- White finger disease
- Raynaud's phenomenon
- Permanent impairment {NEL} (degree of impairment) (hand)
The issue to be determined was whether the worker's NEL award for Hand-Arm Vibration Syndrome (HAVS) was correctly assessed at 15%.
The Vice-Chair found that the rating for the upper extremities was not complete. The worker was entitled to a re-assessment of the degree of permanent impairment of the HAVS, which included the neurological component of the worker's HAVS as reported in the Current Perception Test (CPT) and Purdue Pegboard Test (dexterity test), dated October 14, 2020. The rating for the lower extremities was confirmed.In the Medical Discussion Paper titled "Hand-Arm Vibration Syndrome", it is noted that the CPT is an alternative to a nerve condition study, and allows measurement of all the important nerve fibres in the fingers that may be damaged by vibration. The paper indicates that Quantitative Sensory Tests, such as the CPT, have been found to be better predictors than nerve conduction studies to evaluate the sensorineural component of HAVS. The Vice-Chair acknowledged that the worker's nerve condition study was normal; however, this was not the case for the CPT. The worker had undergone CPT testing which indicated a severe hypoesthetic condition in the index fingers and left little finger, and a mild hypoesthetic condition of the right little finger. The Vice-Chair noted further that the Purdue Pegboard Test indicated that the worker had poor dexterity compared to normative data for male maintenance and service employees. It was noted that OPM Document No. 16-01-09 also indicates that "neurologic symptoms include diminished tactile sensitivity and manual dexterity." For these reasons, the Vice-Chair found it likely that the worker had a neurological impairment as part of his HAVS.The Vice-Chair determined that the NEL assessment of December 1, 2020 did not consider the above noted findings from the worker's CPT and dexterity testing. Consequently, the worker's neurological impairment was not rated. Based on OPM Document No. 16-01-09, the Vice-Chair found that the worker was entitled to a rating for the neurological component of his HAVS, as demonstrated by the CPT and dexterity testing. Therefore, the worker's NEL quantum would need to be adjusted to include the results of the CPT and dexterity test, which determined that the worker did have a neurological HAVS component. In conclusion, the worker was entitled to a re-assessment of his degree of permanent impairment for HAVS.