Decision #114/00 - Type: Workers Compensation
An Appeal Panel hearing was held on August 3, 2000, at the request of the claimant. The Panel discussed this appeal on August 3, 2000 and again on November 6, 2000.
Whether or not the claimant is entitled to benefits and services beyond August 2, 1999.
That the claimant is not entitled to further benefits and services beyond August 2, 1999.
While performing the duties of a general labourer on May 3, 1999, the claimant felt a pull in his back after lifting boxes onto pallets. The claimant was later treated by both a chiropractor and a medical practitioner who diagnosed the claimant's condition as acute dorsal, lumbosacral subluxation and a back strain respectively.
On July 5, 1999, a Workers Compensation Board (WCB) medical advisor examined the claimant to determine his current physical status. Following examination, the medical advisor concluded that the claimant sustained a muscle strain of his mid and low back in early May 1999. There were no present signs of radiculopathy and no history of radiculopathy. The medical advisor commented that even though the claimant felt that he was not fully recovered, there was very little to find on physical examination to support complete disability. It was recommended that the claimant be back at work without restrictions on a graduated return to work program beginning four hours per day for two weeks and then two hours per day per week until he got back to full duties.
The claimant was sent a letter on July 2, 1999, advising that it was the opinion of Rehabilitation and Compensation Services that he was capable of returning to work to his regular duties. A graduated return to work program commencing on July 5, 1999, was outlined to the claimant. The claimant was advised that his employer would pay for his hours worked and that the WCB would pay for partial wage loss. Effective August 2, 1999, it was determined the claimant could resume his pre-accident duties on a full time basis and that the employer would be responsible for his wages.
On August 13, 1999, the claimant appealed the decision that he was fit for full time work as of August 2, 1999 as he felt he was not physically capable of doing so. The case was then listed with Review Office for consideration.
On October 15, 1999, Review Office agreed with the previous decision that the claimant was fit to return to work on regular duties effective August 2, 1999. When rendering its decision, Review Office weighed all the evidence including a report from a physical medicine and rehabilitation specialist dated September 23, 1999. Review Office noted there was little in the way of objective evidence to substantiate the claimant's claim of fairly severe disability. It also noted that the claim was just over five months post accident and that the claimant was way beyond the range of recovery norms for a back strain. On May 2, 2000, the claimant appealed this decision to the Appeal Commission and an oral hearing was held on August 3, 2000.
Following the hearing, the Panel met to discuss the case and requested additional information be obtained from the claimant's treating chiropractor and two treating physicians. On October 11, 2000, all interested parties were provided with copies of two medical reports dated February 24, 2000 and September 1, 2000, along with a memorandum dated October 10, 2000. On November 2, 2000, the Panel met to render its decision and took into consideration a letter received from the claimant dated October 24, 2000.
We find that the claimant is not entitled to benefits and services beyond August 2nd, 1999. We accept the preponderance of medical opinion that the claimant's ongoing difficulty is mechanical back pain. In our view, the claimant's mechanical back pain is, on a balance of probabilities, related to his lack of conditioning and not as a result of the compensable injury, which was initially diagnosed as a back strain.
In arriving at our decision, we attached considerable weight to the following body of evidence:
- WCB medical advisor's July 5th, 1999 examination notes, which reads in part: "Mr. [name of claimant] is a 20-year-old labourer at [name of company] who sustained I believe muscle strain of his mid and low back in early May 1999. There were no signs of radiculopathy today and there is no history of radiculopathy. Although Mr. [name of claimant] noticed that he feels he is not fully recovered, there was very little to find on physical examination today to support complete disability. I note Mr. [name of claimant] takes no analgesics and just about completed a physiotherapy program and has no major sleep disturbance. I would recommend Mr. [name of claimant] be back to work without restrictions on a graduated return to work program beginning at four hours per day for two weeks and then two hours per day per week until he gets back to full duties."
- Treating physical medicine and rehabilitation specialist's September 23rd, 1999 report to the attending physician, which reads in part: "Mr. [the claimant's] symptoms and findings can be categorized as 'mechanical' low back pain. The exercise program that was previously instructed sounds to be appropriate. However, there is still marked deconditioning of the spinal stabilization muscles. The buttock and abdominal muscles are also very weak. I suggested that if his symptoms improve he needs to return to the home based exercise program and perform these on a very regular basis. Apart from introducing an anti-inflammatory agent and being more aggressive in the exercise program, I don't have much else to add."
- Treating orthopaedic surgeon's February 24th, 2000 report to the attending physician, which reads in part: "The straight leg raising test was within normal limits. Both knee and ankle reflexes were normal. Plantar was down going. There was no weakness of the dorsiflexors or plantar flexors of the toes on either side. Pedal pulses well felt (sic). He apparently had x-rays of the lumbrosacral spine done which was also normal. The CT scan examination of the lumbar spine done on December 28, 1999 reportedly showed a small right posterio-lateral disc herniation which may be irritating the right S1 nerve root. The CBC, sedimentation rate was also within normal limits. Diagnosis: Chronic musculogenic low back pain. Recommendation: He really does not have any signs and symptoms suggestive of nerve root entrapment. Even if he had some amount of nerve root entrapment originally, I am not certain it is of any significance. The small disc prolapse he has usually gets symptomatic with time and really does not need any treatment apart from time. He had enough time to recover and the examination today is completely within normal limits and he really does not need any further treatment or investigations. I told him that he does not need any surgical treatment for his back either. He is probably better off to increase his activities with some type of exercise program which he himself can do like walking, swimming, cycling, etc. and try going back to work."
The claimant's appeal is hereby dismissed.
R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
B. Leake, Commissioner
Recording Secretary, B. Miller
R. W. MacNeil - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 21st day of November, 2000