The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on December 13, 2000 at the request of a worker advisor, acting on behalf of the claimant. At this review, the Appeal Panel requested that additional information be obtained from the worker advisor and that the claimant be assessed at the Workers Compensation Board's (WCB's) Pain Management Unit. In March 2001, the claimant and worker advisor were provided with copies of several reports that were obtained from the Pain Management Unit and were asked to provide comment. On April 10, 2001, the Panel met again to discuss the case and render a final decision.

Issue

Whether or not the claimant is entitled to benefits or services beyond June 26, 1998.

Decision

That the claimant is entitled to benefits and services beyond June 26, 1998.

Background

On June 24, 1997, the claimant was unloading proboard sheets from a truck when he felt something "pop" in his left shoulder. The claimant reported injuries to his left shoulder, neck and back. When assessed by the attending physician the claimant was diagnosed with a trapezius muscle strain. The claim was accepted by the Workers Compensation Board (WCB) and benefits commenced on June 25, 1997.

X-rays of the cervical spine were taken on July 18, 1997 and were compared to a previous study dated April 12, 1996. The report noted minor posterior osteophytes at the C5-6 level. Thoracic spine x-rays dated July 18, 1997, were compared with prior x-rays of April 2, 1996. No change had been noted, however, minor osteophyte formation was seen at the T11-12 level. No fracture was identified.

A progress report from the attending physician dated August 18, 1997 noted a change in diagnosis to bilateral lower trapezius spasm and it was questioned whether the claimant was developing myofascial pain.

On August 22, 1997, a physiotherapist noted that the claimant had tenderness in the left upper trapezius with trigger points, tenderness in the left facets, and all of the C-spine especially left C7-T1 and T2-3 levels. The physiotherapist commented that there appeared to be more myofascial involvement compared to the previous diagnosis of muscle strain.

A report was received from a rehabilitation medicine specialist dated October 8, 1997. The specialist indicated the claimant had myofascial pain and recommendations were made for stretching exercises and an assessment at PAR Services. Between December 16, 1997 and January 8, 1998, the claimant was involved in a re-conditioning program.

On January 21, 1998, a WCB medical advisor reviewed the case and made the following comment:

"It is now 7 months post strain injury. The fact that he has had x-rays to neck and back in April of 1996 suggests he has had prior problems as far back as a year or more, predating his June 1997 injury. Claimant felt something "pop" in his left shoulder with carrying at time of injury. This does not include neck and back in my view. Problems listed by P/T re right shoulder are non-CI. Neck and thoracic are non-CI in my view. Suggest he should be recovered by this point in time."

On January 22, 1998, the WCB determined that the claimant had recovered from his compensable injury of June 24, 1997 and that wage loss benefits would be paid to January 30, 1998. It was the opinion of the WCB that the claimant's current problems were due to a non-compensable pre-existing condition.

On May 19, 1998, a WCB physical medicine and rehabilitation consultant assessed the claimant. The consultant was of the view that the current clinical examination did not suggest any active myofascial pain syndrome present. He also stated, "A muscle strain with any developed myofascial irritability would have expected to have resolved long ago."

On June 5, 1998, the case was considered by Review Office at the request of the claimant. Review Office determined that the claimant was entitled to payment of benefits beyond January 30, 1998 for a period of three weeks (from the date of its decision) after which he would be considered recovered from the effects of the compensable injury. Review Office concurred with the findings of the WCB's physical medicine and rehabilitation consultant following his examination of the claimant on May 19, 1998.

Subsequent file documents showed that a worker advisor, acting on behalf of the claimant, requested Review Office to reconsider its decision of June 5, 1998, based on additional medical information by the attending physician. The worker advisor stated that if Review Office was unable to rescind its previous decision, a Medical Review Panel (MRP) was in order as it was felt that a clear difference of medical opinion existed between the WCB's doctors and the claimant's treating physicians.

In a letter to the worker advisor dated February 10, 1999, Review Office stated that no change would be made to its earlier decision based on the additional medical documentation that was submitted. Review Office referred the case back to primary adjudication to consider the request for a MRP. On February 22, 1999, the request for a MRP was granted under Section 67(4) of the Workers Compensation Act (the Act) and a MRP took place on May 28, 1999.

On August 6, 1999, Review Office determined that the claimant was not entitled to further benefits or services for the effects of his work related accident of June 24, 1997. Review Office noted that it was the MRP's findings that the claimant's June 24, 1997 injury was a muscular strain in the area of his left upper trapezius. Review Office stated, in part, that pain had been a part of the claimant's life for many years pre-dating the June 24, 1997 accident. There was clinical evidence of high levels of anxiety, stress and abnormal illness behavior, which again pre-dated the June 24, 1997 shoulder injury. Review Office concluded that on a balance of probabilities, the claimant's chronic pain syndrome was related to his predisposed personality and not to his shoulder injury of June 24, 1997.

In August 2000, the worker advisor appealed Review Office's decision and requested that the Appeal Commission arrange for a non-oral file review to consider the case.

On December 13, 2000, a non-oral file review was held at the Appeal Commission and it was determined that additional medical information was required from the worker advisor and that arrangements be made for the claimant to be interviewed and examined at the WCB's Pain Management Unit (PMU). In March 2001, the claimant and his worker advisor were provided with copies of the correspondence that was received from the PMU and were asked to provide comment. On April 10, 2001, the Panel met to render its final decision on the issue under appeal.

Reasons

This is the case of a worker who sustained a muscular strain to his left upper trapezius while unloading building materials from a truck on June 24, 1997. His claim was accepted by the WCB and he was compensated accordingly.

His benefits were terminated on January 30, 1998. After a successful appeal to the Review Office, benefits were extended to June 26, 1998. A subsequent request for reconsideration of this decision ultimately led to the striking of a Medical Review Panel, which examined the claimant in May 1999.

The MRP came to a diagnosis of Chronic Pain Behaviour Syndrome, but concluded that there was no causal link between the claimant's compensable injury and this chronic pain.

In a subsequent decision, the Review Office held that he was not entitled to any further wage loss benefits or services, beyond June 26, 1998.

It is this decision which is the issue under consideration by this panel: whether or not the claimant is entitled to benefits or services beyond June 26, 1998.

For this appeal to be successful, the panel must determine that the claimant's current medical condition is causally linked to his workplace accident of June 1997.

We have concluded that such a link does exist. In coming to this conclusion we have relied heavily on the report of the WCB's Pain Management Unit.

Our consideration of this file was by way of a non-oral file review. Thus, we did not have the benefit of any testimony from the claimant or other parties. The claimant's advocate did make written submissions on his behalf.

Upon our initial review of the file, we noted that the claimant had undergone a number of medical assessments by a number of different practitioners. While there are differing opinions as to the etiology of the claimant's condition, there is general agreement as to the diagnosis: chronic pain syndrome/behaviour.

Because of this, we were of the view that the claimant was an ideal candidate for assessment by the board's Pain Management Unit. We noted that such an examination had yet to take place.

In our reference to the PMU, we posed some specific questions, which were answered by the unit after the examination. The PMU concluded that the claimant was suffering from "Chronic Pain Syndrome as defined by the WCB." They further concluded that his CPS was causally related to his June 24, 1997 compensable injury.

The PMU went on to recommend a course of treatment for the claimant, as well as noting some workplace restrictions to be placed on the claimant at the time he returns to work.

Based on this medical assessment, the panel has concluded that, on a balance of probabilities, the claimant continues to suffer from the aftereffects of his compensable injury. Thus, he is entitled to benefits and services beyond June 26, 1998.

Accordingly, the appeal is allowed.

Panel Members

T. Sargeant, Presiding Officer
A. Finkel, Commissioner
B. Malazdrewich, Commissioner

Recording Secretary, B. Miller

T. Sargeant - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 24th day of April, 2001