The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel review was held on July 22, 1999, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on several occasions, the last one being June 9, 2000.

Issue

Whether or not the claimant is entitled to further benefits after August 4, 1998, in reference to a work-related accident in April 1998.

Decision

That the claimant is entitled to further benefits after August 4, 1998 up to April 20, 2000 in relation to his compensable injury of April 3, 1998, minus the time that the claimant spent in hospital for non-compensable reasons.

Background

On April 17, 1998, the claimant completed a Worker's Report of Injury or Occupational Disease due to a bilateral groin injury which he reported to have sustained at work on April 3, 1998. According to the claimant's claim form, he was attempting to lift a front quarter of beef from a weigh scale and place it onto an overhead rail hook when he experienced his symptoms.

Initial medical treatment was sought on April 6, 1998, from a general practitioner. On examination, the physician noted the claimant to be tender on the medial thighs, inguinal ligaments and lower abdominal muscles. A diagnosis of moderate-severe bilateral groin strain was provided and it was indicated the claimant would be disabled from his regular employment for a period of 2 - 4 weeks. The claimant was reassessed by the general practitioner on April 14, 1998, and the physician reported the claimant's condition to be improving.

The adjudicator at the WCB spoke with the claimant on May 25, 1998. At that time, the claimant provided a history of injury to his groin approximately two years earlier while in Calgary. Apparently, this injury occurred when the claimant was lifting a keg of beer. Medical treatment was sought at that time and according to the claimant, he was diagnosed as having torn a sheath of abdominal muscle. The claimant reported that this injury continued to bother him for some time off and on whenever he strained himself lifting. During the telephone conversation, the claimant also advised that on April 30, 1998, he attended a local hospital as he was experiencing pain and swelling in the groin area and found that he was unable to urinate. The claimant was transferred to another hospital by ambulance and examined there by a urologist. The claimant was also seen by a surgeon at that facility regarding a possible hernia. The claim was accepted by the WCB on May 25, 1998,

When next assessed by his family physician on May 6, 1998, the claimant was referred for a course of physiotherapy treatment. In a progress report from the physician covering an examination on May 26, 1998, the doctor indicated the claimant was experiencing a very slow recovery and it was recommended the claimant be examined by a WCB medical advisor.

The claimant was assessed by a urologist on April 30 and June 11, 1998. In the covering reports, the urologist expressed the opinion that the claimant experienced a left varicocele on April 30, 1998, when he was assessed in the emergency room facility. The urologist stated that the claimant's major discomfort seemed to be suprapubic and abdominal in nature and in this regard, referred the claimant for imaging studies to out upper urinary tract problems and to ensure that the varicoceles are not due to a worrisome cause. An ultrasound was performed on June 11, 1998, and the results suggested bilateral varicoceles.

As requested by the family physician, the claimant was examined at the WCB by the board's orthopaedic consultant on June 12, 1998. From the examination, the consultant could not detect any evidence of a definite injury. It was felt that the claimant was exhibiting some abnormal pain behavior.

At the request of the family physician, a bone scan was performed on July 15, 1998, the results of which suggested no evidence of abnormal focal bony pathology. The file in its entirety was reviewed by a WCB medical advisor on July 28, 1998. Based on this review, the medical advisor expressed the opinion that there were no objective findings relating to the compensable lifting injury to substantiate an ongoing disability from work. It was felt that a causal relationship between the ongoing complaints and the compensable injury no longer existed.

The adjudicator wrote to the claimant on July 29, 1998, and advised that the WCB would not accept any further responsibility for the claim beyond August 4, 1998. It was stated, following a review of the file, that the weight of evidence did not support an ongoing cause and effect relationship between the work injury and the current medical difficulties.

With the assistance of a worker advisor, an appeal was submitted to the WCB Review Office on November 19, 1998. Included with the appeal, the worker advisor provided the WCB with a medical report dated November 13, 1998, from a sports medicine physician. In the report, the physician expressed the opinion that the claimant sustained an abdominal injury at work which was diagnosed as an external oblique muscle tear and which could create a prolonged period of recovery. The physician stated that this kind of injury was not uncommon in hockey players with a torquing load that is presented to the lower part of the abdomen. The physician felt that the distribution of the claimant's pain was consistent with this diagnosis and with an associated nerve entrapment.

The appeal was addressed by the Review Office and by decision letter dated January 22, 1999, the claimant was advised that he did not have an entitlement to further benefits beyond August 4, 1998. In reaching this conclusion, the Review Office considered all of the file evidence and determined that the claimant likely sustained a muscular strain which would have resolved in a relatively short period of time. It was felt that the diagnosis of bilateral varicoceles was confirmed by objective findings and would reasonably account for the claimant's continuing symptoms. The Review Office was of the opinion that a diagnosis of a muscle tear in the abdominal region was speculative and not supported by any objective clinical findings.

On May 12, 1999, the worker advisor completed an application to appeal and requested that an Appeal Panel be convened to determine the issue of the claimant's entitlement to further benefits. Arrangements were made to convene a non-oral file review on July 22, 1999.

At the non-oral file review held on July 22, 1999, the Appeal Panel requested additional information from two treating physicians and the worker advisor. The Panel then met on December 15, 1999 and requested that the treating physician supply the Panel with a copy of his referral letter to the Pain Clinic. On February 4, 2000, the Panel requested that the claimant be examined by a WCB medical advisor with respect to the current diagnosis/prognosis, a proposed treatment plan and the need for physical restrictions.

On June 9, 2000, the Panel met to review the case along with the examination findings of the WCB medical advisor dated April 20, 2000.

Reasons

The issue in this appeal is whether or not the claimant is entitled to further benefits after August 4, 1998 in relation to the compensable injury of April 3, 1998. The Appeal Panel met on June 9, 2000. We unanimously decided that the claimant is entitled to benefits from August 4, 1998 up until April 20, 2000, less the time that the claimant was hospitalized for non-compensable reasons. The April 20, 2000, date is the first indication on the file that the claimant had no restrictions and was able to return to work.

The April 20, 2000, examination notes outlined by the WCB's physical medicine and rehabilitation consultant confirms the claimant's original diagnosis. When the consultant was asked for an opinion as to what was the original diagnosis following the April 3, 1998, compensable injury, he responded as follows: "It is difficult to be certain of the original diagnosis based on the current examination and file review following the April 3, 1998, compensable injury. However my impression is that this was a lower abdominal wall musculoligamentous strain."

The consultant was also asked what restrictions are indicated and are they considered temporary or permanent and are they related to the compensable injury. His response was as follows: "I would not feel that any restrictions are indicated currently. I would have expected he would have required restrictions previously when the symptoms were more severe. Restrictions would have then been considered temporary and would have been in my opinion related to his compensable injury."

We note that a sports medicine specialist provided a similar diagnosis of the claimant's condition in his examination of January 19, 1999, and provided treatment of that injury and ordered a subsequent MRI which proved to be negative. The next indication that the claimant's symptoms had resolved were considered in the examination of the claimant on April 20, 2000. We find that the evidence establishes, on a balance of probabilities, that the claimant was able to return to work as of the date of the examination and is therefore entitled to receive benefits after August 4, 1998, to April 20, 2000. Therefore, the claimant's appeal is accepted.

Panel Members

B. Campeau, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

B. Campeau - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 23rd day of June, 2000