The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on April 10, 2001, at the request of the claimant. The Panel discussed this appeal on April 10, 2001.

Issue

Whether or not the claimant's current and ongoing back problems are causally related to the general nature of the claimant's work and/or the compensable injuries of February 10, 1994, July 19, 1994, September 2, 1994, October 10, 1995, February 13, 1998, June 25, 1999 or October 13, 1999.

Decision

That the claimant's current and ongoing back problems are not causally related to the general nature of the claimant's work and/or the compensable injuries of February 10, 1994, July 19, 1994, September 2, 1994, October 10, 1995, February 13, 1998, June 25, 1999 or October 13, 1999.

Background

As noted under the heading "Issue", the claimant has had several claims with the Workers Compensation Board (WCB) of Manitoba dating back to 1994 for work related back claims which he incurred during the course of his employment as a sprinkler and fire alarm installer. The following is a brief summary of each claim:

• On February 10, 1994, the claimant was lifting an 8 inch pipe into a pipe stand when he experienced pain in his center and lower back. The diagnosis by the attending physician was a sprained lower back. Ten (10) days of time loss was incurred by the claimant.
• On July 19, 1994, the claimant was lifting one end of a 6 inch diameter piece of pipe about 18 inches long when he hurt his back. The diagnosis reported by the attending physician was an LS strain. Seventeen (17) days of time loss was incurred by the claimant.
• While lifting a box of pipe fittings on September 2, 1994, the claimant injured his lower back. The attending physician diagnosed an LS strain and noted that this injury probably aggravated a previous injury which was not completely healed. The claimant missed approximately 18 days of work regarding this injury.
• On October 10, 1995, the claimant was passing a bag of fittings to his apprentice from the basement up to a crawl space when he felt pain in his lower/middle back. The diagnosis was a low back strain and the claimant missed approximately 90 days from work.
• While descending an 8 foot ladder on February 13, 1998, the claimant fell when he stepped on piece of pipe that was laying on the floor. The claimant sustained injuries to his left elbow, left shoulder and lower back. Eighty (80) days of time loss was incurred.
• On June 25, 1999, the claimant was carrying a 4 foot step ladder with hand tools on it when he felt pain across his entire lower back. The diagnosis reported by the attending physician was a back strain. The claimant missed approximately 6 days of time loss as a result of the accident.
• On October 13, 1999, the claimant reported an injury to his lower back while tightening up a 1 inch pipe. The reported diagnosis was an LS strain and degenerative disc disease. Rest, heat, medication and physiotherapy was the recommended form of treatment. The claimant was considered totally disabled effective October 14, 1999.

In a progress report dated November 5, 1999, the attending physician noted that the claimant's back movements were minimally restricted. He suggested that the claimant continue with heat and back exercises. The suggested return to work date was November 8, 1999.

On December 7, 1999, the attending physician indicated that the claimant incurred a recurrence of pain across his lower back radiating into his left buttock and groin area and inner thighs. The claimant was considered totally disabled effective December 7th.

On January 27, 2000, the attending physician requested that the claimant be assessed by a WCB doctor. It was noted that the claimant continued to have a sore back with pain radiating to the posterior thigh below the left buttock and occasional numbness in the left 3rd and 4th toes. The physician commented that the claimant should not be doing physical labor.

A WCB medical advisor assessed the claimant on March 9, 2000. Under "Discussion/Recommendations", the medical advisor indicated that a review of the mechanism of injury and ongoing sequela point to an initial diagnosis of mechanical lumbar pain with associated left radiculopathy. The medical advisor stated in part, "It appears that the ongoing presentation represents an aggravation of a pre-existing degenerative disc condition, which is recovering toward resolution, the claimant stating '50-60% better'. The absence of myofascial features is noted." A work site assessment by a WCB occupational therapist was recommended. The claimant understood that duties involving plastic piping may be available. The medical advisor was of the view that the claimant should attempt a work re-entry if it involved using lighter materials.

A job evaluation was performed on May 11, 2000. The rehabilitation specialist noted that under the NOC code 7252.2, a sprinkler system installer's work was classified as heavy and required multiple limb co-ordination and multiple body positions. Much of the work that she observed during the job evaluation were outside of the claimant's current restrictions and placed the claimant at risk of exacerbating his back pain. There was little modification that could be done to reduce the claimant's risk should he return to installing systems.

Following a review of the above job assessment, a WCB medical advisor stated in a memo of May 29, 2000, that on balance, the claimant should have recovered to his pre-accident status. However, a review of an MRI (dated March 1998), revealed the claimant had a significant pre-existing condition (i.e. a multi-level degenerative spine). A referral to preventative vocational rehabilitation was suggested together with the restrictions of no lifting greater than 20 pounds and the avoidance of repetitive lumbar twisting/bending.

On June 9, 2000, Rehabilitation & Compensation Services advised the claimant that his benefits would be paid up to and including June 22, 2000. It was the opinion of the WCB that the claimant had recovered from the effects of his compensable injury despite the fact that he was having some ongoing problems due to his degenerative disc disease. As it was considered that the degenerative disc disease was unrelated to the compensable injury, no benefits would be paid beyond June 22, 2000.

In a letter dated July 12, 2000, the claimant appealed the decision to terminate his compensation benefits as of June 22, 2000. The claimant also raised several concerns with respect to preventative vocational rehabilitation and he questioned whether or not his degenerative disc disease was caused by his work activities in general or to the number of work related claims that he had in the past.

On November 24, 2000, a WCB medical advisor indicated that she had reviewed all of the claimant's past claims and noted a pattern of injury relating to sprain mechanisms. The medical advisor indicated that pre-existing degenerative changes were present in 1994 and most likely represented a natural process as opposed to a traumatic process. On November 30, 2000, the claimant was advised by Rehabilitation & Compensation Services that the degenerative changes in his spine were not considered to be related to his previous claims with the WCB or to the amount of years he worked in his specific trade.

In a decision dated September 22, 2000, Review Office confirmed that the claimant was not entitled to wage loss benefits subsequent to June 22, 2000. Review Office was of the opinion that the claimant suffered a back strain at work in October 1999 and that he had a protracted recovery due to the presence of the degenerative disc disease which the WCB had not accepted as being work related. Review Office concluded that the claimant had recovered from the effects of his October 1999 accident and was not entitled to further benefits.

On December 4, 2000, the claimant appealed the decision of Rehabilitation & Compensation Services dated November 30, 2000.

On December 15, 2000, Review Office stated there was no doubt that the claimant had a degree of degenerative changes in his spine and that such a condition was ubiquitous in the general population. There was no documented relationship between working in laboring occupations and the development of degenerative changes in the spine. Review Office summarized by saying that the claimant's back complaints were neither a sequela of his work nor a consequence of either the general nature of his work or any combination of his compensable back injuries.

In a memo dated December 20, 2000, a VRC noted that the accident employer was crafting a position for the claimant as a "Inspector" which was not considered to be so labour intensive. Subsequent file documentation showed that the WCB sponsored the claimant in an 8 month training on the job program with the accident employer.

On January 22, 2001, the claimant appealed Review Office's decision of December 4, 2000. The claimant believed that the disc bulges in his lower back were of a clinical significance. On April 10, 2001, an oral hearing was convened at the Appeal Commission.

Reasons

The weight of evidence does not, on a balance of probabilities, confirm to us that the claimant's current and ongoing back problems are a continuation of his various compensable injuries, as opposed to his non-compensable pre-existing degenerative disc disease. In this regard, we note in particular the following radiological findings:

February 11th, 1994 X-ray report Lumbar Spine - "The normal lumbar lordosis is lost probably on the basis of spasm. The S.I. joints are normal. There is deformity of the L3 vertebral body due to previous injury. There is degenerative narrowing of a moderate nature involving the L3-L4, L4-L5 and L5-S1 disc levels. No other additional feature of note is seen."

January 8th, 1996 CT scan of Lumbosacral Spine - "Impression: Old fracture of L3. A small focal central bulge is present at L5-S1 although no significant disc protrusion has been identified at this time."

March 3rd, 1998 MRI of Lumbar Spine - "Impression: There is loss of height of the mid aspect of the L3 vertebral body felt to be secondary to a compression fracture. Clinical correlation is recommended. There is evidence of a disc bulge at the L2-3, L3-4, L4-5 and L5-S1 levels, however, there does not appear to be significant compression on the ventral aspect of the thecal sac at any of these levels with the exception of compression on the ventral aspect of the thecal sac centrally and paracentrally to the left at the L4-5 level. There is, however, bone bar and disc material which extends laterally to the left at the L3-4 level. Although there appears to be adequate space for the left L3 nerve root to exit, impingement may be present. Clinical correlation is recommended. Other findings as above."

In addition to the radiological evidence, the above referred to "clinical correlation" and/or the clinical examination findings are not supportive of a nerve root entrapment, which has resulted from the various compensable injuries. We attached considerable weight to the commentary contained in the succeeding reports:

Treating Orthopaedic Surgeon's letter to attending physician dated February 22, 1996 - "On examination: he was noted to be a healthy-looking man and was not in any acute distress. His gait was completely normal. The lumbar spine showed normal lumbar lordosis, and movements of the lumbar spine were painfree and complete in all the directions. There was some resistance of the straight leg raising; however, straight leg raising test was 90 degrees on either side and basically painfree. Both knee and ankle reflexes were normal. Plantars were downgoing. There was no wasting or weakness of the muscles in either lower limbs. X-rays of the lumbosacral spine were reviewed. These x-rays showed a well healed fracture of the body of L3 with very minimal deformity. The rest of the lumbosacral spine is unremarkable, though there is a suggestion of osteophytosis at L4-5 anteriorly. He did have C.T. scanning of the lumbar spine at Concordia Hospital in January '9'. This C.T. scan examination basically reported to be showing a small central bulge in the lumbosacral area which may not be clinically significant.

Diagnosis: Degenerative lumbar disc disease.

Recommendations: There is evidence of degenerative lumbar disc disease in the L4-5 level which, however, is quite minimal. The clinical assessment is basically within normal limits, and I did not find any positive clinical findings. As noted earlier, the x-rays and also the subsequent C.T. scan examination did not reveal any significant problems. All in all, in spite of his pain, he seems to be doing well. He is better off trying to go back to work as the exercises he gets at his place of work would help him get stronger, and he should be able to work without any restrictions eventually."

Second treating Orthopaedic Surgeon's letter to attending physician dated February 5th, 1997 - "On examination the patient forward flexes with his fingertips reaching about a foot from the floor. The patient has fair extension of his back on upper bending. The patient has good strength of extension and flexion of his great toes. The patient has good straight leg raising. The patient has normal reflexes of knees and ankles. The patient does not have significant tenderness to palpation of his back at this time. I do note that he has straight leg raising to 80 degrees bilaterally. The patient does have some tightness of his hamstrings as well.

Clinically, it is my impression that the patient does not have a significant disc protrusion or nerve root impingement at this time."

Second treating Orthopaedic Surgeon's letter to a WCB medical advisor dated September 14th, 1998 - "This patient was seen on three occasions. It is of interest that the MRI describes disc bulging at four levels. I should note that this is not a disc protrusion; this is simply just disc bulging and it is my opinion that this is of absolutely no clinical significance. The patient has had both a CT scan and an MRI which have not shown any significant nerve root impingement.

I did advise the patient that he should return to his regular job when I last saw him May 8, 1998. Hence, it is my opinion that the patient, when I last saw him on May 8, 1998, was fit to return to his former duties.

The patient did sustain injuries in the workplace. It is my opinion that the patient did sustain strains of his back. It is my opinion that the patient did not sustain any significant disc protrusion, fracture, nor dislocation.

It is my opinion that the patient may have aggravated the pre-existing degenerative changes of his spine. I do note that the x-rays the patient had February 11, 1994 did demonstrate that the patient had degenerative disc disease with disc space narrowing, multi-level, at L3/4, L4/5 and L5/S1.

It is my opinion that, at this time, the patient does not require further active treatment for his compensable injuries."

WCB medical advisor's examination notes dated March 9, 2000 - "The current clinical evaluation notes slight tension with left SLR [straight leg raising] stretch, however with testing noted to be normal in the seated position. The remainder of the physical examination was relatively unremarkable, with the claimant providing history of progressive improvement with the passage of time and physiotherapy efforts. The claimant is continuing to attend to a daily stretching program, also noting aerobic effort. It appears that the ongoing presentation represents an aggravation of a pre-existing degenerative disc condition, which is recovering toward resolution, the claimant stating "50-60% better". The absence of myofascial features is noted."

We are satisfied based on a preponderance of evidence that the claimant's low back injuries were musculoligamentous strains, which have completely resolved over the course of time. However, because of the nature of his job duties and the heavy lifting, bending and twisting required, he definitely has a back at risk. We find that the claimant's low back pain is, on a balance of probabilities, a consequence of the temporary aggravation caused to his continuing degenerative disc disease. Accordingly, the claimant's appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 17th day of May, 2001