitlement to non-ischemic dilated cardiomyopathy, caused by myocarditis arising from the occupationally compulsory COVID-19 vaccine, is not in order.
The worker’s objection is, therefore, denied.
DATED AUGUST 25, 2025
C. da Cunha
Appeals Resolution Officer Appeals Services Division