APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20260021
OBJECTING PARTY: EMPLOYER
REPRESENTED by: EMPLOYER REPRESENTATIVE
RESPONDENT PARTY: WORKER
REPRESENTED by: WORKER REPRESENTATIVE
HEARING: HEARING IN WRITING
HEARD by: KEVIN MACMILLAN, APPEALS RESOLUTION OFFICER
ISSUE
The employer, through their authorized representative, is objecting to the Case Manager’s decision of November 8, 2022 authorizing entitlement to right shoulder arthroscopic capsular release surgery.
BACKGROUND
On October 20, 2021, this then 47-year-old Team Lead/Assembly Line worker was lifting an empty bin which unexpectedly jammed while their arms were extended overhead. A right shoulder sprain/strain injury was diagnosed on October 21, 2021. A Workplace Safety and Insurance Board (WSIB) decision letter dated October 26, 2021 allowed initial entitlement to the right shoulder. The worker received a COVID-19 booster vaccination shot in their left arm on January 11, 2022. On January 21, 2022, the worker informed the Case Manager that booster shot literally “locked” them back up.
A subacromial injection into the right shoulder took place on April 29, 2022, followed by an ultrasound-guided cortisone injection into the right shoulder joint on June 13, 2022. A Case Manager’s decision letter dated July 13, 2022 accepted entitlement to the diagnosis of posttraumatic adhesive capsulitis. The pre-authorized right shoulder arthroscopic surgery took place on January 13, 2023 which included an evaluation of the rotator cuff and a 270-degree capsule release for adhesive capsulitis. The worker began post-surgical physiotherapy on January 18, 2023. A Case Manager’s decision dated March 14, 2023 allowed entitlement to postoperative edema and scarring to the dorsum area of the left hand as a complication of the intravenous insertion.
A Case Manager’s decision dated October 4, 2023 determined that maximum medical recovery was reached with no permanent impairment as of September 19, 2023. Reconsideration letters from the Case Manager dated July 23, 2025 and January 12, 2026 upheld the decision of November 8, 2022 to grant entitlement to the right shoulder surgery. The administrative decision of January 14, 2026 stated that the employer’s objection would be resolved as a hearing in writing. The issue is of entitlement to the right shoulder arthroscopic capsular release surgery of January 13, 2023 is now before me.
AUTHORITY
Operational Policy Manual
Published
17-01-02 Entitlement to Health Care
January 3, 2023
ANALYSIS
I find that entitlement to the right shoulder surgery of January 13, 2023 is in order. My reasons for this finding are outlined below. I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision.
Employer representative’s position and remedy sought
The employer representative is seeking a determination that the worker’s COVID-19 vaccine booster in early January 2022 began the onset of the frozen shoulder/adhesive capsulitis issues.
It is the employer representative’s position that the medical imaging of November 2021 confirms that there was no objective evidence of injury from the workplace incident. The argument is presented that little was known of the side effects of the COVID-19 vaccines at that time but that it has become known through research that the vaccine can cause frozen shoulder. In support of this position, the written submission of December 22, 2025 encloses medical literature dated March 18, 2022 entitled Frozen shoulder after COVID-19 vaccination.
The employer representative maintains that the operative report confirms there is no identified trauma and that the condition appears mostly to be an idiopathic adhesive capsulitis with no significant structural abnormality. The written submission indicates that this means that there is no identifiable cause for the right shoulder adhesive capsulitis, including any work-related factors. Thus, the argument is made that the adhesive capsulitis appears to have developed following the vaccine being administered, resulting in the surgery addressing a non-work-related condition.
If the employer’s appeal is successful, the employer representative is requesting a rescinding of entitlement for the right shoulder surgery (including health care benefits and loss of earnings benefits), as well as a refund to the employer and a retroactive adjustment to their cost statement.
Worker representative’s position
The worker representative argues that the right shoulder surgery of January 13, 2023 treated an occupational injury. In the view of the worker representative, the surgery would not have been required if not for the workplace injury.
The written submission of March 2, 2026 presents the view that the objective evidence, including testing and the surgical report, support that the right shoulder diagnosis and associated surgery are the result of the workplace injury of October 20, 2021. The worker representative suggests that the prolonged immobility in this case is consistent with the mechanics and sequelae of the original workplace accident. It is submitted that the recommendation for surgery occurs after the failure of conservative treatment.
The worker representative requests that the entitlement to the right shoulder surgery be confirmed.
Entitlement to right shoulder surgery
I am not persuaded that the right shoulder surgical procedure of January 13, 2023 relates to a non-work-related condition caused by the COVID-19 vaccine booster of January 11, 2022.
Policy 17-01-02, Entitlement to Health Care, outlines that workers are entitled to such health care as may be necessary, appropriate, and sufficient as a result of the injury. Policy confirms that the term health professional includes physicians and surgeons, and that health care includes services provided by or at hospitals and health facilities.
In reviewing the evidence, I observe that the Worker’s Report of Injury signed October 23, 2021 states that the worker was unable to use their dominant right arm immediately after the injury. I appreciate the employer representative’s suggestion that neither the x-ray nor ultra-sound dated November 9, 2021 show significant acute findings. Nevertheless, I find it material that the worker’s physiotherapy treatment beginning on November 22, 2021 is primarily passive. I note that the initial assessment report dated November 22, 2021 documents weakness, a painful arc, and loss of motion. There is general agreement that the worker then receives the COVID-19 booster on January 11, 2022. I observe that the physiotherapy outcomes report of January 21, 2022 (or ten days later) documents that the worker is developing frozen shoulder. The worker’s verbal statement to the Case Manager on the same date indicates that the booster shot literally “locked” them back up.
As referenced by the employer representative, the Occupational Health Assessment Program (OHAP) final report of February 4, 2022 documents the worker’s description of experiencing a set back after receiving the vaccination booster. Still, the report lists developing frozen shoulder as an occupational diagnosis and clearly states that there is no non-work-related diagnosis. The OHAP report explains that overall recovery has been delayed from what would normally be expected due to the primarily passive nature of therapy and the development of frozen shoulder. The OHAP Worker Summary Report also dated February 4, 2022 confirms discussing with the worker that lack of movement can lead to adhesions which further restricts movement and can potentially lead to frozen shoulder.
The Upper Extremity Specialty Program’s comprehensive assessment report of February 25, 2022 documents the worker’s description of their right arm locking up the day after the COVID-19 booster vaccine. That being said, I note that the report verifies that the vaccine booster was in the left arm and that the worsening symptoms occurred in the right arm. The listed occupational diagnosis is a right shoulder sprain/strain consistent with the mechanism of injury that resulted in posttraumatic adhesive capsulitis. Once more, no non-work-related diagnoses are identified.
Similarly, the Upper Extremity Specialty Program report of April 29, 2022 states that there are no risk factors other than injury-related trauma for developing adhesive capsulitis. I afford significant weight to the orthopaedic surgeon’s opinion that it is still unclear in the medical literature as to why some people will develop frozen shoulder/adhesive capsulitis following an injury while others do not. The next report from the Upper Extremity Specialty Program dated May 20, 2022 continues to list the occupational diagnosis of posttraumatic adhesive capsulitis, which has had a 30% improvement with the last injection. I observe that the report states that the worker is to follow-up with another orthopaedic surgeon going forward who is a shoulder specialist.
The new orthopaedic specialist’s report from the Upper Extremity Specialty Program dated August 25, 2022 continues to list work-related posttraumatic adhesive capsulitis, that is now 70% improved with very persistent external rotation loss. No non-work-related diagnoses are identified. The next report dated November 1, 2022 documents that the worker has certainly been diligent with therapy and is very motivated to get better.
I acknowledge that the orthopaedic surgeon then performs the right shoulder procedure which includes a thorough diagnostic examination given the concern of traumatic injury. As highlighted by the employer representative, the surgical report of January 13, 2023 confirms that the adhesive capsulitis appears to be mostly idiopathic. The post-surgical Upper Extremity Specialty Program report of January 24, 2023 provides the diagnosis of improving post-right shoulder arthroscopic capsular release. While I recognize that the term posttraumatic is no longer utilized, I must consider that the report does not list any relevant non-work-related diagnoses which is the same in the subsequent two reports dated March 21, 2023 and June 20, 2023.
The final report from the Upper Extremity Specialty Program dated September 19, 2023 summarizes that the worker initially attended therapy in the community which was mostly passive in nature prior to the comprehensive assessment recommending more active therapy to improve range of motion. The report goes on to explain that progress was limited due to poor tolerance for therapy activities, although there was some symptomatic relief after injection. The resulting occupational diagnosis is fully improved post-right shoulder arthroscopic capsular release with no non-work-related diagnoses.
I recognize the employer representative’s position that the right shoulder surgery painted a clearer picture of the worker’s shoulder condition. All the same, I afford little weight to the submitted medical literature as the article confirms that the side of involvement was the same shoulder as the vaccination side in all patients in the series. By comparison, the worker received the COVID-19 booster in their left arm while the work-related injury involves the right arm. Further, I note that the referenced article outlines that vaccines are supposed to be absorbed locally, although it may be possible that the vaccine transfection to the local capsular tissue or nerves may have elicited an autoimmune response leading to the development of frozen shoulder. In any event, I find that the provided medical article does not provide sufficient explanation on how the opposite shoulder would be impacted by a vaccination injection.
Moreover, I note that the article states that the study suffers from certain limitations, involves a small number of patients and that frozen shoulder after COVID vaccination has not yet been reported.
In summary, I find that the treating orthopaedic surgeon who performed the surgery of January 13, 2023 was aware of the worker’s indication of right shoulder issues after receiving a COVID-19 vaccine booster in the opposite left shoulder on January 11, 2022. I further find that there is insufficient evidence of the orthopaedic surgeon providing an opinion, either before or after the surgery, that the adhesive capsulitis is the result of the vaccination and not the workplace injury of October 20, 2021. I note that none of the reports from the Upper Extremity Specialty Program from February 25, 2022 and September 19, 2023 list a non-work-related diagnosis.
Finally, I afford little weight to the medical literature of March 18, 2022 entitled Frozen shoulder after COVID-19 vaccination due to its small sample size and that it addresses situations in which the frozen shoulder is the same side as the vaccination injection. Most importantly, I observe that the post-surgical reports from the Upper Extremity Specialty Clinic are authored by the treating orthopaedic surgeon and continue to list the diagnosis of post-right arthroscopic capsular release as being work-related. On account of these factors, I accept that the right shoulder surgery of January 13, 2023 was necessary, appropriate, and sufficient as a result of the workplace injury as required by Policy 17-01-02.
CONCLUSION
I conclude that entitlement to right shoulder arthroscopic capsular release surgery of January 13, 2023 is appropriate.
The request to rescind entitlement to the right shoulder surgery is denied. The employer’s objection is denied.
DATED MARCH 23, 2026
Kevin MacMillan Appeals Resolution Officer Appeals Services Division