Work-related condition not cause of worker’s impairment: Tribunal

Pleural plaque in worker’s lungs related to exposure to asbestos at work, but medical evidence said condition not related to worker’s impairment

The Ontario Workplace Safety and Insurance Appeals Tribunal has denied a worker’s appeal for a non-economic loss assessment for pleural plaque in his lungs stemming from exposure to asbestos during his working career.

The 79-year-old worker was employed for years in an industry where he was exposed to asbestos. In 2011, he began experiencing chest pain and respiratory impairment. Medical examinations revealed that the worker had developed pleural plaques in his lungs — a fibrous thickening of the lung lining.

Pleural plaques are known to be the result of occupational asbestos exposure, often arising decades after the actual exposure. Though sometimes causing pain or an uncomfortable sensation during breathing, pleural plaques are not known to become cancerous and are generally considered to have no long-term health consequences.

A CT scan in July 2013 showed pleural plaques consistent with past asbestos exposure and early fibrosis, while an April 2013 chest x-ray displayed symptoms of pulmonary fibrosis.

Multiple asbestos-related conditions

The worker’s treating specialist believed that in addition to the pleural plaques, the worker was developing fibrotic changes associated with function impairment that should be followed up with the Ontario Workers’ Compensation Board (WSIB).

The worker’s family physician filed a report that the worker had chest pain related to asbestos exposure at work and was significantly disabled due to asbestos exposure. However, he didn’t provide a diagnosis that established the definite cause of the worker’s pain.

The worker filed a claim for a non-economic loss assessment for respiratory impairment, claiming he suffered from an itchy and congested throat, frequent coughing, and blood in his mouth and nose. The WSIB denied the claim, finding that since pleural plaques aren’t considered to cause health problems, the worker’s health issues were not caused by the work-related pleural plaques. The WSIB based its decision on reports from its medical advisors, who found the worker had “moderately extensive bilateral calcified pleural plaques due to asbestos exposure” but these didn’t cause the worker’s ongoing functional limitations. The experts concluded that the worker had pulmonary fibrosis as the reason for his respiratory impairment.

The worker appealed the decision regarding his asbestos-related pleural plaques to the tribunal.

The tribunal noted that the worker’s respiratory impairment would entitle him to a non-economic loss assessment if it was found to be the result of pleural plaques in his lungs, since it was agreed the plaques were the result of work-related asbestos exposure. However, it found the medical opinions didn’t support that view.

The tribunal noted that the WSIB’s medical experts felt the pleural plaques — while directly related to the worker’s job — were benign and not the cause of his respiratory issues. While the worker’s physician expressed an opinion that the worker suffered from a work-related disablement from asbestos exposure, he didn’t support that opinion with an actual diagnosis explaining that it was the pleural plaques causing the symptoms and not another asbestos-related condition — which was particularly important since the family physician’s opinion differed from the WSIB’s medical experts.

The tribunal accepted into evidence a 2001 report from the Mayo Clinic that described the symptoms of pulmonary fibrosis as similar to the worker’s symptoms. Another medical article from 2015 concluded pleural plaque was not associated with changes in lung function over time in studies.

The tribunal found that the evidence supported the conclusion that the worker’s respiratory symptoms were more likely due to the fibrotic changes in his lungs identified in CT scans and x-rays than his pleural plaques. This was also supported by the worker’s treating specialist, who reported that was the cause of the worker’s functional impairment. With no definitive evidence that pleural plaque could cause the symptoms, the tribunal was left with the conclusion that the worker’s claim for non-economic loss from his pleural plaques must fail.

“The worker’s chief complaint in this case is chest pain. There is no medical opinion that pleural plaques cause chest pain,” said the tribunal. “However, the articles provided indicate that pulmonary fibrosis can cause chest pain along with a broad range of other symptoms.”

The tribunal found the worker’s respiratory impairment was caused by his pulmonary fibrosis, not pleural plaques. Though the pleural plaques were a condition related to work exposure to asbestos, it had been already established as not causing impairment. As a result, the tribunal determined the worker didn’t have an entitlement to a non-economic loss assessment.

The issue of whether the pulmonary fibrosis was compensable was not part of the appeal, so the tribunal couldn’t rule on it. The appeal was dismissed.

For more information see:

Decision No. 1806/16, 2016 CarswellOnt 15552 (Ont. Workplace Safety and Insurance Appeals Trib.).

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