- Disablement (strenuous work)
- Fasciitis (plantar)
- Osteoarthritis (toe)
- Spinal stenosis
A 68 year old worker was employed as a stock keeper by a school board, commencing the employment in 1986. As an order picker, the worker was required to lift cases weighing up to 60 lbs and pack them in a truck. The worker filed a claim for entitlement for the low back, neck, shoulders, arms, and left foot, arising from his repetitive daily duties. The worker was diagnosed with spinal stenosis, a plantar calcaneal spur and metatarsal phalangeal osteoarthritis (MTP OA).
The Vice-Chair noted that the case materials included limited medical information about the worker's conditions. While the worker's treating family doctor noted that the worker had a history of lifting heavy boxes, this was only briefly noted in these forms without any further persuasive medical explanation about how these areas of injury would be related to the mechanics of the nature of the work. There was no other medical evidence which addressed the question of whether the worker's medical conditions were work related. The Vice-Chair relied on the opinion in the Osteoarthritis MDP that epidemiologic studies related to osteoarthritis did not support a causal relationship to heavy work, and that individuals that did heavy work were no more likely to develop OA than those that do sedentary work. It was determined that it was not probable that the worker's osteoarthritis was initiated by his repetitive work duties.The Vice-Chair interpreted the Low Back Pain and the Neck and Arm Pain MDP as meaning that spinal stenosis was an age related process caused by degenerative disease, and that it was not a condition which would be caused by heavy work. These papers supported this proposition both in relation to stenosis of the cervical spine and stenosis of the lumbar spine. The first paper also supported the proposition that spinal stenosis was an imaging finding, not a clinical syndrome. It followed that a finding of stenosis, like other findings related to degenerative change, would not, by itself, be a basis for entitlement to benefits. The Vice-Chair concluded that it was not probable that the worker's heavy work related to his employment initiated the spinal stenosis at either the cervical or lumbar levels of the spine. The Vice-Chair noted that the Plantar Fasciitis MDP stated that although many patients are concerned with the presence of a heel spur, it was not as recognized as an etiologic factor in the development of this condition. On this basis, the Vice-Chair concluded that the worker's left calcaneal spur was not a significant factor contributing to his plantar fasciitis. It was determined that the worker's job duties, which involved heavy lifting, did not initiate the worker's plantar fasciitis. While the MDP stated that the type and level of an individual's activity may contribute to tensile forces leading to plantar fasciitis, this was unlikely in the worker's case, given the relationship between age and the typical timing of the onset of plantar fasciitis. It was concluded that the worker's work duties did not initiate his spinal stenosis, osteoarthritis or left plantar fasciitis.With respect to the claim that the work duties aggravated or worsened the worker's musculoskeletal conditions, the Vice-Chair agreed with Decision No. 1455/18R in that it may be appropriate to apply OPM Document No. 11-01-15 with a broader approach, and to consider the term "aggravation" to mean "worsening" of the condition, regardless of the more precise definitions set out in the policy which may limit its application. The Vice-Chair stated that the Osteoarthritis MDP notes that heavy work may render the joint more symptomatic, and create the impression that osteoarthritis is more common in these workers. In that sense, the MDP distinguished between an actual worsening of pathology, and the experience of pain symptoms - which may be experienced while performing work, without necessarily advancing the pathology of the condition. The Vice-Chair also agreed with Decision 2341/08 that the presence of new symptoms may suggest advancement of the underlying pathology, but could also suggest that the underlying condition has become more noticeable because of certain activities. In the end, the medical evidence must determine the outcome. The Vice-Chair found, in the present appeal, that although the worker may have experienced pain symptoms as a result of performing his work duties, there was no persuasive evidence to support the conclusion that the worker's work duties worsened his conditions or enhanced the pathology of the conditions.The appeal was denied.