Decision #34/02 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on April 24, 2001, at the request of the claimant. The Panel discussed this appeal on several occasions, the last one being March 1, 2002.

Issue

Whether or not the worker is entitled to wage loss benefits beyond June 6, 2000.

Decision

That the worker is not entitled to wage loss benefits beyond June 6, 2000.

Decision: Unanimous

Background

During the course of his employment as a production worker on May 6, 1999, the claimant sustained an injury to his right knee when he slipped on Varsol and his knee struck the bottom corner of a bus frame. Initial medical information diagnosed the claimant with an acute sprain and a patellar injury of the right knee. The Workers Compensation Board (WCB) accepted the claim for compensation and benefits commenced on May 13, 1999.

On June 14, 1999, the claimant was assessed by an orthopaedic surgeon. The surgeon found that the claimant's symptomatology was in keeping with chondromalacia patella. The claimant was instructed to perform quadriceps exercises and to refrain from kneeling or climbing stairs. Subsequent reports from the attending physician revealed that the claimant's right knee difficulties were not subsiding and arrangements were made for made for him to be examined at the WCB's healthcare branch.

Following an examination by two WCB medical advisors on November 30, 1999, it was determined that the claimant's knee injury was more serious than first thought and suggestions were made for arthroscopy and/or an MRI of the right knee. It was also suggested that a physiotherapy treatment plan be devised for the claimant.

In early January 2000, a report was received from a second orthopaedic specialist. The specialist reported that there was no significant intra-articular pathology going on and was of the opinion that the claimant was suffering from a reflex sympathetic dystrophy. Recommendations were made for the claimant to attend the Pain Clinic at the Health Sciences Centre for a sympathetic block and some aggressive physiotherapy if his MRI examination was negative. On January 20, 2000, a MRI examination revealed a normal right knee with no evidence for meniscal tear.

On March 20, 2000, a WCB medical advisor reviewed the case and did not agree with the diagnosis of reflex sympathetic dystrophy. Arrangements were then made for the claimant to be seen at the WCB's healthcare branch on May 8, 2000.

Following an assessment by two WCB medical advisors on May 8, 2000, the following opinions were expressed:
  • Further investigations were not likely to clarify the basis of the claimant's knee posture/symptoms and were therefore not recommended;

  • Currently, there were no clinical findings suggestive of a reflex sympathetic dystrophy and a referral to the Pain Clinic was not recommended;

  • There was currently insufficient indication of an anatomic lesion at the right knee on which to impose workplace restrictions. On the other hand, a return to unrestricted work may not be successful at this time in light of the claimant's reported pain.
In a decision dated May 31, 2000, the claimant was advised that compensation benefits would be paid to June 6, 2000 inclusive and final. It was the WCB's opinion that the claimant had sufficiently recovered from the effects of his workplace accident and any suggestion that he avoid certain activities was made to possibly prevent subsequent exacerbation of symptoms or further injury. On November 28, 2000, the claimant appealed this decision and the case was referred to Review Office for consideration.

Prior to rendering a decision, Review Office sought the medical advice of a WCB orthopaedic consultant on January 8, 2001. In a response dated January 9, 2001, the orthopaedic consultant commented that the most likely diagnosis following the accident was a contusion to the patellar area of the right knee. A differential diagnosis would be a bone bruise or post traumatic chondromalacia patella. The consultant noted that right knee x-rays were normal and this ruled out any pre-existing pathology. The normal MRI test ruled out any meniscal or ligamentous lesions and the claimant did not have any articular cartilage lesion on his patella and there were no signs of reflex sympathetic dystrophy. The consultant concluded that the claimant had recovered from his compensable injury by June 6, 2000, as all tests indicated a normal knee with no significant pathology.

On January 12, 2001, Review Office determined that the claimant was not entitled to wage loss benefits beyond June 6, 2000. Review Office noted that the claimant had received wage loss benefits for a period of one year for a knee that had not shown any ligamentous or meniscal tears. The diagnosis of reflex sympathetic dystrophy had been ruled out by the recent WCB medical advisor examination and the MRI test ruled out any intra articular pathology. Review Office accepted the advice of the WCB's orthopedic consultant that the claimant had recovered from the effects of his compensable injury by June 6, 2000. The claimant later appealed Review Office's decision and an oral hearing was held on April 24, 2001.

Following the hearing and discussion of the case, the Appeal Panel requested additional medical information from the orthopedic specialist who had treated the claimant in October 2000.

On June 26, 2001, the Panel met again to discuss the case which included a report from the treating orthopaedic specialist dated June 1, 2001 along with a letter by the claimant indicating that he had an upcoming appointment at the Pain Clinic for October 22, 2001. The Panel decided that it would await the report from the Pain Clinic prior to rendering a decision on the claimant's appeal.

On November 26, 2001, the Panel met further to discuss the case. The Panel noted that the specialist at the Pain Clinic recommended that the claimant undergo a bone scan and that he be referred back to his treating orthopaedic specialist to consider the possibility of an intra-articular arthroscopy. The Panel therefore decided to await the bone scan results and to obtain an up-to-date report from the treating orthopaedic specialist. On February 14, 2002, all parties were provided with copies of the bone scan results of November 2, 2001 and a letter from the treating orthopaedic specialist dated January 18, 2002 and were asked to provide comment. On March 1, 2002, the Panel met again and rendered a decision on the issue under appeal.

Reasons

This case deals with a worker who injured his right knee at his workplace on May 6, 1999. He received benefits for a period of time, and his wage loss benefits were terminated on June 6, 2000. He unsuccessfully appealed the termination of benefits to the Review Office, and he has appealed that decision to this panel.

Section 39(2) of The Workers Compensation Act (the Act) states that that a worker is entitled to wage loss benefits while the worker is suffering a loss of earning capacity as a result of a workplace injury.

In order for the worker's appeal to be successful and for us to restore wage loss benefits, we would have to find that his medical condition and symptoms after June 6, 2000 are causally related to his workplace injury, and that there is a loss of earning capacity after June 6, 2000 as a result of that medical condition. We were unable to make these determinations in this case.

In deciding this case, we had the opportunity to review all the evidence on the file, and to hear evidence and submissions from the claimant and the employer at the hearing. Following the hearing, we also obtained additional medical reports and results of recent tests and medical examinations undertaken on the claimant's right knee.

In coming to our decision, we noted that the claimant originally reported that he had banged his right knee after a slip at work. The claimant was able to work for another week, before finally leaving work on May 12, 1999. The original diagnosis was an acute sprain and a patellar injury.

We note that this case was perplexing to the various medical professionals who were involved in this case. By October/November 1999, the claimant appears to have regained nearly all his range of movement of his knee, there was no ligament laxity ever noted in his knee, nor was there any evidence of meniscal or cartilage damage. As well, x-ray tests were normal as were the results of an MRI performed on January 20, 2000. Yet, throughout this period, the claimant reported continuing symptoms of pain and exquisite tenderness in the knee. An orthopaedic surgeon then suggested that a reflex sympathetic dystrophy (RSD) might be accounting for the worker's continuing symptoms.

The claimant was also examined on two occasions by a WCB medical advisor. At the first examination, no structural problems were identified, but it was felt that an MRI should be undertaken to ensure that no internal derangement was being missed. An MRI was undertaken in January 2000, with normal findings reported. The second examination by a WCB medical advisor took place on May 8, 2000. Again no structural problems were found during the physical exam. The medical advisor notes the normal MRI findings, and the absence of tropic changes during the examination that would suggest the presence of RSD. The medical advisor then concluded that there was no structural basis for the worker's current complaints. Accordingly, the claimant's benefits were terminated within a matter of weeks.

At the hearing, we asked questions regarding the claimant's ongoing treatment since the termination of his benefits, and found out there were further investigations undertaken regarding his right knee condition. His orthopaedic surgeon continued to investigate the possibility that there was a RSD present, and arranged for a pain specialist (an anesthesiologist) to examine the claimant. The specialist ordered a bone scan to determine whether an inflammatory condition was present. The bone scan was undertaken on November 2, 2000, and was found to be negative. Later reports by the surgeon note that the claimant had returned to work and that he was reporting less symptoms in the knee.

The claimant's treating orthopaedic surgeon, in an earlier report of September 29, 2000 noted, as part of a proposed referral to a pain clinic, that "If he [the claimant] has no response to the blocks, then I would agree that he just basically has a soft tissue discomfort in this knee with no pathological reason for it and will have to learn to live with and do the best he can."

This opinion, once the RSD was ruled out, is very similar to the findings of the WCB medical advisor at the time of the second call in examination in May 2000, and the later file review and comments by a WCB orthopaedic consultant on January 8, 2001. In the consultant's memo, he proposed an initial diagnosis of a bone bruise and post traumatic chondromalacia patella at the time of the accident. When asked whether the claimant had recovered by June 6, 2000, the orthopaedic consultant notes the normal findings on x-ray and MRI examinations, and the absence of ligamentous lesions and no signs of RSD. He then concludes that "all of the above indicate a normal knee with no significant pathology occurring as a result of the CI [compensable injury]."

After a review of all the evidence, we find that the later medical evidence that we received remains consistent with the medical opinion offered by the WCB orthopaedic consultant in January 2001, and we find that the evidence on a balance of probabilities supports our reaching the same conclusion. We find that the claimant had indeed recovered from his workplace incident by June 6, 2000, and that he is not entitled to wage loss benefits after that date. Accordingly, the claimant's appeal is denied.

Panel Members

T. Sargeant, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 11th day of March, 2002

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