Teacher for the deaf developed symptoms after 3 years of using sign language
A teacher at an Ontario school for the deaf who claimed her constant use of sign language at work contributed to a repetitive strain injury in her arm and neck has had her claim rejected for lack of medical evidence linking her work and her injury.
The 34-year-old worker was a teacher at a school for the deaf starting in 2008. On April 27, 2011, the worker began feeling pain and discomfort in her right shoulder and arm. She believed the symptoms were related to her job duties, so she submitted a report of injury to the Ontario Workplace Safety and Insurance Board (WSIB).
In the injury report, the worker claimed she suffered from a repetitive strain injury caused by her having to hold her arms and hands up while using American Sign Language to communicate with her students. Since teaching deaf students required constant communication — and signing — all day and every day in the classroom, this contributed to fatigue and strain in her arm and shoulder. The worker also stated that the grouping of her students — though her students where officially Grade 8, their abilities ranged from Grades 2 to 8 requiring her to teach individualized lessons — left her with not much time when she wasn’t signing and conversing with someone, and since she didn’t grow up using sign language, her body wasn’t accustomed to doing it all the time.
The worker requested an interpreter to sign for her, which the school provided for the last two months of the school year. She received treatment from a chiropractor, who had been seeing the worker already for neck and upper shoulder treatment. She missed three days of work and returned on modified duties involving only class preparation while another teacher took over signing to the students. However, this arrangement wasn’t ideal and the employer suggested the teacher take a 30-day rest while it found her an interpreter. The worker returned to work on modified duties for the rest of the school year and the chiropractor submitted a report to the WSIB diagnosing the worker with “cervical brachial neuralgia” in her arm, thumb, and index finger.
Symptoms returned
In September 2011, she started at a different school for the deaf where she had more breaks and preparation time but after one month, she began experiencing her symptoms again and they soon grew worse. The worker made a claim for workers’ compensation benefits for a work-related injury.
In September 2012, the worker moved to a school for the blind where she didn’t have to use sign language. She didn’t miss any more work but she still experienced intermittent pain in her neck and right shoulder radiating down to her right arm and hand, for which she continued to receive chiropractic treatment.
A WSIB adjudicator spoke with the worker, who said she had some nerve damage in her left arm previously, but didn’t believe it was related to her pain that she had only started feeling recently. She said that she tried to adjust how she was signing for about one week, but the condition worsened and she submitted her injury report. She originally thought her arm and shoulder pain were “general aches and pains associated with the job,” but when it worsened she sought more treatment and received the repetitive strain injury diagnosis along with the recommendation that she stop signing and continue chiropractic adjustments.
The worker acknowledged that she had felt some problems with her left ulnar nerve in 2010 which she thought was related to her signing, but it didn’t interfere with her job until April 2011. She also stated that her spouse and several friends were deaf, and the ongoing pain made it difficult to sign with them, so her social life and communication with her husband were negatively affected.
The adjudicator researched cervical brachial neuralgia and learned that the condition is the result of a disc compression in the spine and features neck pain that radiates down the arm. It is usually caused by herniated discs, arthritis, bone spurs, spinal stenosis, or poor posture — but not repetitive use of the arms such as in using sign language. A nurse consultant confirmed that the condition indicated a pinched or compressed nerve in the neck and was not compatible with the worker’s accident history.
The adjudicator denied the worker’s claim for benefits because her condition had a number of non-occupational causes that could not be ruled out.
The worker appealed the decision, but an appeals resolution officer denied the appeal, finding that while the worker’s job duties involved repetitive movements of her upper extremities and she reported neck and upper extremity pain after working in her job for three years, there was no evidence that her duties were a significant contributing factor to her diagnosed condition.
“While I am aware that there are risk factors which can predispose an individual to develop cervical brachial neuralgia, I am not persuaded, on a balance, that the worker’s description of her work-related duties is one of them,” said the appeals resolution officer.
The worker appealed this decision to the Ontario Workplace Safety and Insurance Tribunal.
The tribunal noted that the issue boiled down to whether the worker’s employment was a “significant contributing factor” to the onset of her symptoms. It also noted that “the worker honestly believes that the pain in her right arm is related to the nature of her duties.”
The tribunal found that the only medical report on the worker’s symptoms was the one filed by her chiropractor in 2011 with the cervical brachial neuralgia diagnosis and saying that using sign language at work exacerbated the symptoms. However, there was no explanation in the report of how the worker’s duties caused the problem.
The tribunal was made aware of two articles discussing a link between “upper-extremity musculoskeletal disorders” and sign-language interpreters — one from Ryerson University and one an OHS guide — but there was no indication the authors were medical experts or they had been peer reviewed. When in doubt, medical opinions had more weight than sources whose qualifications were not established, said the tribunal.
Since both the adjudicator and appeals resolution officer had already considered medical sources that indicated several non-occupational causes of the worker’s condition and there was no substantiated medical evidence directly linking it to the worker’s job teaching deaf students, the tribunal could not find that the worker’s occupation was a significant contributing factor to her arm and shoulder problems.
“Given the state of the evidence currently before me, and in particular the medical evidence on file, I find that such a relationship (of causation) has not been established on a balance of probabilities,” the tribunal said in dismissing the appeal. “In addition, I find that the evidence for and against the worker’s claim is not approximately equal in weight and as such, she is not entitled to the statutory benefit of doubt.”
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