Lam and Australian Postal Corporation

[2006] AATA 428

Administrative

Appeals

Tribunal

 

DECISION AND REASONS FOR DECISION [2006] AATA 428

ADMINISTRATIVE APPEALS TRIBUNAL      )

)          No N2005/749

GENERAL ADMINISTRATIVE  DIVISION		)
Re		THI BICH MY LAM

Applicant

And AUSTRALIAN POSTAL CORPORATION

Respondent

DECISION

Tribunal Ms N Bell, Senior Member
Dr J Campbell, Member

Date17 May 2006 

PlaceSydney

Decision The decision under review is affirmed

..............................................

Ms N Bell
  Presiding Member 

COMPENSATION – Carpal Tunnel Syndrome – Mail Officer – Work Activity Did Not Cause or Materially Contribute to Condition – Decision Under Review Affirmed

Safety, Rehabilitation and Compensation Act 1988

Carboni v Comcare [2005] AATA 409

Ngo v Australian Postal Corporation [2004] AATA 1033

REASONS FOR DECISION

17 May 2006 Ms N Bell, Senior Member
Dr J Campbell, Member     

1.      Ms Lam commenced work at Australia Post in 1989 as a Mail Officer.  In 1996 she made a claim in relation to “numb and tingling fingers, arms, neck, spine and sometimes in the legs and very stiff shoulders”.  Her claim was refused by Australia Post and she did not pursue it.   She continued as a Mail Officer, performing the full range of duties until she made a further claim in December 2004 for “bilateral carpal tunnel syndrome (fingers feel numb)”.  Ms Lam commenced restricted duties and remains on those duties to date.  Australia Post denied liability for carpal tunnel syndrome and affirmed that determination on reconsideration, hence Mrs Lam’s current application with this tribunal.

issues

2.      It is common ground that Ms Lam suffers from carpal tunnel syndrome.  She contends that her condition was caused or materially contributed to by her repetitive and fast paced work as a Mail officer.  In the alternative, she contends that her work activity aggravated her pre-existing carpal tunnel syndrome.  Ms Lam relied on the report and oral evidence of Associate Professor G David Champion, Rheumatologist and the reports of Dr L Anand, Occupational Physician, and Dr P Giblin, Orthopaedic Surgeon.

3.      Australia Post contends that Ms Lam’s carpal tunnel syndrome is not causally linked to her work activities and not aggravated by them.  It relied on the report and oral evidence of Dr N McGill, Rheumatologist, to contend that Ms Lam’s carpal tunnel syndrome is constitutional.

was the condition caused by or materially contributed to by work?

4.      Ms Lam’s evidence was that, after developing numbness in the fingers of her right hand in 1996, she attended her doctor who told her to “work slower”.  She did so and the numbness went away.  After 3 months on light duties, she continued to work at full duties until December 2004.

5.      Ms Lam described the introduction of some new machines for mail processing in 2000, a multi level optical code reader which required the operator to work at hip and shoulder level and a bar code sorter which also required work at several levels.

6.       Ms Lam said her right hand problem completely disappeared between 1996 and 2004 when, in September, she began to have problems with her left hand and with her right hand, on and off.  She saw her general practitioner, Dr Tran, who referred her to Dr Anand.  She saw Dr Anand on 2 occasions only because, she said, her condition improved when she was placed on light duties.  Those duties allow her to do manual sorting without using a machine, to change her position from sitting to standing and doing mail culling handling only thick items.  She said she is coping well with her current duties.

7.      She described her current symptoms as a loss of strength in her hands but said she can hold objects and reach up and grasp for up to 20 minutes without her fingers going numb.  She said she has no problem with repetitive work but if it is fast paced she has difficulty.  She described her current duties as being at a pace much slower than that of her former full duties.

8.      Dr Champion reported that Ms Lam gave a history of numbness in her fingers of both hands, shoulders, arms, back and legs together with stiffness in her neck in 1996.  She attributed these sensations to “a build up slowly after a long period of  time where I worked in the indexing, flat sorting machine and loading heavy mail bags and trays”.   Nerve conduction studies were undertaken and showed a “moderately severe delay in conduction across both carpal tunnels”.  Dr Champion noted Ms Lam recovered from these disorders.  However, he reported that from early 2001 she began to experience minor intermittent symptoms including tingling, numbness and minor pins and needles in her hands but she did not seek medical treatment.

9.      Dr Champion reported that Ms Lam’s symptoms intensified in September 2004 and also produced pain in her left hand.  She attributed this to grasping bundles of mail in her left hand.  Dr Champion concluded there was no indication of abnormal predisposition to carpal tunnel syndrome on the part of Ms Lam and that, in 1996, she was “performing duties that did put her substantially at increased risk of regional pain disorders and carpal tunnel syndrome”.

10.     Dr Champion said it is “well recognised” that mail sorting increases the likelihood of carpal tunnel syndrome being suffered by an individual.  However, he conceded that the research he referred to concerned only manual sorting and not machine sorting.  He was unable to explain the long period of “quiescence” in Ms Lam’s symptoms from 1996 to 2004.  However, he stated that if she returns to her full duties her symptoms will become worse.  At present, she is able to work at her own pace and this makes her symptom free.

11.     Dr Giblin, in his report of 20 April 2005 asserted that there is a relationship between Ms Lam’s work and her carpal tunnel syndrome.  He did not discuss, in his report, the nature of her work or any of the particular activities that might give rise to the condition.

12.     Dr Anand, in his report of 9 May 2005, described Ms Lam’s work as involving sorting mail, keying and feeding the machines and involving repetitive finger motions and over use of her hands.  He concluded that her condition was work related.

13.     Dr McGill considered Ms Lam’s carpal tunnel syndrome is due to constitutional narrowing of the carpal tunnels and not due to work or any other physical activity.  Dr McGill said carpal tunnel syndrome is a nerve entrapment condition and not an overuse condition.

14.     Dr McGill noted that in 1996 Dr Storey, who diagnosed Ms Lam’s carpal tunnel syndrome, reported a night time increase in symptoms as did Dr Kandiah, Rheumatologist, who reported an increase in symptoms when she is supine.  Dr McGill found this pattern of reaction to fluid redistribution to be inconsistent with a connection between her symptoms and her work activity.  He also noted the tendency in carpal tunnel syndrome for symptoms to fluctuate with no connection to activity undertaken. 

15.     Dr McGill referred to 2 studies that have shown keying and other manual occupational activities have no effect on carpal tunnel syndrome (Nordstrom et al, Risk Factors for Carpal Tunnel Syndrome in a General Population, in Occupational and Environmental Medicine 1997, volume 54, p. 734 and Nathan et al, Occupation as a Risk Factor for Impaired Sensory Conduction of the Median Nerve at the Carpal Tunnel, in Journal of Hand Surgery 1988, vol. 13B, p. 167).

16.     Dr McGill said the key factors producing carpal tunnel syndrome are constitutional (the largest group), weight gain and obesity, diabetes and inflammatory synovitis.  Dr McGill concluded that, given Ms Lam does not have any of the conditions in this list of factors, her carpal tunnel syndrome is most likely to be constitutional.

17.     We prefer the opinion of Dr McGill that Ms Lam’s carpal tunnel syndrome is constitutional in origin.  That opinion is supported by the pattern of the development of the condition including its 8 year quiescence, the fluctuation of symptoms with no apparent relationship to activity undertaken and by the research studies he referred us to.

18.     We note the decisions of the Tribunal in Carboni and Comcare [2005] AATA 409 and Ngo and Australian Postal Corporation [2004] AATA 1033, referred to by Mr Mr Burge for Ms Lam, and in which the Tribunal found carpal tunnel syndrome to be caused by work. However, we consider that the Tribunal’s conclusions were specific to the particular circumstances of those applications and similar conclusions are not justified in the circumstances of this application.

was the condition aggravated by work?

19.     On the question of aggravation, Dr Champion considered that mail sorting could make existing carpal tunnel syndrome painful.  He said repeated flexion of the flexor tendons may contribute to the pathology of the condition.  He also said that once a person has had carpal tunnel syndrome, the healing of the nerve fibres is incomplete and an abnormal sensitivity remains.  He agreed, however, that Ms Lam had enjoyed a very long quiescent period between 1996 and 2004.  He emphasised that it is the pace of her work, which she cannot control when working on the machines, that makes her symptomatic.

20.     Dr McGill said he thinks it is possible, but not probable, that Ms Lam’s activities, including her work activities, have at times increased the level of her symptoms but he did not think her activities have changed the natural history of her carpal tunnel syndrome.  In particular, he considered that moving from shoulder to hip level while using an optical code reader would not change Ms Lam’s wrist posture to anything but a very mild extent and would have no effect on her carpal tunnel syndrome.  He referred, in this respect as well, to the studies cited above.  He said any effect of her work duties on her level of symptoms would have been restricted to the period of time of doing those duties and for up to a day or two later.  He said her work activities will not change the underlying pathology of her condition even though she may sometimes experience an increase in symptoms at the time of doing those activities.

21.     We consider that the symptoms experienced by Ms Lam in 2004 were most likely the result of the natural progression of her constitutional condition.  We are persuaded in this view by the opinion of Dr McGill and by the lengthy quiescence of her symptoms from 1996 to 2004 during which she was performing her full duties, including, for a significant part of that period, her duties on the new machines.  On this basis, we do not consider that Ms Lam’s condition was aggravated by her work.

decision

22.     The decision under review is affirmed.

I certify that the 22 preceding paragraphs are a true copy of the reasons for the decision herein of Ms N Bell, Senior Member and Dr J Campbell, Member

Signed:         ..........[Linda Blue]..............................
  Associate

Dates of Hearing  16 and 17 March 2006
Date of Decision  17 May 2006
Counsel for the Applicant         Mr C Burge
Solicitor for the Applicant          Turner Freeman Lawyers
Counsel for the Respondent     Miss R Henderson
Solicitor for the Respondent     Graham Jones Lawyers