71 Van Natta 494 (2019)
In the Matter of the Compensation of MARTIN GAUGHAN, Claimant
WCB No. 17-03204
Oregon Worker Compensation
May 1, 2019
Hollander & Lebenbaum et al, Claimant Attorneys
SAIF
Legal Salem, Defense Attorneys
Reviewing Panel: Members Curey, Lanning, and Wold.
ORDER ON REVIEW
Claimant
requests review of Administrative Law Judge (ALJ)
Otto’s order that upheld the SAIF Corporation’s
denial of claimant’s occupational disease claim for
bilateral carpal tunnel syndrome (CTS). On review, the issue
is compensability. We reverse.
FINDINGS
OF FACT
We
adopt the ALJ’s “Findings of Fact” with the
following supplementation.
In
January 2017, claimant began a position as a motorcycle
mechanic for his employer. (Ex. 6-2; Tr. 5). Previously, he
had been working as a “service manager” for
approximately 12 years, a position that did not require
intensive, forceful use of his hands. (Tr. 5).
In May
2017, claimant was evaluated by Dr. Pape, who diagnosed
bilateral CTS and recommended a nerve conduction study. (Ex.
1). Claimant filed an 827 form initiating a claim for
bilateral CTS as an occupational disease. (Ex. 2).
In June
2017, Dr. Kim performed a nerve conduction study that
suggested a diffuse symmetrical axonal polyneuropathy. (Ex.
5). He commented that diagnosis of a more localized
entrapment neuropathy, such as CTS, was difficult in the
presence of polyneuropathy, though claimant did have
abnormalities of the right median motor nerve. (Id.)
In July
2017, claimant was evaluated by Dr. Nolan, a hand surgeon, at
SAIF’s request. (Ex. 6). Dr. Nolan diagnosed probable
right CTS “in the context of a diffuse symmetrical
axonal polyneuropathy,” and severe obesity. (Ex. 6-5).
Based on claimant’s history of returning to the
hand-intensive work of a mechanic, Dr. Nolan believed that
claimant’s work “played some role” in the
development of his CTS symptoms. (Ex. 6-6). Dr. Nolan noted
that while the record mentioned [71 Van Natta 495] a video of
claimant’s work activities, it was not available for
his review. (Id.) He described “significant
use” of the hands, involving air-powered impact tools,
electric-powered impact wrenches, regular wrenches and
screwdrivers. (Id.) Dr. Nolan described
claimant’s work as “intermittently
forceful.” (Ex. 6-11). However, Dr. Nolan explained
that the cause of CTS is “multifactorial” and
would not begin “from scratch” after a few months
of working as a mechanic. (Id.) Instead, based on
claimant’s age, obesity, and the presence of his
nonwork-related polyneuropathy, Dr. Nolan considered
claimant’s personal factors to be the major
contributing cause of the CTS condition. (Ex. 6-7).
On July
19, 2017, SAIF denied the claim. (Ex. 7).
In
September 2017, Dr. Johnson performed a right CTS release
surgery. (Ex. 7BB).
Thereafter,
claimant was evaluated by Dr. Bell, a neurologist, at
SAIF’s request. (Ex. 8). Dr. Bell reviewed the
“raw data” from the nerve conduction study and
concluded that there was evidence of a “diffuse”
polyneuropathy, and superimposed median entrapment
neuropathies at both wrists (right greater than left). (Ex.
8-6). Dr. Bell reviewed a video of claimant performing his
work activities. (Ex. 8-8). She noted that there was little
to no tool use, and no impact tool use, with the left hand.
(Id.) She understood that claimant’s work
involved some high force and gripping movements, as well as
the use of vibrating air impact tools. (Ex. 8-11, -12).
However, Dr. Bell did not consider claimant’s hand use
to be performed at a high rate of repetition. (Ex. 8-11). She
considered the combination of claimant’s age, obesity,
and the systemic causes of his polyneuropathy to be the major
contributing cause of the bilateral CTS condition. (Ex.
8-13).
Dr.
Bell subsequently opined that claimant’s polyneuropathy
was an active contributor to his bilateral CTS, explaining
that the condition will cause symptoms in the median nerve
because of its constricted location. (Ex. 9-3). She
reiterated her opinion that claimant’s polyneuropathy,
obesity, and age, were the primary contributors to his
bilateral CTS. (Ex. 9-4). Dr. Bell did not consider
claimant’s job activities to involve continuous and
repetitive pressure, as the video depicted, and claimant
described briefly forcefully gripping a tool before moving to
another task that did not require as much force or grip. (Ex.
9-3). Therefore, she did not consider claimant’s work
activities to be of the type, frequency, or duration to be
the major contributing cause of his CTS condition.
(Id.)
[71 Van
Natta 496] Dr. Johnson opined that based on claimant’s
“excellent response” to the right CTS surgery, in
addition to decreased symptoms in the left hand after being
off-work, he was able to “assess the [CTS] as separate
and apart from the polyneuropathy.” (Ex. 10). He
considered claimant’s positive response to the left CTS
release as indicating that the condition was caused by
claimant’s work activities as a mechanic. (Ex. 10-2).
He believed that the onset of claimant’s CTS symptoms
two months after transferring from service manager to
mechanic was a “critical factor” in determining
the causes of claimant’s CTS. (Ex. 10-2). Dr. Johnson
considered a description of claimant manipulating wrenches
and motorcycle parts on a frequent to constant basis using 80
to 90 percent of his strength, as shown in a video that
claimant obtained of his work activities. (Ex. 10-1). Dr.
Johnson attributed the major contributing cause of
claimant’s...
