The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on April 20, 2000, at the request of the employer. The Panel discussed this appeal on April 20, 2000.

Issue

Whether or not treatment received by the claimant commencing April 1, 1997 is related to the November 12, 1996 accident.

Decision

That treatment received by the claimant commencing April 1, 1997 is related to the November 12, 1996 accident.

Background

On April 16, 1997, the claimant submitted an application for compensation benefits indicating that he had injured his right knee on November 12, 1996, when kneeling down to clean the base of a toilet. The claimant stated on the application that he did not seek immediate medical treatment as he thought his knee would get better. Information received from the employer indicated that the claimant was going to have surgery performed on his right knee on August 13, 1997 which he claimed was related to his November 12, 1996, injury. In a letter dated April 22, 1997, the employer requested that the claim be thoroughly investigated given the delay between the injury date and the date of first medical treatment.

In a declaration dated May 13, 1997, the claimant stated that he hurt his right knee at work in November 1996 and that he had filled out a green card and kept on working. Sometimes his knee would give out and sometimes it would swell but he kept on doing his regular duties. By April 1, 1997, his knee was too sore. He went to see a sports medicine specialist and was subsequently referred to an orthopaedic specialist. There were no new injuries to his knee after November 12, 1996.

A doctor's first report dated April 4, 1997, indicated that the claimant sought medical treatment on April 1, 1997. The diagnosis was a meniscus tear.

On June 5, 1997, the orthopaedic specialist requested permission from the Workers Compensation Board (WCB) to perform a right knee arthroscopy. On July 15, 1997, financial responsibility for all costs associated with this proposed surgery was authorized by a WCB medical advisor.

The claimant underwent surgery on August 13, 1997. The postoperative diagnosis was a medial meniscus tear of the right knee plus chondromalacia patella on the medial femoral condyle and medial plica. In a follow-up report dated September 16, 1997, the orthopaedic specialist recommended a couple of weeks of intensive physiotherapy and considered the claimant fit to return to work on September 29, 1997. The claimant returned to regular work duties on September 29, 1997, and continued to attend the sports medicine specialist for treatment.

On February 12, 1998, the orthopaedic specialist noted that the claimant suddenly developed some pain and swelling laterally in his knee while attending physiotherapy treatments. Following examination of the knee, the specialist concluded that the claimant had an iliotibial tract tendinitis and would benefit from localized massages, anti-inflammatories and a stretching program. If the claimant developed effusions, then a tear of the lateral meniscus was a possibility.

Following consultation with a WCB medical advisor on March 18, 1998, the claimant was informed on March 27, 1998, that no responsibility would be accepted for treatment associated with the iliotibial tract tendonitis as it was considered that this was not directly related to the 1996 compensable injury. This decision was later overturned on May 20, 1998, as it was determined that the iliotibial tract tendonitis was caused through the physiotherapy which the claimant had been receiving as a direct result of the compensable injury.

On July 21, 1999, an employer representative appealed the decision to accept the claim and provided a report from an independent orthopaedic specialist dated July 5, 1999 in support. The employer representative was of the opinion that the evidence did not maintain a relationship between the claimant’s right knee problems and the November 12, 1996, accident. On November 12, 1999, a union representative provided rebuttal argument to the employer’s appeal.

Following consultation with a WCB orthopaedic consultant on November 23, 1999, Review Office confirmed that the claim was acceptable. In a decision dated February 11, 2000, Review Office noted the WCB’s orthopaedic consultant felt that the mechanism of injury as described could have produced a meniscal tear, especially with the presence of degenerative changes noted at the arthroscopy. The consultant indicated that the bucket handle type tear of the meniscus suffered by the worker was not typical of a degenerative type tear and that it would be unusual for a person to sustain a large tear of the meniscus without this immediately causing some restriction in activity. It was noted that even after seeking medical treatment on April 1, 1997, the worker continued to perform his regular work activities until such time as he underwent surgery on August 13, 1997. The orthopaedic consultant postulated that the incident at work could have caused a small tear of the meniscus which worsened over time.

Based on a balance of probabilities, Review Office believed that the incident occurring on November 12, 1996 resulted in internal disagreement of the right knee for which the worker ultimately underwent surgery on August 13, 1997.

At the request of the employer's representative, an Appeal Panel hearing was held on April 20, 2000. A March 30, 2000, report from the independent consultant was submitted for consideration by the employer.

Reasons

The claimant provided, on November 9th, 1999, a written narrative of the details surrounding his accident to his union representative:

"On Nov 12th, 1996, I was cleaning a transit washroom. My regular routine is to spray the entire outside of the toilet with cleaner. In doing this I am on my right knee on concrete. I use my right leg to kneel & use my left leg for leverage. As you can picture by spraying the bowl, I am moving/rotating my knee. Once this is done, I wipe the bowl with a paper towel, again rotating the knee. On this day, I sprayed the toilet bowl & proceeded to wipe it down. When reaching for the rear of the bowl, I felt a pop in my right knee...".

The claimant's description at the hearing of the mechanism of injury was consistent with the employer's medical consultant's summary of a typical meniscal tear. In a letter dated July 5th, 1999 to the employer's representative, the consultant stated, "Torn meniscus occurs in kneeling occupations, e.g. carpet laying, when the knee is rotated, and on moving the knee is twisted, tearing the cartilage."

Also of significance were the responses to questions posed to the WCB's orthopaedic consultant on November 19th, 1999 by Review Office.

Q. In your opinion, does the evidence support the contention that the worker sustained a torn medial meniscus while kneeling to clean the base of a toilet on November 12, 1996?
A. The claimant could have torn a meniscus in the knee with the mechanism described - kneeling, flexed knee & rotation as in carpet layers, miners, etc.

Q. Is there any further information required, or are there any additional comments you to make?
A. The subsequent articular changes noted at arthroscopy are indicative of pre-existing degenerative changes. Meniscal tears in degenerative knees can occur with lesser trauma. The bucket handle type tear of a meniscus is not the typical degenerative type tear which is usually a horizontal type tear.

We find based on the weight of evidence that the treatment received by the claimant commencing April 1, 1997 is related to the November 12, 1996 accident. We agree with the medical suggestion that the claimant sustained, on a balance of probabilities, a small tear at the time of the compensable injury and that this became enlarged over time.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

R. W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 10th day of May, 2000