Worker receiving benefits for work-related carpal tunnel syndrome can’t prove second condition was caused by the first
An Ontario office worker who was entitled to workers’ compensation benefits for carpal tunnel syndrome is not entitled to additional benefits for her fibromyalgia, the Ontario Workplace Safety and Insurance Appeals Tribunal has ruled.
The worker was hired in 1988 to be a technical secretary, which required a large amount of typing and data entry as part of the job duties. She worked in the position for almost a decade until 1998, when she began experiencing pain and discomfort in her wrists. The worker was assessed by a physiatrist, who diagnosed carpal tunnel syndrome in both wrists.
The worker underwent decompression surgery on her right wrist in March 1999 and on her left wrist in July 1999.
Shortly after her first surgery, the worker filed a claim for benefits for her carpal tunnel syndrome. The Ontario Workers Safety and Insurance Board found her condition was caused by the repetitive nature of her work duties and approved her claim. The board also found that the worker’s carpal tunnel syndrome was a permanent impairment and awarded her a non-economic loss award.
Worker had other issues with chronic pain
In 1997, before the worker was diagnosed with carpal tunnel syndrome, she was diagnosed with another condition — fibromyalgia, a condition causing fatigue and chronic pain in the muscles and tissues surrounding the joints. A physiatrist’s report in April 1997 indicated the worker had “unprovoked episodes of musculoskeletal symptoms” in her chest that were “unrelated to any injury or incident.” There were some medical opinions disagreeing with the initial diagnosis, but it was confirmed in 2001.
Following the confirmation of fibromyalgia in 2001, the worker filed a claim for benefits for this condition, claiming it was caused by her bilateral carpal tunnel syndrome — which was in turn caused by her job duties. The board found the worker’s fibromyalgia wasn’t caused by her work-related carpal tunnel syndrome and denied the claim.
The board’s decision was influenced by a 2005 report by a rheumatologist that stated the worker had had musculoskeletal pain for 10 years, including back, shoulders, neck, arms, knees and hips. This pain made it difficult for the worker to walk and sleep. The report also mentioned her problem with chronic fatigue, irritable bowel syndrome, depression, and panic attacks.
The board’s medical consultant also found there were other areas of pain in the worker’s body that were not attributable to her wrist condition. In addition, the worker’s family physician said she had “various medical issues contributing to the worker’s pain syndrome” and wouldn’t definitively say there was a link.
The worker appealed the board’s decision to the tribunal.
The tribunal referred to the board’s policy on chronic pain disability, which is part of the operational policy manual governing workers’ compensation decisions in Ontario. The policy indicates that for chronic pain caused by a work-related injury to be compensable, there must be a medical opinion that the worker’s pain is compatible and resulting from the work-related injury.
No evidence fibromyalgia was caused by work-related injury
The tribunal found the medical reports in 1997 and 2005, as well as additional medical evidence showing chest and back pain going back to 1995, showing “long-standing, chronic, musculoskeletal pain in areas of her body that were not affected by her bilateral carpal tunnel syndrome, and which pre-dated the diagnosis of carpal tunnel syndrome.” The tribunal noted that it would be difficult to make a connection between pain in the worker’s back that later spread to her shoulders, neck, arms, knees, and hips could be caused by her carpal tunnel syndrome.
The tribunal noted that the worker had been experiencing pain in her wrists for some time — as long as five or six years earlier, according to her workers’ compensation claim — before being diagnosed with carpal tunnel syndrome. However, at this stage it was “a relatively mild condition and non-disabling condition” and the worker was diagnosed with fibromyalgia during a time there were no documented complaints of pain in the worker’s wrists — between 1993 and 1998 — said the tribunal.
“During that five-year period, in which there were no documented complaints of carpal tunnel syndrome, the worker was diagnosed with a chest wall pain syndrome, back pain which became diffuse and affected her walking, and with fibromyalgia,” said the tribunal. “It is difficult to attribute the worker’s fibromyalgia to her bilateral carpal tunnel syndrome, when the former condition was diagnosed during a period in which there was a lengthy absence of any documented complaints of wrist pain,” said the tribunal.
In addition, the tribunal pointed to medical reports stating no link between the worker’s musculoskeletal pain and her carpal tunnel syndrome.
Considering all of the medical evidence couldn’t show a link between the worker’s carpal tunnel syndrome and her fibromyalgia, the tribunal found no reason to overturn the board’s denial of workers’ compensation benefits to the worker for her fibromyalgia. The appeal was denied.
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