Canadian Safety Reporter

2 Canadian HR Reporter, a Thomson Reuters business 2017 CSR | November 2017 | News and discomfort in her right shoulder and arm. She believed the symptoms were related to her job duties, so she submitted a report of injury to the Ontario Workplace Safety and Insurance Board (WSIB). In the injury report, the work- er claimed she suffered from a repetitive strain injury caused by her having to hold her arms and hands up while using American Sign Language to communicate with her students. Since teaching deaf students required constant communication — and signing — all day and every day in the classroom, this contributed to fatigue and strain in her arm and shoulder. The worker also stated that the grouping of her students — though her students where officially Grade 8, their abilities ranged from Grades 2 to 8 re- quiring her to teach individual- ized lessons — left her with not much time when she wasn't sign- ing and conversing with some- one, and since she didn't grow up using sign language, her body wasn't accustomed to doing it all the time. The worker requested an in- terpreter to sign for her, which the school provided for the last two months of the school year. She received treatment from a chiropractor, who had been see- ing the worker already for neck and upper shoulder treatment. She missed three days of work and returned on modified duties involving only class preparation while another teacher took over signing to the students. However, this arrangement wasn't ideal and the employer suggested the teacher take a 30-day rest while it found her an interpreter. The worker returned to work on modified duties for the rest of the school year and the chiropractor submitted a report to the WSIB diagnosing the worker with "cer- vical brachial neuralgia" in her arm, thumb, and index finger. Symptoms returned In September 2011, she start- ed at a different school for the deaf where she had more breaks and preparation time but after one month, she began expe- riencing her symptoms again and they soon grew worse. The worker made a claim for work- ers' compensation benefits for a work-related injury. In September 2012, the worker moved to a school for the blind where she didn't have to use sign language. She didn't miss any more work but she still experienced intermittent pain in her neck and right shoulder radi- ating down to her right arm and hand, for which she continued to receive chiropractic treatment. A WSIB adjudicator spoke with the worker, who said she had some nerve damage in her left arm previously, but didn't believe it was related to her pain that she had only started feeling recently. She said that she tried to adjust how she was signing for about one week, but the condi- tion worsened and she submitted her injury report. She originally thought her arm and shoulder pain were "general aches and pains associated with the job," but when it worsened she sought more treatment and received the repetitive strain injury diagnosis along with the recommendation that she stop signing and contin- ue chiropractic adjustments. The worker acknowledged that she had felt some problems with her left ulnar nerve in 2010 which she thought was related to her signing, but it didn't interfere with her job until April 2011. She also stated that her spouse and several friends were deaf, and the ongoing pain made it difficult to sign with them, so her social life and communication with her husband were negatively affect- ed. The adjudicator researched cervical brachial neuralgia and learned that the condition is the result of a disc compression in the spine and features neck pain that radiates down the arm. It is usually caused by herniated discs, arthritis, bone spurs, spinal ste- nosis, or poor posture — but not repetitive use of the arms such as in using sign language. A nurse consultant confirmed that the condition indicated a pinched or compressed nerve in the neck and was not compatible with the worker's accident history. The adjudicator denied the worker's claim for benefits be- cause her condition had a num- ber of non-occupational causes that could not be ruled out. The worker appealed the de- cision, but an appeals resolution officer denied the appeal, finding that while the worker's job duties involved repetitive movements of her upper extremities and she reported neck and upper ex- tremity pain after working in her job for three years, there was no evidence that her duties were a significant contributing factor to her diagnosed condition. "While I am aware that there are risk factors which can pre- dispose an individual to develop cervical brachial neuralgia, I am not persuaded, on a balance, that the worker's description of her work-related duties is one of them," said the appeals resolu- tion officer. The worker appealed this de- cision to the Ontario Workplace Safety and Insurance Tribunal. The tribunal noted that the issue boiled down to whether the worker's employment was a "significant contributing factor" to the onset of her symptoms. It also noted that "the worker hon- estly believes that the pain in her right arm is related to the nature of her duties." The tribunal found that the only medical report on the work- er's symptoms was the one filed by her chiropractor in 2011 with the cervical brachial neuralgia di- agnosis and saying that using sign language at work exacerbated the symptoms. However, there was no explanation in the report of how the worker's duties caused the problem. The tribunal was made aware of two articles discussing a link between "upper-extremity mus- culoskeletal disorders" and sign- language interpreters — one from Ryerson University and one an OHS guide — but there was no indication the authors were med- ical experts or they had been peer reviewed. When in doubt, medi- cal opinions had more weight than sources whose qualifica- tions were not established, said the tribunal. Since both the adjudicator and appeals resolution officer had already considered medical sources that indicated several non-occupational causes of the worker's condition and there was no substantiated medical evidence directly linking it to the worker's job teaching deaf stu- dents, the tribunal could not find that the worker's occupation was a significant contributing factor to her arm and shoulder prob- lems. "Given the state of the evi- dence currently before me, and in particular the medical evi- dence on file, I find that such a relationship (of causation) has not been established on a bal- ance of probabilities," the tribu- nal said in dismissing the appeal. "In addition, I find that the evi- dence for and against the work- er's claim is not approximately equal in weight and as such, she is not entitled to the statutory benefit of doubt." For more information see: • Decision No. 2237/17, 2017 CarswellOnt 13931 (Ont. Workplace Safety & Insurance Trib.). Sign language < pg. 1 Teacher's condition had several non-occupational causes Credit: Shutterstock/Photographee.eu

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