Public Decisions | The Appeal Commission

Decision #98/02 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on July 16, 2002, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on July 16, 2002.

Issue

Whether or not the worker's ongoing difficulties with his coccyx are related to the compensable injury of March 17, 2000; and

Whether or not the worker sustained a recurrence of his compensable injury of March 17, 2000 on October 5, 2001, which precluded him from returning to his usual work.

Decision

That the worker's ongoing difficulties with his coccyx are related to the compensable injury of March 17, 2000; and

That the worker sustained a recurrence of his compensable injury of March 17, 2000 on October 5, 2001, which precluded him from returning to his usual work.

Decision: Unanimous

Background

While in the course of his employment as a long distance truck driver on March 17, 2000, the claimant was climbing backwards out of his truck when he slipped on ice which was located on the running board of his truck and landed on his back. The claimant reported injuries to his neck, back, rib, knee and elbow. Initial medical information showed that the claimant attended a local hospital for treatment on the same day and was diagnosed with a back strain and contusion. The claim was accepted by the Workers Compensation Board (WCB) and benefits commenced on March 18, 2000. Subsequent medical information revealed the following:

x-rays of the lumbar spine and pelvis dated March 17, 2000, showed no acute pathology and no definitive fracture.
on March 20, 2000, a general practitioner noted that the claimant fell off the running board of his truck onto his mid back. There was no head injury and the claimant was not knocked out. The claimant experienced immediate pain in his back and ribs and went to an emergency room in Toronto. The claimant now had lower back pain which traveled up his spine and into the back of his neck and down the back of his legs. The claimant had a sore left elbow and an injuries to his 3rd and 4th fingers of his left hand. The claimant's right knee cap was also painful. The diagnosis rendered was "numerous bony injuries" and a referral to physiotherapy was arranged.
in March and April 2000, the claimant attended physiotherapy treatments. The area of injury was recorded as "neck/back/right knee". The diagnosis was muscular/ligamentous strains.
the claimant was treated by a chiropractor on April 13, 2000. The claimant complained of pain in his ribs, low back, neck, left arm and right knee along with headaches. The diagnosis rendered was rib strain, sacroiliac strain/sprain and left tennis elbow.
on August 11, 2000, a WCB medical advisor interviewed and examined the claimant with respect to his low back, elbow, forearm and knee areas. With respect to the low back, the claimant stated he was sore all of the time and the pain was localized mainly over his coccyx area and both buttocks. The claimant said he had problems with his low back in the past but it was nothing to the extent that it was now. The medical advisor concluded that the claimant was suffering from a sacroiliac joint strain as well as quite marked coccydynia. A clear cut cause for the coccydynia had not been found and the medical advisor arranged for a bone scan to rule out occult fracture or dislocation.
the bone scan results of August 31, 2000, identified no bony abnormalities.
in a November 22, 2000 report, the treating chiropractor noted that the claimant had fallen backwards from a truck and he landed on his lower back. "The ensuing collision with the ground created a sacroiliac sprain/strain in two places, where the coccyx and the lower sacroiliac joints are formed." The chiropractor commented that the claimant's arm, neck and mid back were improving. The sacroiliac area was the most difficult area to resolve and it was the most critical in terms of the claimant's job function. It was felt that the claimant was not fit to return to his job but was capable of sitting on a hard surface for at least two hours at a time without having extreme symptoms occurring.
on December 19, 2000, primary adjudication asked a WCB medical advisor to review up-dated reports on file and to provide his opinion as to whether or not there was a continuing relationship between the claimant's current condition and the compensable injury. The medical advisor replied, "Yes-coccydynia". The medical advisor was also of the opinion that the claimant had not yet recovered from the compensable accident and there was little to suggest a pre-existing condition.
an x-ray report of the sacrum and coccyx dated December 12, 2000, showed "slight posterior subluxation of the coccyx. Although the position of the coccyx can vary, this may well represent recent injury. Clinical correlation is required."

On February 19, 2001, primary adjudication determined that the claimant was fit for some form of work. Temporary restrictions were outlined to avoid sitting for over hours and to avoid lifting over 40 pounds. The employer provided the claimant with temporary alternate employment while the claimant attended chiropractic treatment.

on July 31, 2001, the claimant was assessed by a WCB medical advisor and chiropractic advisor. After the assessment, it was determined that the claimant continued to have problems with coccydynia and sacroiliac joint dysfunction and that he would benefit from ongoing chiropractic care. The claimant was advised to increase his working hours. It was determined that the claimant should be able to drive with only the restriction of changing position on an as-needed basis.
an x-ray report of the lumbosacral spine dated September 17, 2001, noted no significant bone, joint or soft tissue abnormality. X-rays of the coccyx taken the same date revealed, "Suspected transverse fracture through the coccyx with posterior displacement of the distal fracture fragment on the order of 5 mm.".
in a September 18, 2001 report, an orthopaedic specialist felt that the claimant still had soft tissue sensitivity across the lumbosacral region and sacrococcygeal area. The claimant was considered fit and able to continue with his usual activities and work including that of a truck driver on a regular daily basis.
a chiropractic progress report dated September 20, 2001, indicated that the claimant had been cleared for 12 hour/day driving. The chiropractor was of the view that the claimant was not fit for 8 hours of driving per day. The chiropractor noted that the claimant drove the first overnight 8 hour shift and was unable to walk, sit or lie down, etc. without pain.

Based on the weight of evidence and section 39(2) of The Workers Compensation Act (the Act), primary adjudication concluded that the claimant had recovered from his work injury and that partial wage loss benefits would be paid up to September 27, 2001 inclusive. The claimant was advised that the WCB was unable to accept any costs associated with chiropractic treatment beyond September 27, 2001.

On September 28, 2001, a WCB adjudicator spoke with the treating chiropractor. The chiropractor stated that the claimant showed some disc signs since he had started to take some longer trips.

During a telephone conversation with a WCB adjudicator on October 10, 2001, the claimant reported a recurrence of his work place injury as of October 5, 2001. On this date, the claimant advised that he left Winnipeg and drove to Maple Creek, Saskatchewan. He then had a layover of ten hours during which he switched trailers, ate and slept in the sleeper of his truck. By the time he got to Maple Creek he was sore and in a lot of pain. The pain began in his tailbone and then moved into his hip and down his right leg. When he returned to Winnipeg on Saturday his symptoms were worse. He was in a lot of pain and had trouble walking. The claimant stated he did nothing out of the ordinary to cause his difficulties but this was the third time he had a flare up of pain after driving a long distance. The claimant said his sitting tolerance was about 20 minutes and after that his tailbone begins to sting.

On November 7, 2001, the claimant was advised by primary adjudication that it was unable to find that he suffered a recurrence and that benefits would not be reinstated. "The healthcare consultants reviewing the medical information found nothing in the medical on file or during their call in examination to suggest a prolapsed disc."

On November 27, 2001, a worker advisor provided a number of reports from the claimant's treating physicians and physiotherapist. The worker advisor felt that these reports all supported the claimant's position that he remained incapable of tolerating his usual job duties on a full time basis. The worker advisor also was of the opinion that when the claimant attempted a full return to work, as suggested by the WCB, he suffered a recurrence as defined by WCB policy 44.10.20.50.

Following a review of the medical reports submitted by the worker advisor along with updated information that was obtained from the claimant's treating physicians, primary adjudication determined on January 25, 2002, that no change would be made to its previous decision. Primary adjudication was unable to establish a clear relationship between the coccydynia and the March 17, 2000 compensable injury. Primary adjudication pointed out that there was no mention of coccyx pain until the claimant was examined on August 11, 2000. It was also determined that the claimant's low back condition was the result of pre-existing degenerative changes and not the accident of March 17, 2000. Primary adjudication made reference to a November 30, 2001 report from the claimant's treating surgeon whereby the report stated that x-rays showed disc degeneration (L5-S1) consistent with the pain location in the back. These changes were pre-existing and degenerative in nature and were not the result of the workplace injury. On February 13, 2002, the worker advisor appealed the decision to Review Office.

On March 15, 2002, Review Office determined that no responsibility would be accepted for the worker's ongoing difficulties with his coccyx. Review Office was of the opinion that it was extremely doubtful and certainly not probable that the claimant sustained any injury to his coccyx in the accident. The descriptions of the accident all indicated initially that the claimant fell flat on his back landing on the mid portion of his back also injuring other areas of his anatomy consistent with this type of fall. Review Office concurred with the opinion expressed by a WCB orthopaedic consultant that in order to injure the coccyx area, a direct blow or fall onto this specific area would be required. Review Office concluded that it did not believe responsibility should be accepted for the worker's claimed recurrence of coccydynia following his overnight driving venture in October.

On April 10, 2002, the worker advisor asked Review Office to clarify its March 15, 2002 decision. In a response dated April 23, 2002, Review Office stated, "I do not believe the worker suffered a recurrence of what I would deem to be his compensable injury following the accident of March 17, 2002. In my view any injuries he sustained on that date would not have caused him further difficulty as claimed following his driving run of October 5, 2001. Therefore, I do not believe any time loss or wage loss associated with his claimed problems would be a consequence of this claim and the injuries that Review Office has accepted as being a consequence of this claim. Further I note that the Orthopaedic Consultant to Review Office stated that regardless of the worker's claimed difficulties, these would not preclude work. Review Office concurs with this opinion."

The worker advisor subsequently appealed Review Office's decision and requested an oral hearing. On July 4, 2002, the worker advisor provided the Appeal Commission with a May 12, 2002, report from the attending physician for consideration. On July 16, 2002, an oral hearing took place at the Appeal Commission.

Reasons

We are satisfied based on the weight of evidence that the claimant's ongoing difficulties with his coccyx are related to the compensable injury of March 17th, 2000. In arriving at this decision, we attached considerable weight to the following body of evidence. On August 11th, 2000, a WCB medical advisor examined the claimant and based on his clinical findings concluded in part: "Mr. [the claimant] is suffering from a sacroiliac joint strain as well as marked coccydynia. A clear-cut cause for the coccydynia has not yet been found. Mr. [the claimant] would likely benefit from a bone scan to rule out occult fracture or dislocation." The medical advisor then proceeded to order a bone scan in order to rule out an occult fracture or dislocation. After reviewing the test results, the medical advisor commented in a memorandum to file, "Bone scan negative. Not easy to explain coccydynia."

In December 2000, a WCB adjudicator requested the medical advisor to provide his opinion with respect to whether there was a continuing relationship between the claimant's current condition and the compensable injury. In a response dated December 19th, 2000, the medical advisor replied, "Yes - coccydynia."

It should also be noted that the claimant was experiencing low back pain and sitting difficulties for a period of time prior to the WCB's acknowledging coccydynia as a compensable condition. His presenting symptomatology was not inconsistent with this condition. In this regard, specific reference can be made to the following evidence:

May 31st, 2000 attending physician's progress report - "low back pain. Had hour tolerance for sitting in vehicle due to back."
June 19th, 2000 attending physician's progress report - "Pain in low back. Can't sit longer than hour, pain worst when 1st gets up."
July 10th, 2000 therapist's report requesting extended therapy - "His knees are no longer problematic with activities. However sustained postures, particularly sitting increases lower back pain. His job as a truck driver requires + + + sitting."
July 19th, 2000 Therapist's progress report outlining current symptoms - "Lower back pain. Worse with sustained standing & sitting, better if activity variable. Forward flexion & extension through the lumbar spine still tender & limited."
March 1st, 2001 chiropractic x-ray - "There is a minor posterior deviation of the first coccyxial segment, it appears to be an osteophytic spur extending on the posterior superior of the first coccyxial segment behind the fifth sacral segment. There appears to be a lateral movement of the coccyx. Impression: Old lateral displacement, osteoarthritic changes of the coccyx.

As to the second issue, we find that the claimant was not totally disabled and as such not fully precluded from truck driving. However, we further find that the claimant nevertheless exceeded his physical capacity in October 2001 and as a consequence he incurred a recurrence of his low back injury, which precluded him from returning to his usual work. The claimant testified at the hearing that he could drive up to 6 hours, but going beyond this limit required frequent rests and that he would experience an increase in pain.

The claimant's appeal with respect to both issues 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 28th day of August, 2002

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