- Causation (medical evidence) (standard of proof)
- Climate (heat)
- Foot condition
- Skin condition
- Initial entitlement (eligibility)
A worker sought entitlement for a left foot injury, cellulitis in his right foot, as well as entitlement for a heat rash and right buttock abscess. The worker had been working as a solid waste collection operator when he developed these conditions.The worker's appeal for entitlement for right foot cellulitis was allowed. In denying the initial claim for cellulitis, the Board placed emphasis on the fact that the worker could not recall there being a cut or break in the skin. The Eligibility Adjudicator stated: "As there was no disruption in the worker's skin barrier, there was no means by which the bacteria could enter his tissue and cause an infection in his foot". The Panel suggested two possibilities here: either the worker had a small break in the skin that he had not noticed at the time and/or was unable to recall, or the infection occurred without a break in the skin. The latter suggestion, that an infection can occur without a break in the skin, was supported by an article submitted by the worker from the Merck Manual (Consumer Version), which states that "cellulitis can also occur in skin that is not obviously injured". The Panel noted that the Merck Manual is a recognized source of standard medical information that has been relied upon in a large number of prior Tribunal decisions.In addition, there was a report from a medical consultant retained by the Board that supported the conclusion that the footwear worn by the worker at work contributed to or aggravated his cellulitis condition. The Panel noted that while the content of the report was not conclusive proof of a causal connection between the worker's employment duties and his cellulitis condition, it was sufficient in this claim to support the conclusion, on a balance of probabilities, that the worker's workplace duties likely made a significant contribution to his cellulitis.Furthermore, the Panel did not take a position with respect to whether any delay in accident reporting or the seeking of medical care affected the worker's entitlement to benefits for his cellulitis, given its decision to allow the workers' appeal for initial entitlement.The worker's appeal for entitlement for a left foot injury and for entitlement for a heat rash and right buttock abscess were denied. The worker's representative requested that the Panel draw a reasonable inference in adjudicating these claims; however, it was determined that there was a lack of medical evidence to support entitlement.