- Death (maintenance of claim by estate)
- Evidence (epidemiological)
- Heart condition (stress)
- Neuropathy (peripheral)
- Preexisting condition (disc, degeneration) (lumbar)
- Gastroenteritis
- Consequences of injury (secondary condition)
- Viral infection (influenza)
The worker's estate sought initial entitlement for conditions arising from a compensable Influenza A ("flu") infection, including the development of peripheral neuropathy, stress-induced cardiomyopathy, and aggravation of degenerative disc disease of the lumbar spine.
The Board allowed entitlement for Influenza A and LOE benefits for the period of time that the worker was hospitalized. It requested an opinion from a medical consultant regarding medical compatibility with neuropathy and cardiomyopathy. The consultant was initially of the view that there was no association; however, in a subsequent opinion, he noted that he "could not discount that the physical and emotional stresses that resulted from infection may have precipitated" the worker's stress-induced cardiomyopathy. With respect to the worker's neurological symptoms, the consultant recognized that there were reported cases of acute motor axonal neuropathy associated with the pandemic H1N1 virus, but the medical literature did not reveal a similar association between Influenza A and sensory loss. It was further commented that the diagnosis related to the worker's condition was unclear, and the consultant was unable to provide an opinion regarding compatibility. Furthermore, the consultant opined that it was unlikely that the worker's degenerative disc disease was related to the flu.Upon further assessment by the Tribunal Medical Assessors, it was determined that the worker's Influenza A infection and resulting illness precipitated Takotsubo's cardiomyopathy, which is brought on by physical or emotional stress, and is more common in women. However, complications and mortality rates are low, and there was no evidence to suggest any complications arose in the worker's case. A follow up echocardiogram also showed normal cardiac function.In addition, with respect to the association between Influenza A infection and sensory neuropathy, the assessor noted that an influenza infection may cause an ascending paralysis and loss of reflexes called Guillain-Barre syndrome, but ultimately, the assessor was of the view that the flu did not cause the worker's transient sensory neuropathy. However, it was noted that the transient neuropathy likely arose from an "exceptional occurrence", which has been reported in medical literature, in which the worker's body suffered from dehydration and shock as a result of the influenza infection and gastroenteritis (the worker's secondary diagnosis). Furthermore, the assessor noted that it could be possible the worker had both neuropathy and the exacerbation of degenerative disc disease; however, the investigations with respect to the exacerbation of degenerative disc disease were inconclusive. The worker was granted entitlement for stress-induced cardiomyopathy - given the lack of significant cardiac history, the temporal connection between the worker's illness and the onset of this condition, and the absence of any other associated cause. The worker was also granted entitlement for peripheral neuropathy, which was related to the worker's severe dehydration and acute rental failure as a direct result of the Influenza A infection and gastroenteritis. The Vice-Chair elaborated on the standard of proof and stated that the evidence must establish, on a balance of probabilities, that the compensable illness was a significant contributing factor. This does not mean that it has to be more likely than not, but rather, that the workplace illness materially contributed to the development of the worker's peripheral neuropathy.Lastly, the worker was denied entitlement for lumbar degenerative disc disease. The Vice-Chair stated that in order to find entitlement for this condition, the evidence would need to demonstrate, on a balance of probabilities, that the illness changed the natural course or progression of the worker's pre-existing degenerative disc disease. In this case, there was no evidence of significance that established a nexus between the worker's compensable condition and the worker's degenerative disc disease.