Decision #42/02 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on November 6, 2001, at the request of the claimant. The Panel discussed this appeal on several occasions, the last one being March 18, 2002.Issue
Whether or not the claimant is entitled to payment of wage loss benefits beyond March 3, 2000.Decision
The claimant is not entitled to payment of wage loss benefits beyond March 3, 2000.Background
On June 21, 1999, the claimant was climbing a ladder to get up onto a cooler. When reaching for the refrigeration pipe to pull himself up, the pipe pulled off the cooler and the claimant fell backwards landing on his feet. The claimant indicated that although he felt discomfort, he did not seek immediate medical attention.A doctor's first report dated July 21, 1999, noted paralumbar tenderness and spasm and the claimant was diagnosed with degenerative narrowing at L4-S1. Arrangements were made for the claimant to attend physiotherapy sessions and he was advised to remain off work. The Workers Compensation Board (WCB) accepted the claim and wage loss benefits beginning on July 20, 1999.
On July 22, 1999, x-rays of the claimant's lumbar spine revealed degenerative narrowing of both the L4-L5 and L5-S1 interspaces.
A WCB medical advisor reviewed the case on August 26, 1999. He commented that the diagnosis related to the compensable injury was not degenerative disc disease as it would not develop that quickly post CI (compensable injury). He felt the claimant likely had a contusion and muscle strain.
Between August 1999 and January 2000 the claimant continued to seek medical attention from his physician and physiotherapist, however his back condition was not improving. On January 12, 2000, a WCB medical advisor assessed the claimant and the following findings were noted:
- The claimant exhibited tenderness over the lumbosacral spine area.
- There were no signs or symptoms of nerve root compression or irritation.
- The claimant had no radicular symptoms except for right groin pain, which may or may not be radicular in nature.
- Physiotherapy was offering little to the claimant and should be discontinued.
- A CT scan would be arranged to rule out a small central disc protrusion.
- The most likely diagnosis was mechanical low back pain secondary to degenerative disc disease;
- The claimant had a back at risk for further pain but should be able to return to work without restrictions after the CT scan was done.
- At the present time, the claimant was capable of light duties. Temporary restrictions were outlined for a one-month period.
- Degenerative disc disease and narrowing at L4-L5 and L5-S1 and some facet arthropathy present at both levels.
- Left lateral disc protrusion at L4-L5 which appeared to be incidental.
- Fragments of degenerative disc material was present at L5-S1, slightly more pronounced in the right paracentral location in close continuity to the right S1 nerve root. These changes may be incidental although clinical correlation would be required.
A WCB medical advisor reviewed the case on February 11, 2000. The medical advisor opined that the claimant sustained an aggravation of an underlying pre-existing condition that had now resolved.
Following a review of the claim which included the opinion expressed by the WCB medical advisor, primary adjudication advised the claimant on February 24, 2000 that he was considered to be recovered from the effects of his workplace injury and any ongoing problems were the result of a pre-existing condition. In accordance with sections 4(1) and 39(2) of The Workers Compensation Act (the Act), primary adjudication determined that wage loss benefits would be paid to March 3, 2000 inclusive and final.
In July 2000, the claimant wrote to the WCB requesting that his claim be reconsidered as he attended a specialist for treatment who believed that his back pain was work related.
In a report dated August 25, 2000 (examination date was June 30, 2000), a physical medicine and rehabilitation specialist (physiatrist) outlined the history of back difficulties that were described by the claimant and his clinical findings/diagnosis. The specialist was of the opinion that the claimant's present difficulties were related to the June 1999 accident and that he was partially temporarily disabled from performing his job duties due to his ongoing back pain symptomatology. A 6-week work hardening program was recommended. The specialist also felt that the claimant's prognosis with regard to a return to work was good and that his prognosis with regard to pain symptomatology was fair. The specialist's review did not involve consideration of the two CT scans which had been performed in January, 2000.
On October 20, 2000, a WCB adjudicator spoke with the claimant after a WCB medical advisor reviewed the case. The adjudicator advised the claimant that there would be no change in the WCB's decision as there was little objective evidence to suggest his ongoing difficulties were related to the accident. The case was then referred to Review Office for further consideration.
Prior to considering the claimant's appeal, Review Office sought the opinion of a WCB orthopedic consultant on November 7, 2000. The consultant reviewed the case and provided the Review Office with the following opinions:
The most likely diagnosis of the June 1999 injury would have been an aggravation of a pre-existing degenerative disc disease and osteoarthritic condition of the lumbar spine that was a mechanical pain back.
When examined on January 11, 2000, a WCB medical advisor found the claimant to be capable of light work. There had been no significant medical input based on subsequent examinations between that date and the termination of the claimant's benefits on March 3, 2000.
The findings by the treating physiatrist on June 30, 2000 was minimal and would indicate that the claimant was capable of work considering as he had full range of back movements and only minimal pain.
In a November 10, 2000 decision, the Review Office confirmed that the claimant was not entitled to wage loss benefits beyond March 3, 2000 as it was considered he had recovered from the effects of his compensable injuries. Review Office noted that the claimant had pre-existing spinal problems at the L4-5 and L5-S1 levels of his lumbar spine and that the June 21, 1999 accident aggravated the underlying condition. When examined on January 12, 2000, the findings were minimal apart from some tenderness in the lumbosacral area. Review Office found it reasonable to conclude that the claimant had recovered from the temporary aggravation of his pre-existing condition by March 3, 2000.
With respect to the report from the physiatrist, Review Office found very little in the way of objective findings apart from those consistent with the claimant's underlying pre-existing condition. Review Office was of the view that these limited findings would not have prevented the claimant from engaging in employment.
On June 12, 2001 a worker advisor submitted additional information from an occupational health physician dated May 10, 2001 for consideration by Review Office. The worker advisor stated the following in connection with this report:
- "In this report Dr. [name] brings to your attention that Mr. [the claimant] did not receive the recommended treatment. We submit that had the Board authorized the six week work hardening program, in all probability Mr. [the claimant] would have been able to return to his usual work duties. Please note that no light duty work was available."
Dr. [name] confirms ongoing symptomatology, which he feels is related to his fall as he landed more on his right side. Please refer to his last paragraph on page 2."
On July 13, 2001, Review Office confirmed its earlier decision that no benefits were payable to the claimant beyond March 3, 2000. Review Office noted that it had reviewed the previous medical information on file and agreed with the occupational health physician that it was indeed difficult to correlate the current findings to the worker's earlier examinations (i.e to the accident of July 1999). The actual physical findings produced from various examinations were minimal dating back to January 2000. The main findings were of tenderness or discomfort which have been attributed to the mechanical low back pain secondary to the pre-existing degenerative disc disease condition. There was no information in the current report that led Review Office to reverse the decision made in November 2000.
On November 6, 2001, an oral hearing was held at the Appeal Commission as the claimant appealed Review Office's decision. Following the oral hearing the Panel met to discuss the case and it requested that additional information be obtained from the claimant's physiatrist and the treating physiotherapist prior to discussing the case further.
The report from the physiotherapist was received on December 14, 2001. The report from the phsyiatrist was received on February 18, 2002. The phsyiatrist noted that the claimant's file had been reviewed as well as the CT report of June 19, 2000. The physiatrist noted that he "did not see the report of the CT scan" at the time of the preparation of his original report and that the injury was likely an aggravation of the mechanical back pain with pre-existing degenerative involvement.
On February 26, 2002, all parties were provided with copies of reports from the physiotherapist and from the physiatrist. On March 18, 2002, the Panel met further to discuss the case and make its final decision.
Reasons
Based upon the evidence presented, it is the Panel's view that the claimant suffered an aggravation of an underlying pre-existing condition when he fell in June of 1999 but that the effects of the compensable injury were resolved by March 3, 2001. The Panel is of the view that the claimant's current difficulties are not related to the compensable injury but to the underlying pre-existing condition.In coming to its conclusion, the Panel considered all written and oral evidence. The Panel notes that by July 21, 1999, the first report and x-ray regarding the injury identify a degenerative condition which could not have developed that quickly from the compensable injury. This diagnosis is reinforced by the findings from the medical examination of January 12, 2000. When these reports are coupled with the results from the CT scans of January 18, 2000 and January 25, 2000 which ruled out a central disc protrusion, there is strong evidence to support the finding of a pre-existing degenerative condition.
The Panel notes that the report of the Physiatrist dated August 25, 2000 was made without the benefit of the CT scan. Following his review of the file and the CT scan, the Physiatrist also expressed the view that there was a pre-existing degenerative involvement.
Panel Members
B. Williams, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
B. Williams,
B. Williams - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 12th day of April, 2002