The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on May 9, 2001, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on May 9, 2001.

Issue

Whether or not the worker's left upper arm and shoulder problems are causally related to the compensable injury of July 21, 1999.

Decision

That the worker's left upper arm and shoulder problems are not causally related to the compensable injury of July 21, 1999.

Background

While employed as a truck driver on July 21, 1999, the claimant went to jump out of his truck when his foot slipped and he fell to the cement. On his application form for compensation benefits, the claimant reported injuries to his left arm, scrapes on his face and broken glasses.

On July 21, 1999, a hospital emergency report noted that the claimant fell out of his truck and landed on his outstretched left arm. X-rays of the left wrist revealed an undisplaced triquetral fracture. No other fractures or dislocations were seen. A below elbow fiber cast was applied to the left arm and the attending physician referred the claimant for physiotherapy treatments.

On December 30, 1999, a Workers Compensation Board (WCB) orthopaedic consultant reviewed the case. The consultant stated that a fractured triquetrium was not a significant injury in itself and that the claimant should have recovered by now. The consultant recommended a new set of x-rays and a call-in examination to determine if there may be another injury.

The claimant was examined at the WCB offices on January 20, 2000. During the interview portion of the examination, the claimant recalled that the accident (the slip) resulted in his falling forwards probably onto his hands, left more than right. He did not recall any bruising or dislocation at the time. The claimant now complained of pain in the anterior aspect of the left upper arm and that there was tenderness in the muscle. The claimant indicated the pain had been present since the accident, but he had not mentioned it in his report.

Following examination of the claimant, the WCB orthopaedic consultant made the following comments: "If there is any other injury, as yet undiagnosed, there is no specific evidence of this on today's examination. I have referred him for a full series of wrist x-rays in attempt to identify any intercarpal instability. If these films are negative, I will recommend a short work hardening physiotherapy program maximum duration 6 weeks on completion of which he should return to his previous occupation, regular duties, full time. I do not have a diagnosis for the left upper arm complaint of pain which appears to be muscular. It does not amount to a loss of function resulting in a disability."

In addendum notes dated January 20, 2000, the orthopaedic consultant stated that the x-ray with stress films of the wrist of January 27, 2000 had identified no abnormal carpal motion. A small lucency had been identified in the distal ulna which at most was a small bone cyst, possible non-ossifying fibroma, unrelated to the trauma situation of this claim. The consultant referred the case to a WCB physiotherapy consultant to arrange a work hardening program.

In a letter addressed to the attending physician dated February 22, 2000, a treating orthopaedic surgeon noted that the claimant had tenderness directly over the lateral aspect of his shoulder. The surgeon was of the impression that the claimant's problems were arising from the shoulder itself and that he appeared to have some bursitis. A shoulder injection was carried out.

In an initial physiotherapy assessment report dated March 6, 2000, the following was noted under "Impression/Problem List" of the report, "L glenohumeral myofascial pain with capsular restriction ? swelling."

On March 13, 2000, the claimant was informed by primary adjudication that upon completion of his physiotherapy program (treatment between March 6, 2000 and April 14, 2000), he would have sufficiently recovered from the effects of his compensable accident and fit to resume his full and regular duties. Wage loss benefits would therefore be paid to April 14, 2000, inclusive and final.

In a memo to the WCB's physiotherapy consultant dated March 24, 2000, the WCB orthopaedic consultant indicated that the physiotherapy program was to be directed towards the claimant's wrist and hand function and that the shoulder was not a WCB concern.

On April 5, 2000, the claimant wrote to the WCB indicating that when he first was hurt on July 21, 1999 he broke his left wrist, smashed his right knee and face. He also stated that he smashed his left shoulder but was in so much pain that he forgot to mark it down on his compensation report. The claimant stated that he phoned and talked to someone at the WCB to see if they would or could add it to his list, which had been previously submitted. The WCB said certainly, but apparently that was not done. The claimant said there was no way in the world he could throw boxes or freight up into a 5 ton truck. The claimant said that he saw his doctor on March 30, 2000 and the doctor knew his arm was still sore.

On April 13, 2000, primary adjudication advised the claimant that his case had been reviewed by a WCB orthopaedic consultant on March 24, 2000, and based on this review it was determined that his left upper arm difficulties were not related to the compensable injury. The appeal was then forwarded to the Review Office.

In a decision dated April 21, 2000, Review Office determined that there was no relationship between the claimant's left upper arm and shoulder problems and the July 21, 2000 compensable injury. Review Office noted that throughout the medical documentation on file there was no comment of problems the claimant had experienced either from the date of accident until he was examined at the WCB's offices on January 20, 2000 involving either the left upper arm, shoulder or his knee. Review Office noted that February 10, 2000 was the first indication from the attending physician that the claimant had experienced pain in the left upper arm.

On October 2, 2000, a worker advisor requested Review Office to reconsider its decision of April 21, 2000 based on a medical report dated September 26, 2000. The worker advisor also requested that Review Office write to the claimant's treating physician to obtain additional medical information concerning his left upper arm and shoulder complaints as several attempts to obtain information from this physician had failed.

On January 12, 2001, Review Office considered the case again, taking into consideration the worker's advisor's submission of October 21, 2000 (including the submitted medical report of September 26, 2000) together with two letters from the treating physician both dated January 2, 2001. Review Office ultimately confirmed its earlier decision that there was no relationship between the worker's left upper arm and shoulder problems and the injury of July 21, 1999. On February 19, 2001, the worker advisor appealed Review Office's decision of January 12, 2001 and an oral hearing was arranged. Also on file is a report from a physiotherapist dated January 11, 2001.

Reasons

The preponderance of evidence has lead us to conclude that the claimant's left upper arm and shoulder problems were not, on a balance of probabilities, causally related to the July 21st, 1999 compensable injury. In particular, we made note of the following:

• Inconsistent description of the mechanism of injury;
• There was never an initial reporting of a shoulder problem;
• The shoulder difficulties were only first observed by the treating physician on December 16th, 1999, which was several months after the compensable incident;
• The continuous reports received from the physiotherapist throughout 1999 make no reference to any shoulder difficulties;
• The WCB medical advisor's examination of the claimant on January 20th, 2000 recorded no loss of shoulder function;
• February 22nd, 2000 report to the attending physician from an orthopaedic consultant, in which he states - "On examination, I note that the patient does have a little restriction of motion of his left shoulder. I did review the x-ray film of his left humorous and it looks fine. It is my impression that some of the problems the patient has is arising from the shoulder itself. He appears to have some bursitis. At this time I gave the patient an injection."
• Letter from the treating physician to the claimant's worker advisor dated January 2nd, 2001 - "Mr. [the claimant] first complained of his left shoulder
• on December 16, 1999. It is my opinion that Mr. [the claimant] did not have a pre-existing left shoulder condition."

In light of the foregoing, 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 12th day of June, 2001