The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on September 25, 2000, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on September 25, 2000 and on January 23, 2001.

Issue

Whether or not there is a cause and effect relationship between the claimant's present difficulties and the injuries sustained on August 16, 1996.

Decision

That there is no cause and effect relationship between the claimant's present difficulties and the injuries sustained on August 16, 1996.

Background

While employed as a construction labourer on August 16, 1996, the claimant was pushing a wheelbarrow full of concrete when he felt pain in his lower back when the wheelbarrow struck a 2 x 4. On August 19, 1996, the attending physician diagnosed the claimant with a left sacroiliac sprain. The claim was accepted by the Workers Compensation Board (WCB) and benefits commenced on August 19, 1996.

Between August 22, 1996 and October 31, 1996, the claimant was followed up by his treating physician and attended physiotherapy sessions. In a progress report of October 23, 1996, the physician noted that the claimant had occasional pain but it was less severe in the left lower back. The claimant also displayed improved range of movement and less spasm. It was felt that the claimant could return to work by November 1, 1996 and wage loss benefits were paid to that date.

On July 15, 1999, a second physician made reference to the 1996 injury, indicating that the claimant continued to have back complaints since the accident and was tolerating the pain until two weeks ago. Examination revealed left lumbar pain radiating to the anterior upper thigh with numbness in the leg. An x-ray of the lumbosacral spine taken July 15, 1999, read as follows: "Suspected lower lumbar spinal stenosis. In view of the patient's symptoms of pain radiating to the left leg, a C.T. evaluation of the spine is suggested."

In a telephone conversation on August 20, 1999, the claimant informed a WCB adjudicator that he had not sustained any new accidents since the 1996 compensable injury. The claimant indicated that his back gets sore and his left leg locks up occasionally since the accident. The claimant said that he sought medical attention on July 15th because the pain in his back and leg became worse.

At the request of primary adjudication, the case was reviewed by a WCB medical advisor on August 30, 1999. The medical advisor was asked for his opinion as to whether there was objective medical information which would establish a cause/effect relationship between the claimant's current symptoms and the compensable injury. In response, the medical advisor answered no to the question, indicating that it was difficult to relate the claimant's current problems to the 1996 injury unless ongoing problems could be proven.

On September 14, 1999, a CT scan of L-spine read as follows:

1. "Mild diffuse posterior disc bulging at L4-L5. Clinical correlation would be required.
2. Small focal left paracentral disc protrusion. Again, clinical correlation regarding the left S1 nerve root would be required."

On September 20, 1999, a WCB medical advisor was asked to review the CT report and to provide comment as to whether there was an ongoing cause/effect relationship between the claimant's current symptoms and the compensable injury. The medical advisor responded that he was unable to relate the claimant's current problems or the CT findings to the 1996 injury. There was no medical information to link these findings in a positive or negative fashion to the 1996 injury.

In letter dated September 22, 1999, Rehabilitation & Compensation Services advised the claimant that in its opinion, the medical information did not substantiate an ongoing relationship between his current back difficulties and the strain he sustained in 1996. On February 7, 2000, a worker advisor appealed this decision to Rehabilitation & Compensation Services and then to the Review Office on April 18, 2000.

In a May 5, 2000 decision, Review Office determined that there was no cause and effect relationship between the difficulties expressed by the claimant in July 1999 and the injuries he had sustained August 16, 1996.

Review Office indicated that the claimant was injured in August 1996 and was deemed fit to return to work on November 4, 1996. As he had been laid off by his employer due to seasonal employment, he then went on Employment Insurance. The claimant worked in 1997 and 1998 and for part of 1999. It was in July 1999 that the claimant experienced further difficulty. Review Office noted that the claimant had other pre-disposing problems identified on file which were unrelated to the compensable injury and which may also have had an impact on his present well-being. Review Office concluded that it had been unable to establish that the claimant's present medical difficulties were directly related to the injury that he had sustained on August 16, 1996.

On June 16, 2000, the worker advisor submitted additional medical information to Review Office, which was obtained from the claimant's attending physician dated June 6, 2000. In a letter to the worker advisor dated June 30, 2000 following a review of the additional information provided, Review Office confirmed its decision of May 5, 2000, indicating that there was no cause and effect relationship between the problem expressed by the claimant in July 1999 and the original accident of August 16, 1996.

On July 14, 2000, the worker advisor appealed Review Office's decision and an oral hearing was held on September 25, 2000.

Following the hearing, the Panel met to discuss the case further. Prior to rendering a decision on the issue under appeal, the Panel requested that the claimant be examined by an independent orthopaedic specialist. On December 1, 2000, the claimant was assessed by an independent orthopaedic specialist and his report of December 11, 2000, was distributed to the parties with a direct interest for comment. On January 23, 2001, the Panel met to again to discuss the case and took into consideration comments received from the worker advisor dated January 18, 2001.

Reasons

When he first attended his general physician, the claimant was diagnosed with a left sacroiliac sprain. The physician initially prescribed the following modes of treatment, which included anti-inflammatory analgesic medication, rest, ice and home exercise. After two to three weeks of treatment, there was no significant improvement in the claimant's condition. The treating physician then decided to perform a local corticosteroid injection into the left sacroiliac joint as well as refer the claimant for physiotherapy. At the conclusion of the physiotherapy treatment, the physician gave his approval for the claimant to return to work on November 2nd, 1996. The claimant had remained off work for total of eleven weeks as a result of his injury.

A period of two and a half years elapsed before the claimant once again sought medical treatment for his back. His evidence was that he never fully recovered from the 1996 compensable injury. He reported that he had been experiencing chronic recurrent low back pain ever since the incident. It should be noted that there was a complete absence of any medical information between October 1996 and July 1999.

In July 1999, the treating physician attributed the claimant's symptomatology to the 1996 compensable injury. A CT scan identified a mild diffuse posterior bulging of the L4-5 disc, which extended into both exit foramina and a small left paracentral disc protrusion, which approached the left S1 nerve root. The physician provided his opinion that the claimant's low back pain in 1999 and the continuing pain over the intervening years subsequent to the initial injury were due to this L4-5 disc protrusion, which he regarded as having occurred when the claimant was injured in August of 1996 and which had not been recognized at the time.

In light of the facts that the claimant was able to return to full work duties following the 1996 injury and that he did not seek any medical attention between October 1996 and July 1999, we decided to have the claimant examined by an independent external orthopaedic specialist. We attached considerable weight to this consultant's clinical findings and overall opinion.

"[The] CT scan showed some disc protrusion at L5/S1 but it did not show specific entrapment. Clinically it suggested some root irritation on the left with straight leg raising to 45 degrees. When examined on December 1, 2000 however with his sitting he could fully extend both knees. There was also ability to hold toes and ankles in forced dorsiflexion on the left yet in fact he could walk on his heels, therefore he presents with some inconsistency in his physical findings and they do not help substantiate specific ongoing root entrapment or left sided sciatica.

There has never been any measurable recorded neurological findings or evidence of significant root tension signs with diminished straight leg raising to confirm a specific herniation on the left side .

There is no doubt that Mr. [the claimant] had sustained a significant injury to his lumbar back in 1996. The diagnosis of the injury in 1996 by Dr. [treating physician] was left sacroiliac joint injury or strain. Dr. [treating physician] and the therapist thought there was significant improvement of his symptomatology that he could return to work by November of 1996. Mr. [the claimant] did work for a number of years and did not receive any medical assessment despite complaining of ongoing symptomatology. Therefore it is very difficult to rationalize what might have been causing the symptomatology over that three year period. Symptomatology is described as worsening in 1999 but there is not a specific event or cause for same. Therefore it is hard to attribute all the ongoing symptoms and perceived impairment as to the event that occurred in 1996. There could have also been a multitude of other events in the interval that may have slowly made him feel worse.

Mr. [the claimant's] present diagnosis is one of mechanical lumbar back pain, presumably on the basis of some lumbar degenerative disc disease. There is no evidence of nerve root entrapment or nerve root malfunction. One cannot say that the prominence of L4/5 disc seen on CT of September 14, 1999 is related to a specific event. Also it is difficult to know if the small left L5/S1 disc protrusion is related to the 1996 injury or some other specific event."

After having taken into consideration all of the evidence, we find, on a balance of probabilities, that there is not a cause and effect relationship between the claimant’s present difficulties and the injuries he sustained on August 16^th, 1996. Accordingly, the claimant’s appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
B. Malazdrewich, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 20th day of February, 2001