$135,000 Non-Pecuniary Damages for Multiple Crush Syndrome, TOS and TMJ Injury
Reasons for judgment were released today by the BC Supreme Court, Vancouver Registry that are worth reviewing for anyone involved in an ICBC Claim for damages for accident related Thoracic Outlet Syndrome.
In today’s case (Sauer v. Scales) liability was denied but Mr. Justice Cohen found the defendant 100% at fault for the collision. In valuing the Plaintiff’s non-pecuniary damages at $135,000 Mr. Justice Cohen found as follows with respect to the severity of the accident related injuries:
I find that the plaintiff’s medical experts not only established the plaintiff’s diagnosis that he suffered from thoracic outlet syndrome, but also that of a multiple crush syndrome… he sustained a serious TMJ injury as a result of the accident, and that he should undertake dental reconstruction to treat this disorder…
 In the result, I find, on the whole of the evidence, that the plaintiff has proven to the requisite standard that as a result of the accident he sustained moderate to severe injuries to his eyes, teeth, jaw, neck and back. I accept Dr. Fry’s opinion, confirmed by the other experts for the plaintiff who opined on this issue, that as a result of the accident the plaintiff has significant musculoskeletal and neurological symptoms with respect to his left arm and that the diagnosis is one of multiple crush syndrome, where he has evidence of cervical spine compression, of neurogenic thoracic outlet syndrome, of cubital tunnel syndrome and of carpal tunnel syndrome.
 I also find that the injuries he sustained in the accident and the requirement to take therapy and medication on a continuing basis since the accident to treat those injuries has had a significant impact on the quality of the plaintiff’s life, including sleeping, eating and physical fitness, as well as upon his social and personal relationships.
 I am mindful of the evidence that since the accident the plaintiff has experienced varying degrees of improvement in his overall symptoms; that to some limited extent he has been able to return to physical pursuits such as tennis, jogging and skiing; that he has been able to travel on family vacations; and, that during the time he was involved with the affairs of Global Synfrac he frequently commuted to Calgary to attend Board meetings. I am also mindful of the evidence that his prognosis remains poor with regard to his TMJ disorder and thoracic outlet syndrome, and there remains the possibility of him having to undergo further surgical procedures to address these conditions. Moreover, he will have to continue taking therapy and medications to treat his ongoing symptoms.
 Taking all of the above factors into account, I find that $135,000 is a fair and reasonable sum to award the plaintiff for general damages.
Paragraphs 233-236 of this case will be of particular interest to anyone who has undergone an ‘independent medical exam‘ with Dr. A.I Munro. Dr. Munro has conducted many of these exams on behalf of ICBC and often disagrees with the diagnosis of Thoracic Outlet Syndrome. Mr. Justice Cohen held that “no weight should be given to the opinions of Dr. Munro on this issue (the Plaintiff’s Thoracic Outlet Syndrome)”. In reaching this conclusion extensive portions of Dr. Munro’s cross examination were reproduced which I set out below:
 In the report of Dr. A.I. Munro, a specialist in thoracic and cardiac surgery, dated March 9, 2006, he concluded that as a result of the accident the plaintiff sustained a mild soft tissue injury of the neck and that he did not have thoracic outlet syndrome. He also concluded that the plaintiff had a left ulnar entrapment syndrome which was causing his disability, and that the bilateral carpal tunnel syndrome had recovered, stating that, “only one hand was on the steering wheel so it cannot be due to the MVA.” He also said that the plaintiff’s disability is associated with numbness and weakness caused by a left ulnar entrapment syndrome plus cervical nerve root pains. However, despite his experience as a thoracic surgeon, Dr. Munro testified that he may have done one thoracic outlet syndrome surgery between the years 1994 to 2001. He said that he may have done one at St. Paul’s Hospital, but he was not sure, and otherwise a previous one would have been done at UBC Hospital. He also testified:
Q — at VGH? Mm-hm. And what type of surgeries were you performing over that period from ’68 to 1990, if I have the years roughly correct.
A General thoracic surgery and cardiac surgery, both closed and open heart surgery.
Q Okay. And of the — I take it there were other surgeons who performed a similar practice to yours?
A I suppose all the surgeons had slight variations in their practices.
Q Mm-hm. Were any of these surgeons –
A Some of them were purely thoracic, some of them were purely cardiac, and some were mixed.
Q Okay. Were any of the ones that were purely thoracic involved with thoracic outlet syndrome and surgeries on that condition?
A Early on, no. Probably I saw most of them until probably Dr. Fry, Dr. Nelems came on staff, and they saw most of the thoracic outlet surgery after that.
Q And when would that be?
A I’m not sure of the actual dates.
Q Was it shortly after –
A Probably in the — my guess would be the early ’80s, —
Q And prior to 2001 when you were at VGH after Dr. Fry and the other physician you mentioned began to specialize, those cases would be — TOS cases would be sent to them for –
Q — assessment at surgery; correct?
A The second aspect is looking at a specific five-year period and analyzing what cases I had seen during that five-year period.
Q And what five-year period is this?
A That was 2002, 3, 4, 5 and 6.
Q Mm-hm. Mm-hm. And — and that — that is where you were giving me these approximate numbers?
Q Okay. So during that period, there were somewhere between 25 to 30 per cent that were involving non-severe neck injuries that — where — that could have been, in your opinion, thoracic outlet syndrome issues?
A No. There was a fair percentage of people who had such bizarre symptoms and signs that you couldn’t fit them into any logical medical diagnosis, —
A — often associated with psychiatric disease.
Q Mm-hm. But other specialists had assessed them as thoracic outlet syndromes?
A These were all people who had been sent to me to consider this diagnosis.
Q Mm-hm. Now, going back to my question in terms of your — oh, maybe I’ll finish. In that five-year period, I take it, Doctor, there were people who you did concur with the other physician that the diagnosis was thoracic –
A In that particular –
Q — outlet syndrome?
A — five-year period, no. In the previous five years, yes.
Q Okay. And how many occasions was that, do you recall?
A In the previous five years, —
A — I think it was two, but I cannot tell you for sure.
Q Two of approximately 30 per year? Thirty reports a year?
A Probably at that time I was seeing less than 30 per year.
A I do not have the exact figures –
A — for that previous –
A — five-year period.
Q So — but in the last 10 years it would be reports in the order of several hundred reports, and of those several hundred reports you concurred with the other specialists on two occasions that you can recall?
Dr. Munro, icbc injury claims, Mr. Justice Cohen, Multiple Crush Syndrome, Sauer v. Scales, Thoracic Outlet Syndrome, TMJ, TOS
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