Decision #51/00 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on February 1, 2000, at the request of the claimant. The Panel discussed the case on February 1, 2000 and May 11, 2000.
Issue
Whether or not the claimant is entitled to payment of wage loss benefits beyond October 19, 1999.
Decision
That the claimant is not entitled to payment of wage loss benefits beyond October 19, 1999.
Background
On September 11, 1998, the claimant was installing basketball hoops and backboards when he developed pain in his left hip and leg region. Examination by a chiropractor on September 14, 1998, diagnosed the claimant with an acute traumatic strain/sprain of the lumbosacral spine and left sacroiliac joint and sciatica. The claim was accepted by the Workers Compensation Board (WCB) and benefits were paid accordingly. In the interim, the claimant was scheduled to undergo surgery for a non-compensable left inguinal hernia on January 12, 1999.
In a progress report dated April 12, 1999, the treating chiropractor noted that the claimant continued to have groin and left leg pain radiating to the gastrocnemius muscle. Objective findings revealed loss of segmental range of motion in the L5-S1 region. Global range of motion was normal. On May 6, 1999, the chiropractor advised a WCB adjudicator that the claimant had had a set-back without any new accident or injury. He stated that the claimant was totally disabled from working and may have permanent damage.
On May 11, 1999, a WCB chiropractic consultant examined the claimant. In his opinion, the claimant had recovered from his left inguinal hernia surgery. With respect to the hip region, examination findings pointed strongly to myofascial pain involving the left gluteus medius muscle. He recommended that the claimant be referred for a brief series of acupuncture treatments to alleviate the myofascial pain in the area.
The chiropractic consultant also noted that the claimant had reasonably good function and intact lower limb strength. He did not consider the claimant to be disabled. He encouraged the claimant to be as active as possible in preparation for his return to work, which was planned for June 1999.
On May 26, 1999, the claimant underwent a CT scan of the lumbosacral spine. The impression was, "Far left lateral L4-5 disc protrusion which approaches the left L4 root in its exit foramina. Small central and left posterolateral L5-S1 disc protrusion."
On June 29, 1999, a specialist with the Centre for Pain and Stress Management indicated that the claimant had been treated four times with acupuncture with no affect.
A WCB medical advisor reviewed the case on July 20, 1999, and was of the opinion that although the claimant's myofascial pain was related to the compensable injury the claimant could resume employment. Following a review of the CT scan results, the WCB medical advisor, on August 31, 1999, indicated that the claimant was capable of returning to work without restrictions.
On September 7, 1999, the claimant was informed that in the opinion of Rehabilitation & Compensation Services, he had recovered from the effects of his work injury and that benefits would be issued up to September 14, 1999.
Subsequent reports were received from both the treating chiropractor and the attending physician who was of the view that the claimant had still not recovered from the effects of his compensable injury. On October 19, 1999, an orthopaedic specialist's impression was that the claimant seemed to be recovering satisfactorily from his lumbar disc protrusion. The claimant had normal micturition with practically no major neurological deficit on examination of his lower limbs. He seemed to be sensitive, however, around his left inguinal region pointing to the possibility of a scar neuroma. The claimant was encouraged to continue with his back flexion exercises.
At the request of Review Office, a WCB orthopaedic consultant reviewed the case on October 28, 1999. Based on the WCB chiropractic examination of May 11, 1999, and the recent orthopaedic specialist's report, the WCB orthopaedic consultant believed that the claimant had recovered from the September 11, 1998, compensable injury and no restrictions were warranted.
On October 29, 1999, Review Office determined that the claimant's wage loss benefits should be extended to October 19, 1999 inclusive. Review Office based its decision on the WCB orthopaedic consultant's opinion that the claimant had recovered from the compensable injury. Review Office did not believe that the CT scan findings were of clinical significance given the clinical examination findings.
On December 17, 1999, the claimant appealed Review Office's decision and the case was referred to the Appeal Commission for consideration. File documentation included a neurologist's report dated December 2, 1999.
An Appeal Panel hearing was held on February 1, 2000. Following the hearing and discussion of the case, the Panel requested that the claimant be assessed by a WCB medical advisor specializing in physical rehabilitation medicine. The claimant was then assessed by the medical advisor on March 14, 2000, and the examination results were forwarded to the claimant for comment. On May 11, 2000, the Panel met to render its final decision.
Reasons
At the Panel's request, a WCB medical consultant examined the claimant on March 14th, 2000. He recorded the following comments in his examination notes:
"On the current clinical examination there was little to find. This restricted (sic) to some muscular tightness left quadriceps muscle with some sensitivity to pressure of the left buttock muscles primarily. No identification of any definite active myofascial pain involvement on the current examination either and only some minor subjective report of sensory symptoms long standing in the left lower extremity. There was no evidence of any definite active mechanical low back present on the current examination."
In the medical advisor's opinion, the claimant appeared to have essentially recovered from his prior low back musculoligamentous sprain/strain and possible aggravation of mechanical low back pain. In addition, he felt that there would be no requirement for restrictions based on the reported injury of September 11th, 1998.
We find that the minimal clinical findings recorded by the WCB's medical consultant are entirely consistent with the findings documented by the WCB's chiropractic consultant on January 15th, 1999 and by the treating orthopaedic surgeon on October 25th, 1999. We are satisfied based on a preponderance of evidence that the claimant had, on a balance of probabilities, recovered from the effects of his compensable injury by the time his benefits were terminated. Accordingly, the claimant is not entitled to payment of wage loss benefits beyond October 19th, 1999.
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 23rd day of May, 2000