- Non-economic loss {NEL} (calculation)
- Permanent impairment {NEL} (degree of impairment) (wrist)
- Permanent impairment {NEL} (rating schedule) (AMA Guides) (applicability)
- Permanent impairment {NEL} (rating schedule) (AMA Guides) (loss of grip strength)
The issues under appeal were: a) whether the worker had entitlement to an increase in the quantum of his Non-Economic Loss (NEL) award for his left wrist for loss of grip and pinch strength; and, b) whether a rating for his arthrodesis surgical procedure should be factored into his NEL award for his left wrist.
The appeal was allowed, in part.Tribunal case law has accepted that the assumption that a rating for range of motion will include a rating for loss of grip strength applies to listed sections, but does not apply to wrist ratings under s. 3.le, as in the worker's case (see Decision No. 829/16). It must be considered whether, on the balance of probabilities, the impaired grip and pinch strength constitutes a specific and separate functional impairment that should be compensated (see Decision No. 1380/15). The Vice-Chair found that the medical evidence established, on the balance of probabilities, that the worker developed a loss of grip and pinch strength due to his 2016 work accident, and that this impairment was permanent. This constituted a specific and separate functional impairment which should be compensated in the worker's NEL award. With respect to whether a rating for the arthrodesis surgical procedure should be factored into the NEL award for the worker's left wrist, the appeal on this issue was denied. The Vice-Chair found that the worker had a permanent impairment due to the arthrodesis procedure performed on his wrist; however, given that the AMA Guides provide specific criteria concerning rating an arthrodesis surgical procedure, it was not necessary to rate the worker's arthrodesis procedure by analogy using Table 19.The AMA Guides indicate that while ratings for abnormal range of motion are combined with ratings for arthroplasty, they are not combined with ratings for arthrodesis. The Vice-Chair also noted as significant that the worker had limited movement in all planes following his arthrodesis procedure. The arthrodesis did not result in an absence of motion as contemplated by the definition of ankylosis in the AMA Guides. In these circumstances, where the arthrodesis did not result in an absence of motion, the Vice-Chair found that the Board correctly rated the worker's NEL award for his wrist using the ratings for range of motion in Tables 26 and 29, rather than the ratings for ankylosis in those Tables. The Vice-Chair also referenced Decision No. 1983/13R, which addresses how to rate an ankylosis impairment when some range of movement is present.