- Medical opinion (repetitive strain injury)
- Initial entitlement (eligibility)
The worker sought initial entitlement for an injury to her right upper extremity as a result of repetitive forward reaching, over the course of an unusually busy school day, which required her to operate the school's door buzzer more frequently than normal. The worker was initially diagnosed with what appeared to be Ulnar Nerve Compression and Thoracic Outlet Syndrome. Entitlement was denied on the basis that there was no causal connection with the worker's job duties.The worker suffered from pre-existing Charcot-Marie Tooth disease (CMT) which affected her lower limbs, and for which she received accommodations at work through a standing desk. The worker was responsible for operating the school buzzer to allow individuals onto the premises. On this particular day, a community walk-a-thon was occurring at the premises. The worker explained that she would press the button on the console with her thumb, but she would have to lean forward and wrap her hand around the console to prevent it from sliding away. The worker testified that she tried different locations for the console but the cables for the console limited the distance it could be moved. The worker testified her symptoms progressed throughout the day, spreading from her right hand through her arm. The Panel determined that the worker's duties that day were out of the ordinary in terms of volume and required repetitive reaching and pushing of the buzzer. However, the Panel also took note of a Medical Discussion Paper, titled "Thoracic Outlet Syndrome", which stated that it remains speculative and controversial how much the thoracic outlet can be narrowed by swelling or overgrowth of the muscles or swelling of adjacent ligaments or other tissues due to wear and tear, repetitive awkward movements or by a sudden straining injury. For the purposes of the appeal, the Panel relied on the diagnosis of a repetitive strain injury as confirmed by the worker's chiropractor and neurologist, and pointed out that the diagnosis of Thoracic Outlet Syndrome had not been confirmed by a specialist.The Panel stated that normally it would make a determination on a diagnosis when granting initial entitlement, but in this case there was a lack of reliable evidence to make a finding on the correct diagnosis. However, the Panel was satisfied that the worker sustained a repetitive strain injury to her right upper extremity due to repetitive and forceful activity which arose out of the worker's ordinary duties.The appeal was allowed. The nature and duration of benefits flowing from this decision were returned to the WSIB for further adjudication, subject to the usual rights of appeal.