- Delay (onset of symptoms)
- Post-concussion syndrome
- Loss of earnings {LOE} (eligibility) (impairment)
- Concussion
The issues under appeal were: a) entitlement for a concussion, including post-concussive syndrome; and, b) entitlement to Loss of Earnings (LOE) benefits from October 9, 2019.
The Vice-Chair denied the appeal.The Vice-Chair found, on a balance of probabilities, that the worker did not experience concussion symptoms, such as headaches and dizziness, until on or around October 23, 2019, which was approximately 19 days after the workplace accident. The Vice-Chair found that the delay in the onset of symptoms broke the chain of causation between the worker's slip and fall and his subsequent concussion symptoms. The Tribunal's Medical Discussion Paper, "Traumatic Brain Injury and Concussion", identifies the timeline for delay in the onset of symptoms as hours and days, rather than weeks. In particular, physical symptoms, such as headaches and dizziness, usually develop within days of the concussion. The Vice-Chair found that 19 days, almost 3 weeks, stretched the acceptable period of onset beyond what would be considered reasonable. In appeals where there has been no blow to the head, the diagnosis of a work-related concussion has been accepted where the treating neurologist has provided support for a causal relationship, including the identification of a mechanism of injury. For example, in Decision No. 1807/18, the worker's neurologist stated that the worker had sustained a concussion via a whiplash mechanism. In Decision No. 1917/18, the worker suffered a recognized work-related perforated tympanic membrane injury from an explosion, which his neurologist opined had likely caused a "coup-contrecoup injury." Both instances were impulse injuries, which are one of the two causes of traumatic brain injury described in the medical discussion paper. There was no medical evidence to support that the worker sustained an impulse injury in the course of his slip and fall. The Vice-Chair found that the worker had entitlement to full LOE benefits for the period of time that his right elbow was immobilized, from October 9, 2019 to November 29, 2019, minus any actual earnings. The duties offered by the employer were not physically suitable and no accommodations were available for the worker's inability to use his right arm while it was in a sling. The Vice-Chair found that the worker would have been able to return to accommodated regular duties by November 29, 2019, and that his inability to return to work after this date was due to his continuing non-work-related concussion symptoms. There was no entitlement to LOE benefits after that date.