FD: FD: DT:D DN: 675/93 STY: PANEL: Newman; M. Cook; Chapman DDATE: ACT: KEYW: Delay (onset of symptoms); Heart condition (traumatic).

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1 FD: FD: DT:D DN: 675/93 STY: PANEL: Newman; M. Cook; Chapman DDATE: ACT: KEYW: Delay (onset of symptoms); Heart condition (traumatic). SUM: The worker's arm was caught in a conveyor belt and was pulled around the head pulley up to and including his shoulder. The worker appealed a decision of the Hearings Officer denying entitlement for a cardiac condition which the worker related to blunt trauma to the heart suffered in the accident. The Panel accepted the opinion of a medical assessor that it is possible for blunt trauma to the heart to cause a cardiac condition but that the worker's cardiac condition was not related to the compensable accident considering delay in onset of cardiac symptoms for three years after the accident. The appeal was dismissed. [6 pages] PDCON: TYPE: A DIST: X-REF: Decision No. 675/93I IDATE: HDATE: TCO: KEYPER: R. Seguin; D. Lenihan TEXT:

2 WORKERS' COMPENSATION APPEALS TRIBUNAL DECISION NO. 675/93 This appeal was heard in Timmins on October 12, 1993, by a Tribunal Panel consisting of: E. Newman : Vice-Chair, S.L. Chapman: Member representative of employers, M. Cook : Member representative of workers. The post-hearing process was completed on February 18, THE APPEAL PROCEEDINGS The worker brings this appeal from the decision of Hearings Officer, N. Ranta dated June 5, The Hearings Officer concluded that the worker was not entitled to workers' compensation benefits for a cardiac condition. She also concluded that an accident of September 2, 1975, was not a significant contributing factor in the development of that cardiac disability. On this appeal the worker attended, and was represented by R. Seguin of the Office of the Worker Adviser. The employer was represented by D. Lenihan, human resources superintendent. THE EVIDENCE The Panel heard evidence from the worker under oath and considered the following documents: Exhibit #1: Case Description; Exhibit #2: Addendum #1; Exhibit #3: Addendum #2; Exhibit #4: Addendum #3; Exhibit #5: report of Dr. Lenkei-Kerwin dated January 7, 1994; Exhibit #6: submissions of the parties. THE NATURE OF THE CASE On September 2, 1975, the worker suffered a terrifying and severe accident. He was employed in a copper mill, and was cleaning the head pulley of a copper conveyor. His right arm became tangled between the head pulley and the conveyor belt. The pulley controlled a conveyor belt which was 300 feet long. The worker was unable to free his right arm, and his right arm was pulled by the belt around the head pulley. The worker's arm was pulled in by

3 2 the belt, and around the bottom of the pulley, up to and including his right shoulder. The worker felt immediate and intense pain in the right arm and right shoulder, as well as a feeling of compression in his chest, which was lodged against the guard plate at the side of the pulley. It took approximately 45 minutes to free the worker. He was in intense pain during this time. The belt did not stop when the worker's arm became caught in it, and he continued to be pulled by the belt until co-workers stopped it, and cut him free. When the worker was finally freed, he was taken to hospital where a fracture of the head of the radius and avulsion of the nail of his right thumb were diagnosed. There was no diagnosis made of any injury to the chest. At the time of the worker's immediate examination at hospital, x-ray was taken of the right arm, but of no other part of his body. No chest x-ray was taken. The worker states that there were bruises on his chest and the plant's safety supervisor confirms this observation. It is the worker's claim on this appeal that in the accident of September 2, 1975, he suffered a blunt trauma to his heart. It is his position on this appeal that the blunt trauma to his heart, as well as a change in lifestyle occasioned by the injuries sustained in this accident, were significant contributing factors in the development of a cardiac disability. This cardiac disability was diagnosed in 1978, some three years after the accident. (i) The issue This is a case in which it is necessary for the Panel to determine, on a balance of probabilities, whether any of: 1. the accident in 1975, 2. the ensuing injury, and/or 3. consequent change in lifestyle represent significant contributing factors to a subsequent cardiac disability. THE PANEL'S REASONS Factual findings are recorded in the Panel's interim decision. These will not be repeated. As a result of the Panel's interim decision, an opinion was obtained from Dr. Lenkei-Kerwin, of the Toronto Hospital. Relevant excerpts from that opinion include the following:

4 3 1. "Is it medically plausible, in an accident such as that described above, that the worker would have suffered a contusion or bruise directly to the heart? Whereas cardiac contusion in the absence of any external sign of injury can occur, the trauma must involve either the front or the back of the chest wall and cannot occur from remote injury such as described in this case. All the description pertaining to this injury involves the right arm and right shoulder. Even assuming that the chest wall adjacent to the right shoulder was compressed, this is quite remote from the actual anatomic location of the heart. Therefore it is my conclusion, that in this particular case, the accident did not produce subclinical injury to the heart. 2. "Absent immediate complaint of chest pain or shortness of breath on or immediately following the accident on September 2, Is it medically plausible that the accident caused or contributed to the development of cardiac disability." The simple short answer to this question is no, it is not plausible. The time frame between the accident and the development of cardiac symptoms precludes any causal connection. 3. "Of what diagnostic significance, if any, are the worker's complaints of shortness of breath first evidenced nine months after the accident in 1975 coincident with a case of the flu and upper respiratory infection." Shortness of breath is a non-specific symptom and can occur in a large variety disorders, some of which have nothing to do with the heart. Shortness of breath in a patient who has the flu and has an upper respiratory infection and who is known to be obese and a smoker cannot be connected to an injury which he suffered nine months before. Symptoms of a cardiac trauma must have a temporal relationship to the injury and would occur either immediately or within a very limited time frame, not exceeding two weeks following injury. 4. "If an `old' inferior myocardial infarction was found on ECG in 1978, what is the medical plausibility that this indicates that in 1975, at the time of this accident, the worker did suffer from a previously undiagnosed myocardial infarction? Is there any means by which one can reasonably fix the probable timing of

5 4 that `old' infarction? Can it be linked to the 1975 accident?" I have addressed in my preamble the issue pertaining to the diagnosis of "old inferior myocardial infarction" in the electocardiogram. I do not accept the diagnosis as either being proven, of significance or having any relationship, in this particular case to the injury this worker sustained three years previously. There is no objective evidence to connect his problem from 1978 onward to the injury he sustained in It is my belief that the claimant did not suffer blunt trauma to his chest wall causing cardiac damage. The opinion of Dr. Lenkei-Kerwin, briefly, is that the facts described in this case do not support the likelihood that the worker suffered an injury to the heart as a result of the September 2, 1975, accident. The opinion is that the events of that day, as dramatic and significant as they were, did not likely contribute to the worker's later cardiac disability. In post-hearing submissions, the worker's representative argues that notwithstanding the clear opinion of the medical assessor, it remains within the realm of medical possibility that the accident of September 2, 1975, did contribute, in a significant way, to the later cardiac problems suffered by this worker. Mr. Seguin reminds that Panel, in his submission, that where the circumstances themselves are persuasive enough, a claim for workers' compensation benefits may be granted, in the absence of conclusive medical evidence. The Panel agrees with the principle as stated. However, in the circumstances of this case, is not satisfied that the facts do support the conclusion sought. In fact, from a lay person's perspective, a connection between the accident and the later cardiac problem seems implausible. The opinion of an objective expert medical witness was sought in the interests of ensuring that the theory asserted by the worker's representative was given thorough exploration. The worker's cardiac disability became manifest almost three years following the accident which he suffered at work. This fact, from a lay person's perspective, strikes the Panel as significant. If the facts disclosed an immediate myocardial infarction, or one which followed soon after the events of the accident, common sense would cause the Panel to have difficulty discounting the strong probability of a connection between the trauma of the accident, and the cardiac disability. But, given the period of time which elapsed between the accident and the manifestation of cardiac symptoms, the Panel is not of the view that there is a clear and reasonable factual link between the two. Rather, the Panel finds the views of Dr. Lenkei-Kerwin clear, sensible, and persuasive.

6 5 The fact that there was no injury at the location of the chest near the heart forms an important part of the medical assessor's observations. From a lay perspective, it strikes the Panel as an important point. The absence of immediate chest pain and shortness of breath following the accident is another fact of which the Panel takes note. Dr. Lenkei-Kerwin identifies this fact as important to her conclusion that there is no connection between the accident, and the later cardiac disability. For these reasons, the Panel is of the view that it is more probable than not that the worker's accident of September 2, 1975, did not precipitate, and was not a factor in the development of, the worker's later cardiac disability. THE DECISION The appeal is denied. DATED at Toronto, this 8th day of April, SIGNED: E. Newman, S.L. Chapman, M. Cook.

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