In re Compensation of Gaughan, 050119 ORWC, 17-03204

Docket Nº:WCB 17-03204
Case Date:May 01, 2019
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...

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