The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on March 19, 2002, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on March 19, 2002.

Issue

Whether or not the claimant is entitled to wage loss benefits beyond June 18, 2001; and

Whether or not responsibility for costs associated with physiotherapy treatment should be accepted beyond June 18, 2001.

Decision

That the claimant is entitled to wage loss benefits beyond June 18, 2001; and

That responsibility for costs associated with physiotherapy treatment should be accepted beyond June 18, 2001.

Decision: Unanimous

Background

During the course of his duties as a unit assistant on August 7, 2000, the claimant was transferring a patient from a car to a wheelchair when he experienced a pull in his groin. As a result of the incident, the claimant received medical attention from his family physician, a physiotherapist as well as an orthopaedic specialist for right hip and groin difficulties. The claimant also underwent the following laboratory procedures:

A November 21, 2000 bone scan:

"There are small, and relatively mild, areas of increased uptake in the proximal right femur and the left medial acetabulum. The underlying etiology is uncertain. They do not appear to be represent either fractures or significant arthridities, although an alternative explanation is not apparent. Radiographic and clinical correlation is clearly required."

An April 12, 2001 MRI:

"Normal MRI right hip. No evidence of avascular necrosis."

In a report dated April 26, 2001, the treating orthopaedic specialist noted that the claimant had some pain with abduction of his hip joint but the movements of the hip were within normal limits. Examination of the other hip joint was negative. The specialist saw no reason why the claimant should change his occupation considering the minor degenerative changes he had in his hip joint. He thought that the claimant had been symptomatically aggravating the arthritic condition of his hip joint.

On May 1, 2001, a Workers Compensation Board (WCB) medical advisor reviewed the case. The medical advisor noted that in view of little physical findings and with good hip range of motion, the best course of action for the claimant would be to return to work on a graduated basis.

On May 14, 2001, a WCB case manager wrote to the claimant and a return to work plan was outlined between May 13 to June 18, 2001. The claimant was advised that there were no specific restrictions/activities which he should avoid during the return to work program and that wage loss benefits would be paid to June 18, 2001 inclusive and final.

Subsequently, the claimant contacted the WCB stating that he was experiencing ongoing difficulties in his right hip, groin, leg and lower back while engaged in his return to work program. The claimant was of the view that he required more treatment in the form of work hardening and physiotherapy so that he could fully perform his work duties.

In a progress report dated May 25, 2001, the attending physician commented that the claimant had a pulling sensation in his right hip with tenderness in his right groin. He suggested that the claimant be assessed by a WCB medical advisor and a further consult with his orthopaedic specialist.

On June 26, 2001, a WCB medical advisor reviewed the file and was of the opinion that, on a balance of probabilities, the claimant had incurred an aggravation of early hip osteoarthritis. The consultant agreed with the orthopaedic specialist that there was no apparent need for restrictions.

A report was received from a sports medicine specialist dated June 12, 2001. The diagnosis rendered was chronic groin strain right, weak and irritated right gluteals and decreased range of motion hips bilaterally and a suspicion of early OA (osteoarthritis). Recommended treatment included progressive stretching and massages.

A report was received from a physiotherapist dated June 25, 2001. The assessment revealed "a chronic groin strain that continues to be aggravated due to the shortening and scar tissue formation in the area which leads to weakness and makes the area more prone to reaggravation." A course of therapy three times a week for the next six weeks was recommended.

In a memo to file dated July 3, 2001, the claimant was informed by a WCB adjudicator that a WCB call in examination would not be arranged as there were no objective medical findings to support a call in exam.

On July 31, 2001, a WCB medical advisor reviewed the case. The medical advisor stated that the question of cause and effect remained difficult to answer. The treating orthopaedic specialist did not find much in April 2001, especially with adductors. By June 2001 the treating sports medicine specialist's findings had been received. On a balance, it was difficult, given the minimal findings in April 2001, to relate the present problems to the compensable injury. There was continuity only of symptoms not of physical, objective findings.

A progress report was received from the attending physician concerning a July 6, 2001 examination. The new diagnosis reported was myofascial pain syndrome. A referral was then made to a rehabilitation medicine specialist.

In a September 4, 2001 submission, a worker advisor requested Review Office to reconsider the WCB's decision of May 14, 2001. Additional information was submitted with the appeal from a sports medicine specialist dated July 17, 2001 and August 24, 2001, a report from the physiotherapist dated August 20, 2001, and bone scan results of August 1, 2001. Based on this information, the worker advisor contended that the claimant had not recovered from the compensable injury as of June 18, 2001.

In a decision dated October 5, 2001, Review Office determined that the WCB was not responsible for any loss of earning capacity beyond June 18, 2001. Review Office noted that WCB coverage was granted for the claimant 10 months post the August 7, 2000 injury and that there was a paucity of objective findings to substantiate the claimant's subjective complaints of pain. This was a difficult area of anatomy to obtain conclusive evidence, but it was an established fact that the multitude of tests ordered by the orthopaedic specialist early in the claim all came up negative with no indication of an injury other than that of a strain. The therapist and sports medicine specialist were both in harmony on the issue of the claimant's not pushing himself enough during exercises and the claimant was going to have to recognize this point as being a concern by all parties involved.

Based on a review of all medical evidence, Review Office indicated that with the passage of time and the lack of solid medical evidence to support a contention of significant functional impairment disability, it supported primary adjudication's decision to end WCB's responsibility by June 19, 2001.

In a submission dated November 2, 2001, the worker advisor requested clarification as to whether or not the WCB would accept responsibility for the cots of physiotherapy treatments beyond June 18, 2001. As this issue had not been previously addressed in writing by primary adjudication, Review Office referred the case back to primary adjudication for a decision with respect to this issue.

On November 13, 2001, primary adjudication made reference to a May 2, 2001 meeting that was held with the claimant's employer and union to arrange a gradual return to work program. This gradual return to work program was arranged in lieu of the claimant's request for a reconditioning program. On May 10, 2001, the claimant was verbally advised that no further physiotherapy would be granted beyond June 18, 2001 as he was considered to have recovered from the effects of his compensable injury. This conclusion was also the confirmed by a WCB physiotherapist on November 13, 2001. Primary adjudication therefore concluded that the claimant had recovered from the effects of his workplace injury upon completion of his graduated return to work program and therefore the WCB was not accepting responsibility for the costs related to continued physiotherapy beyond June 18, 2001. On November 22, 2001, the worker advisor appealed this decision to Review Office.

In a decision dated November 30, 2001, Review Office agreed with the position taken by primary adjudication that the WCB would not accept responsibility for costs related to physiotherapy beyond June 18, 2001. On December 28, 2001, the worker advisor appealed Review Office's decisions and an oral hearing was held on March 19, 2002.

Reasons

Right from the very outset when the claimant submitted his worker's report of injury form to the WCB, he was aware of the pull to his groin ("pull to both sides of groin"). After carefully reviewing and considering the evidence, we were able to conclude that the claimant's compensable condition had not been completely and/or accurately diagnosed until such time as a sports medicine specialist examined him on June 12th, 2001.

Based on his physical assessment, the specialist diagnosed the claimant with "a chronic and recurrent right groin strain with an associated iliotibial band syndrome and gluteal muscle weakness and irritability bilaterally". We accept the specialist's diagnosis. We further find that this diagnosis is consistent with the claimant's mechanism of injury. In addition, we note that the treatment plan recommended by the specialist has led to the claimant's full and complete recovery and allowed him to return to unrestricted pre-accident employment duties on October 26th, 2001.

In light of our foregoing findings, it necessarily follows that the claimant is entitled to wage loss benefits beyond June 18th, 2001 and that responsibility for costs of the physiotherapy treatment should be accepted by the WCB beyond the same date. Accordingly, the claimant's appeal is hereby allowed.

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 19th day of April, 2002