APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20250035
OBJECTING PARTY: WORKER
REPRESENTED by: WORKER REPRESENTATIVE
RESPONDENT PARTY: EMPLOYER (NOT PARTICIPATING)
HEARING: VIDEOCONFERENCE
HEARD by: S. Crisostomo, appeals resolution officer
ISSUE
The worker objects to the Case Manager’s decision dated December 29, 2022, which denied entitlement for his diagnosed left little finger herpetic whitlow, as a secondary condition resulting from his work-related left little finger laceration and related cellulitis.
At the oral hearing, the worker’s representative withdrew the objection to the December 29, 2022 decision that denied entitlement for a recurrence of the worker’s left-hand cellulitis.
BACKGROUND
On April 16, 2015, the worker, a Firefighter, cut his left little finger on the fire truck. Soon after, the worker developed an infection at the site of the cut. Entitlement in the claim was reviewed and allowed for a left little finger laceration with resulting cellulitis of the upper extremity.
Entitlement for a January 2016 recurrence of the worker’s left upper extremity cellulitis was accepted in the claim.
The worker was seen by Dr. Ghosh, Infectious Diseases Specialist, in 2016 and diagnosed with left little finger herpetic whitlow.
Entitlement for the worker’s left little finger herpetic whitlow as a secondary condition resulting from his work-related left little finger laceration and resulting cellulitis was reviewed and denied after the Case Manager determined there was no causal link between the worker’s diagnosed herpetic whitlow and his work-related left little finger laceration and resulting cellulitis. This decision was communicated on December 29, 2022.
The worker objected to the December 29, 2022 decision; however, it remained unchanged and as a result, the matter was referred to the Appeals Services Division for further consideration.
Worker Representative’s Position
The worker’s representative submits:
- The worker is a credible witness.
- The worker sustained a cut injury to his left little finger on April 16, 2015 and later developed herpetic whitlow at the site of the cut.
- The worker’s job duties as a Firefighter exposes him to different bodily fluids and the worker’s cut and/or resulting cellulitis was a significant factor in him developing herpetic whitlow at the site of the cut.
- Any benefit of doubt should be resolved in favour of the worker.
- Entitlement in the claim should be extended to include the worker’s diagnosed herpetic whitlow.
Employer’s Position
The employer is not participating in the appeal and did not provide a submission related to the issue before me.
Worker’s Testimony
The worker testified to the following related to the issue before me:
- He has been a Firefighter since 2004. As a Firefighter, he provides emergency response to different situations. He wears Personal Protective Equipment (PPE) at work such as gloves. He could be exposed to different bodily fluids and infectious diseases at work.
- In 2016, he was the driver of the fire truck, and he sustained a cut on his left little finger. He explained the cut was about a half inch long and was located around the lateral DIP joint of his left little finger. The cut was open for several days post injury. While at work, he recalled touched soiled gloves, which may have caused him to be exposed to the herpes simplex virus.
- He feels the soiled gloves had the herpes simplex virus that caused him to development herpetic whitlow, as he recalled when the fluid from the soiled gloves made contacted with his cut, he felt something enter his body.
- He developed an infection shortly after sustaining his left little laceration and was treated with antibiotics. He was diagnosed with cellulitis on a number of occasions; however, once a sample of the fluid in his little finger was tested, he was diagnosed with herpetic whitlow by Dr. Ghosh.
- He has had numerous herpetic whitlow flare-ups at the site of the original cut.
- In questioning, the worker confirmed that he has never had the herpes simplex virus or any pre-existing issues with left little finger including any symptoms similar to herpetic whitlow.
AUTHORITY
Operational Policy Manual
Published
15-05-01 Resulting from Work-Related Disability/Impairment
April 9, 2021
ANALYSIS
I have carefully considered all of the available information, the testimony of the worker, and the relevant operational policy in reaching this decision.
I find the worker’s diagnosed herpetic whitlow of the left little finger is a secondary condition that resulted from his work-related left little finger laceration. The reasons for my decision follow.
Operational Policy 15-05-01 related to secondary conditions states in part:
Workers sustaining secondary conditions that are causally linked to the work-related injury will derive benefits to compensate for the further aggravation of the work-related impairment or for new injuries.
A review of the file reveals:
- The worker sustained a work-related laceration to the lateral part of his left little finger at the DIP joint.
- Entitlement in the claim was extended to include cellulitis of the left little finger and left upper extremity.
- The worker developed pustules on his left little finger numerous times around the lateral DIP joint.
- Dr. Ghosh assessed the worker on October 18, 2016 and noted that he suspected the worker had herpetic whitlow on his left fifth digit (little finger), on the lateral part of the DIP joint in April of 2016. Based on the assessment, Dr. Ghosh diagnosed the worker with herpetic whitlow of the left little finger.
- The file was reviewed by Dr. Razavi, Occupational Medical Consultant, on December 22, 2022, who opined the worker’s herpetic whitlow was not compatible with the original mechanism of injury and was not causally linked to the worker’s work-related cellulitis.
- Dr. Thorogood’s report dated June 28, 2023 noted the worker cut his left hand on April 16, 2015 and shortly after the injury, the worker experienced herpetic whitlow. Dr. Thorogood explained that the virus enters through broken skin and that based on the worker’s open skin due to his work-related cut, there is a temporal association related to the worker’s herpetic whitlow and his workplace injury. Dr. Thorogood opined there was little doubt of a casual association between the worker’s herpetic whitlow and his work-related cut injury.
I recognize that the herpes simplex virus causes herpetic whitlow and that it is usually acquired from contact with another person who has the virus, especially after contact with a cold sore or “fever” blister. The virus usually penetrates the skin through a cut/break in the skin.
In this case, the worker sustained a cut on the lateral side of his left little finger and then developed herpetic whitlow at the site of the cut. The worker also testified to not having the herpes simplex virus prior to or after the work-related injury sustained on April 15, 2015 or any issues with left little finger including any symptoms consistent with herpetic whitlow.
Noting, the worker sustained a work-related cut on the lateral side of his left little finger, I find the worker was susceptible of being exposed to the herpes simplex virus at the site of the cut, as the break in the worker’s skin provided a means for the entry of the virus. As the worker developed herpetic whitlow at the site of the cut only, with no prior history of having the herpes simplex virus or symptoms related to herpetic whitlow, I am in agreement with Dr. Thorogood’s medical opinion that there is a casual association between the worker’s left lateral side little finger laceration and the development of his herpetic whitlow at the same site, as I am satisfied that if not for the cut on the worker’s left little finger, the worker would likely not have developed herpetic whitlow at the site of the laceration.
As such, I find a causal relationship between the worker’s herpetic whitlow of the left little finger and his work-related laceration injury of the left little finger has been established. Therefore, entitlement to the worker’s diagnosed herpetic whitlow of the left little finger in 2016 as a secondary condition that resulted from his work-related left little finger laceration is allowed.
CONCLUSION
Based on the evidence outlined in this decision, I conclude the worker’s diagnosed herpetic whitlow is a secondary condition that resulted from his work-related left little finger laceration. As such, entitlement for the worker’s diagnosed herpetic whitlow in 2016 is allowed.
The worker’s objection is allowed.
DATED February 6, 2025
S. Crisostomo Appeals Resolution Officer Appeals Services Division