SUMMARY DECISION NO. 1242/99 White finger disease; Rheumatoid arthritis; Disablement (vibrations) (tools). The worker was a jackleg driller until 1976 and then a hoist man until he retired in 1991. The worker appealed a decision of the Appeals Officer denying entitlement for hand-arm vibration syndrome. The medical evidence was uncertain as to whether the worker was suffering from hand-arm vibration syndrome or rheumatoid arthritis. In either case, the worker's condition was related to work with vibratory tools. The appeal was allowed. [5 pages] DECIDED BY: Sajtos DATE: 04/12/2000 NUMBER OF PAGES: [5 pages] ACT: WCA CROSS-REFERENCE: Decision No. 1242/99I
2000 ONWSIAT 3399 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1242/99 [1] Tribunal Vice-Chair E. J. Sajtos heard this appeal in Sudbury on July 5, 1999. THE APPEAL PROCEEDINGS [2] The worker appeals the decision of Appeals Officer S. Cavaric, dated December 23, 1997. That decision concluded that the worker was not entitled to benefits for hand/arm vibration syndrome. [3] The worker appeared and was represented by Mr. Hamilton, Officer of the Worker Adviser. The employer was notified but chose not to participate. [4] Subsequent to the proceeding of July 5, 1999, the Vice-Chair in Decision Number 1242/99I requested that the worker be assessed by a vascular surgeon. The Tribunal received a report from this physician dated May 2, 2000. THE RECORD [5] The Vice-Chair considered as evidence the Case Record, two addenda and correspondence with attachments dated May 6, 1999, June 28, 1999 and December 5, 1973. Post-hearing, the Vice-Chair received two addenda. [6] The worker testified under oath. The worker s representative provided written submissions. THE ISSUES [7] The Vice-Chair must determine whether the worker is entitled to benefits for a hand/arm condition. THE REASONS (i) Background [8] The worker was employed for twelve years as a mine jackleg driller until 1976. In 1976, he attended Sault College for two years and then worked as a hoist man until he retired in 1991. [9] The worker was assessed by a rheumatologist Dr. Piper in August 1977, who stated that the worker had rheumatoid arthritis, however, there was also a possibility of chondrocalcinos possibly secondary to hemochromatosis and sarcoidosis. Dr. Long, MBBS, FRCS made the first diagnosis of white hand syndrome on December 7, 1977. [10] Dr. Field, MB, FRCSC, in a report dated August 21, 1978 was of the view that the worker had a clinical picture of rheumatoid arthritis combined with sed. Rate elevation to 51.
Page: 2 Decision No. 1242/99 Dr. Field indicated that the worker did not have vibration induced white finger syndrome rather, his cold sensitivity was due to collagen disease. [11] In 1978, the Board s Unit Medical Adviser, Dr. Burton noted that the worker s drilling exposure was adequate to support a finding of vibration induced white finger disease. In addition, the worker had developed symptoms in 1974, which were compatible with his employment. However, due to Dr. Field s diagnosis of rheumatoid arthritis, the Board physician recommended that the claim be rejected. [12] Dr. Long, in a report of September 4, 1990 indicated that the worker was having increased problems with his hands and his fingers, which turned white in the summer. Dr. McMillan MB, CH.B confirmed the worker s increased symptoms in February 1994. [13] On December 9, 1994, Dr. Pelmear, a vascular surgeon, first tested the worker for vibration induced white finger disease. The doctor concluded that the worker had significant exposure to HAV and was suffering from hand/arm vibration syndrome. He was found to have a mild stage I vascular impairment in his left hand and mild to moderate stage I vascular impairment in his right hand. [14] In a Board memorandum dated August 26, 1997, a Unit Medical Adviser provided the following opinion: (ii) The present information on file does not confirm a diagnosis of vibration induced vascular disease of the hands. There are abnormal serological tests highly suggestive of some type of collagen disease. It is known that secondary Raynaulds is common and occasionally presenting symptoms with collagen disease. There has been a suggestion of rheumatoid arthritis, scleroderma, lupus etc but the clinical report confirming either one, is not on file. The neurological tests carried out by Dr. Pelmear in 1994 do not suggest any digit sensory neuropathy, consistent with vibration exposure in the hands. The nerve conduction was reported as being normal. Tribunal Assessor [15] Dr. Maggisano, a vascular surgeon from the Sunnybrook Health Science Centre provided the Tribunal with a report dated May 2, 2000. The Assessor noted that he reviewed the case record materials and clinically examined the worker with a dabbler evaluation on May 2, 2000. [16] The doctor indicated that the worker s symptoms began in 1972 and they consisted of white discoloration in his hands on cold exposure with associated pain in the fingers. The worker was unable to continue ice fishing or participate in activities in the cold. The symptoms are now better then they were in the 1970 s. However, on minimal cold exposure, the worker s fingers become white and have associated pain. [17] Dr. Maggisano stated that the worker had extensive symptoms related to arthritis in most of his joints and that he had total knee arthroplasties in 1991 and bilateral total hip replacements in 1995. Upon physical examination, the physician was of the opinion that the worker had a small degree of vaso motor disturbance in the digital arteries of both his hands and feet.
Page: 3 Decision No. 1242/99 [18] The doctor noted that the issue before the Tribunal related to whether the worker s symptoms were attributable to a diagnosis of rheumatoid arthritis, or whether he had hand/arm vibration syndrome. In providing his opinion, the physician reasoned as follows: In my opinion, the worker definitely suffers from rheumatoid arthritis, which has been conclusively proven by the fact that he has a positive latex fixation test, which is pathognomic for rheumatoid arthritis. In fact, the reason for his knee and hip arthroplasties relates to this condition. The issue, however, of his hands becoming white and being afflicted with paresthesias and pain is a bit more difficult to attribute entirely to the diagnosis of rheumatoid arthritis. There is no doubt that rheumatoid arthritis can be associated with Raynaud s phenomenon, but patients with rheumatoid arthritis may also have no symptoms of Raynauds and hence the dilemma. It has been categorically shown that the worker has had significant exposure to vibrating tools to cause hand/arm vibration syndrome and hence we are left to resolve what effect, if any, this exposure has had on his current symptomatology. Currently there are no objective tests available that can distinguish between the Raynaud s phenomenon seen in rheumatoid arthritis, compared to that seen in hand/arm vibration syndrome. Since that is the case, it is my feeling that one has to give the worker the benefit of the doubt and assume that the hands symptomatology that the worker is describing is either secondary to hand/arm vibration syndrome, or at least is related to his rheumatoid arthritis and has been aggravated by his extensive exposure to jack leg and plugger vibrating injuries. At this point and time, the degree of involvement is no different then what he was diagnosed by Dr. Pelmear in 1994. I would agree that he has mild stage one vascular involvement in both hands, and similarly stage one SN involvement in both hands. The confusion that has evolved in the worker s case since 1977 is unfortunate but, to be fair to the medical profession, there was little known about hand/arm vibration syndrome in those former years, and it has only been in the last five to ten years that knowledge in this condition has advanced so that we can now make these assertions. (iii) The Vice-Chair s Reasons [19] The Vice-Chair must determine whether the worker s employment aggravated or caused his rheumatoid arthritis and or his hand/arm vibration syndrome. [20] The worker s representative, Mr. Hamilton, submitted that the benefit of the doubt ought to be given to the worker in this case. The representative argued that the Tribunal Assessor, Dr. Maggisano was of the view that the worker s condition was caused or aggravated by his employment as a jackleg driller. [21] The Vice-Chair notes the comment made by the Tribunal assessor that little was known about hand/arm vibration syndrome in 1977 when the worker first complained of symptoms. In addition, the worker lived in a northern community and he did not have access to appropriate testing until December 1994. At that time, Dr. Pelmear, who did the vascular testing, confirmed that the worker had hand/arm vibration syndrome. Previously, the worker had been diagnosed with rheumatoid arthritis and possible chondrocalcinosis or sarcoidosis. [22] The Vice-Chair notes that two vascular surgeons, Dr. Pelmear and Dr. Maggisano have now assessed the worker. Dr. Pelmear was of the opinion that the worker has hand/arm vibration syndrome. The Tribunal assessor stated that his current hand symptomatology is either
Page: 4 Decision No. 1242/99 secondary to hand/arm vibration syndrome or at least is related to his rheumatoid arthritis and has been aggravated by his extensive exposure to jack leg and plugger vibrating injuries. [23] The Board physician, Dr. Burton, in his memorandum of 1978 confirmed that the worker had adequate employment exposure to vibratory tools to support entitlement for vibration induced white finger disease and the development of his symptoms were also consistent with his employment. [24] Based on a balance of possibilities, the Vice-Chair is satisfied that the work place exposure was a significant contributing factor to his current hand symptoms and as such entitlement to benefits is granted. THE DECISION [25] The worker s appeal is allowed. The Board is directed to determine the duration and the quantum of benefits that flow from this decision subject to the usual rights of appeal. DATED: December 4, 2000 SIGNED: E.J. Sajtos