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Workers' Compensation Board

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Case # G1356863
Date of Accident: 12/07/2015
District Office: Rochester
Employer: County of Orleans Treasurer
Carrier: Orleans County Self-Insurance
Carrier ID No.: W858005
Carrier Case No.: 6876
Date of Filing of Decision: 10/04/2017
Claimant's Attorney: Lewis & Lewis PC
Panel: Clarissa M. Rodriguez


The Full Board, at its meeting on September 19, 2017, considered the above captioned case for Mandatory Full Board Review of the Board Panel Memorandum of Decision filed January 20, 2017.


The issue presented for Mandatory Full Board Review is whether the record supports finding that the claimant's work caused her bilateral carpal tunnel syndrome and left elbow tendonitis.

The Workers' Compensation Law Judge (WCLJ) found insufficient evidence to support the establishment of an occupational disease of bilateral carpal tunnel syndrome and left elbow tendonitis and disallowed the claim.

The Board Panel majority affirmed the decision of the WCLJ.

The dissenting Board Panel member would find that the claimant provided sufficient credible evidence of causal relationship between her repetitive job duties and her disability.

The claimant filed an application for Mandatory Full Board Review on February 20, 2017, arguing that the claim should be established as the uncontroverted medical evidence supports a finding that the claimant has an occupational disease due to her work duties.

The self-insured employer (SIE) filed a rebuttal on March 21, 2017, asserting that the decision of the Board Panel majority is supported by the record.

Upon review, the Full Board votes to adopt the following findings and conclusions.


This is a controverted claim for occupational bilateral carpal tunnel syndrome and left elbow tendonitis. In a C-2F (Employer's First Report of Work-Related Injury/Illness) form filed on January 15, 2016, the employer indicated that the claimant provided notice that her bilateral carpal tunnel syndrome and left elbow tendonitis were caused by repetitive motion at work. In an attached employee incident report, the claimant reported experiencing a stabbing pain in her left elbow along with numbness and tingling in her left and right hands. The claimant noted that she was evaluated by Dr. Gibbs and the doctor recommended that a nerve study be conducted for cubital tunnel in the left elbow and bilateral carpal tunnel, all a result of repetitive use.

In a medical narrative filed on January 25, 2016, for an examination performed on December 7, 2015, the claimant's treating physician, Dr. Gibbs, noted that the claimant presented to his office with bilateral hand numbness and left elbow pain. The doctor indicated that the claimant believed her problem was a result of repetitive type work. After examination, Dr. Gibbs diagnosed left carpal tunnel syndrome with constant numbness, moderate right carpal tunnel syndrome, and mild left elbow tendonitis. The doctor noted that given her worsening symptoms on the left, he was recommending a nerve conduction study to help further elucidate her underlying problem. The doctor indicated that the claimant's condition was work related. However, Dr. Gibbs did not state in his report what claimant's job duties entailed.

In a FROI-04 (First Report of Injury-Denial) form filed on January 20, 2016, the SIE controverted the claim, citing no compensable accident and no causal relationship.

At a hearing held on March 23, 2016, the claimant testified that she was a secretary for the Orleans County Sheriff's Office and her job duties included personnel issues, typing, and executing letters, pistol permits, and grants. She described her position as involving a lot of paperwork and keyboarding. The claimant indicated that she was given additional keyboarding tasks formerly performed by a retired colleague, resulting in more than half of her work day requiring keyboarding work. She testified that her symptoms progressively worsened since she was given her additional job duties, and that she began waking up at night with pain in her arm and numbness in her hands, which prompted her to seek treatment with Dr. Gibbs.

Deposition testimony of Dr. Gibbs was taken on April 21, 2016. Dr. Gibbs testified that he first examined the claimant on December 7, 2015, and diagnosed her with bilateral carpal tunnel and left elbow tendonitis. The claimant had reported numbness and tingling in digits one through three and occasionally in four and five, with nighttime symptoms. When asked what he understood the claimant's work conditions to be, Dr. Gibbs testified "I don't know off the top of my head right now. I'd have to go back and search, but I don't have anything in front of me." (Deposition, Dr. Gibbs, 4/21/16, p. 6).

On cross-examination, Dr. Gibbs testified that he had examined the claimant prior to December 7, 2015, for an unrelated knee and ankle problem that was not workers' compensation related. The doctor noted that the claimant had a medical history that included cubital tunnel on the right and fibromyalgia, but that none of her underlying conditions seemed to stand out as a direct cause of her carpal tunnel. When asked whether he was aware of what kind of hobbies the claimant did at home and whether they could cause or contribute to her symptoms, Dr. Gibbs testified "I don't know. Again, I don't have that information in front of me." (Deposition, Dr. Gibbs, 4/21/16, p. 10). The doctor further testified that, assuming no history of traumatic injury to her wrists or hands, the claimant's symptoms were more likely than not caused by her duties at work.

In a reserved decision filed May 23, 2016, the WCLJ disallowed the claim, finding insufficient evidence given the failure of the claimant's doctor to specify or detail any specific aspect of the claimant's work as causing or contributing to the diagnoses indicated.

The claimant filed an application for administrative review on June 22, 2016, arguing that the case should be established for bilateral carpal tunnel syndrome and left elbow tendonitis as the claimant testified to a long career of using her hands for keyboarding and other administrative tasks. The claimant asserted that Dr. Gibbs' diagnosis was based upon a clinical examination as well as his discussion with the claimant regarding her work and other history. As the SIE failed to present any evidence to the contrary, the claim must be established for an occupational disease of bilateral carpal tunnel syndrome and left elbow tendonitis due to repetitive typing at work.

The SIE filed a rebuttal on July 22, 2016, requesting that the reserved decision be affirmed.


A claim for occupational disease "is restricted to medical conditions resulting from the ordinary and generally recognized risks incident to a particular occupation" (Matter of Mack v County of Rockland, 71 NY2d 1008 [1988]). "'An occupational disease is a condition which derives from the very nature of the employment and not from an environmental condition specific to the place of work' (Matter of Bates v Marine Midland Bank, 256 AD2d 948 [1998]). To establish an occupational disease, a claimant must demonstrate a 'recognizable link' between the alleged condition and a 'distinctive feature' of his or her work (Matter of Winn v Hudson Val. Equine Ctr., 215 AD2d 920 [1995])" (Matter of Ball v New Era Cap Co., Inc. 21 AD3d 618 [2005] [additional citations omitted]).

"[I]t is axiomatic that a claimant bears the burden of establishing a causal relationship between his or her employment and a disability by the proffer of competent medical evidence" (Matter of Williams v Colgate Univ., 54 AD3d 1121 [2008] [citations omitted]). The medical opinion need not be expressed with absolute or reasonable certainty (Matter of Norton v North Syracuse Cent. School Dist., 59 AD3d 890 [2009]). It must, however, be an indication of sufficient probability as to the cause of the injury, and the medical opinion must be supported by a rational basis (id.). "[M]ere surmise, or general expressions of possibility, are not enough to support a finding of causal relationship" (Matter of Mayette v Village of Massena Fire Dept., 49 AD3d 920 [2008] [citations and internal quotation marks omitted]).

Here, though the claimant testified that her job duties involved repetitive typing, the medical evidence does not provide a recognizable link between her condition and a distinctive feature of the claimant's work. Dr. Gibbs' medical report and testimony provide no basis for a finding that the claimant's repetitive motions at work caused the claimant's symptoms, nor does the doctor ever identify what the claimant's job duties even entail. Rather, in opining causal relationship, Dr. Gibbs' appears more to have adopted the claimant's opinion of causation.

While Dr. Gibbs was familiar with the claimant from treating her previously, there is nothing in the record that suggests he was aware of what the claimant did at work on a daily basis; the claimant had no reason to ever discuss her work in detail with Dr. Gibbs during visits prior to this claim as any such treatment was for conditions that were unrelated to her work. Moreover, while his medical report noted that the claimant believed her symptoms were a result of repetitive type work, Dr. Gibbs makes no mention of specific repetitive computer use or typing at all in the remainder of his report or in his testimony. The nature of the claimant's work is vital to finding that Dr. Gibbs' medical opinion is based upon a rational basis. Absent a history of the claimant's job duties, a doctor's opinion of causal relationship is mere speculation. As such, the claimant has not met her burden of establishing causal relationship.

Therefore, the Full Board finds that there is insufficient medical evidence in the record to find that the claimant's work caused her bilateral carpal tunnel syndrome and left elbow tendonitis. This finding is without prejudice and claimant submitting supplementary medical evidence on the issue of causal relationship.


ACCORDINGLY, the WCLJ reserved decision filed May 23, 2016, is AFFIRMED. No further action is planned by the Board at this time.