- Shoulder condition
- Second Injury and Enhancement Fund {SIEF} (preexisting condition) (normal condition)
- Medical report (Tribunal medical discussion paper)
The worker suffered a right shoulder injury in October 2016. The Board granted the employer 25% SIEF relief based on an accident of moderate severity and a pre-existing condition of minor medical significance. The employer appealed, submitted that it should be entitled to 90% SIEF relief.
The Vice-Chair confirmed the Board decision that the accident was of moderate severity.A post-operative report found fraying in the worker's right rotator cuff, severe biceps tenosynovitis, grade III AC joint with severe synovitis, severe subacromial bursitis, and type III acromion with moderate lateral down slope. These are at least partly degenerative conditions. Thus, it was likely they were present in the worker's shoulder at the time of the work accident.The Vice-Chair reviewed the Tribunal's recently revised medical discussion paper on Shoulder Injury and Disability. The acromion "can have different shapes which may impact on the space present for gliding of the rotator cuff." The hooked type III acromion is associated with rotator cuff tears, though it is not clear if the type III hook shape causes rotator cuff tears or occurs in response to rotator cuff tears. Type III acromion has an incidence rate of from 8 to 39%. The revised discussion paper also discusses impingement syndrome, synovitis, and bursitis, which the medical reports show were present in the worker's shoulder.Based on the discussion paper and other medical evidence, the Vice-Chair found that, currently, there is no unanimity whether a type III acromion causes rotator cuff issues or is an indication that rotator cuff issues exist. Either way, or SIEF purposes, a type III acromion shows there is a pre-existing degenerative condition in the shoulder.Type III acromion demonstrates a pre-disposition to develop rotator cuff issues and impingement syndrome, as compared to a normal person, and so may cause the development of a shoulder disability of greater severity than a normal person. This does not mean that the presence of a type III acromion automatically means there is entitlement to SIEF cost relief. Type III acromion should be assessed in the same way other pre-disposing conditions are considered for the purpose of SIEF relief, that is, in accordance with medical opinion specific to the condition of the worker in question.The Vice-Chair found that the severe AC joint condition was of minor significance by itself, but the type III acromion in conjunction with severe AC joint synovitis and bursitis made the worker more likely to develop a disability of greater severity than a normal person. The Vice-Chair concluded that the pre-existing condition was of moderate medical significance.Based on an accident of moderate significance and a pre-existing condition of moderate medical significance, the employer was entitled to 50% SIEF relief. The appeal was allowed in part.