The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on July 25, 2002, at the claimant's request. The Panel discussed this appeal on July 25, 2002 and again on September 30, 2002.

Issue

Whether or not the worker's current left shoulder complaints are related to the July 13, 1999 compensable injury.

Decision

That the worker's current left shoulder complaints are not related to the July 13, 1999 compensable injury.

Decision: Unanimous

Background

In July 1999, the claimant filed a claim for worker's compensation benefits when he injured his left shoulder and neck while unloading a truck of roof braces. Subsequent file correspondence revealed the following:

• the claimant was first treated on July 13, 1999 with complaints of pain and swelling in his left shoulder. The diagnosis rendered was a left shoulder contusion.
  
  
• when seen by a chiropractor on July 27, 1999, the claimant complained of neck and left shoulder pain along with stiffness, headaches, and weakness of the left arm. The diagnosis rendered was an acute left cervico-thoracic sprain/strain injury and tension headaches.
  
  
• chiropractic x-rays were performed on July 28, 1999. The cervical spine was essentially negative and the thoracic spine demonstrated minor vertebral rotation.
  
  
• on August 31, 1999, the WCB authorized chiropractic treatment for a maximum of 14 weeks to November 2, 1999.
  
  
• on November 9, 1999, the claimant was assessed by a WCB chiropractic advisor. The chiropractic advisor was of the view that the claimant had either partially or completely dislocated his left shoulder at the time of his compensable injury and that this had now corrected itself with movement. The chiropractic advisor believed that the injury resulted in soft tissue damage around the shoulder and that the claimant probably had a rotator cuff injury with chronic tendonitis.
  
  
• on November 10, 1999, the claimant was examined by a second physician with respect to both shoulders. The diagnosis rendered was pericapsulitis of the left shoulder. Physiotherapy, medication and a referral to an orthopaedic specialist was recommended.
  
  
• a WCB physical medicine and rehabilitation (physiatrist) consultant saw the claimant on February 1, 2000. The consultant noted that the claimant's left shoulder injury appeared to have resolved. The mechanism of injury suggested that the claimant sustained a hyper-extension injury to his neck.
  
  
• on February 22, 2000, the attending physician reported that the claimant developed fibromyalgia and that he should be sent to the Wellness Centre for a multidisciplinary approach of treatment.
  
  
• the attending neurologist reported on March 28, 2000, that he could find no significant neurological defect. It was felt that the claimant's symptoms were related to the posterior fossa region which seemed to be vascular. The claimant insisted, however, that these symptoms started after his neck injury. In a follow up report dated April 4, 2000, the neurologist stated that the claimant's neurological exam was normal and he could find no evidence of an organic basis for his symptoms. An orthopaedic evaluation was suggested with regard to the claimant's neck problems.
  
  
• in April 2000, the claimant was assessed by a physician at the Pain and Injury Clinic who found myofascial activity in the left sternomastoids area with referred pain and other sensations in the head and ear. A course of acupuncture treatment was recommended and was authorized by the WCB.
  
  
• the claimant was referred to a physiotherapist in June 2000 and the WCB authorized the proposed treatment plan as noted in the physiotherapist's report of July 6, 2000.
  
  
• on August 21, 2000, the physician from the Pain and Injury Clinic reported that the claimant was doing well. He no longer had any headaches, dizziness or autonomic phenomena. The claimant complained of some neck and upper back stiffness but this seemed to be improving. The specialist was of the impression that the claimant could return to work following his course of physiotherapy.
  
  
• on September 18, 2000, the physician from the Pain and Injury Clinic noted that the claimant was seen on September 6th and had decreased range of motion of the neck, soft tissue tenderness of the lateral and posterior neck and thoracic paraspinals, associated with some myofascial activity in the sternomastoid. The physician commented that the claimant's symptoms "have been aggravated in the past by overly enthusiastic treatment of his neck and shoulder not only by previous physiotherapists and chiropractors, but me." The specialist suggested that the claimant would benefit from 5 further treatments to settle down his symptomatology. He also recommended that the claimant continue on a home exercise program and that he did not need any further physiotherapy treatments.
  
  
• in a chiropractic report dated October 16, 2000, a diagnosis of cerviothoracic myofascial pain syndrome was made and it was felt that the claimant required treatment at 3 times per week for 12 weeks.
  
  
• following a WCB call-in examination on November 8, 2000, it was the opinion of the chiropractic consultant that the claimant's shoulder was fine, his back had almost returned to normal and that the claimant had some tightness in his thoracic region. It was determined that the claimant was fit for work with no restrictions and one more month of physiotherapy was authorized.
  
  
• on November 18, 2000, primary adjudication advised the claimant that based on the call-in examination results, responsibility for chiropractic treatment would be accepted by the WCB until December 8, 2000.
  
  
• on December 6, 2000, primary adjudication notified the claimant that responsibility for chiropractor treatment was extended to January 8, 2001 at a frequency of one treatment per week.
  
  
• the Pain and Injury Clinic physician noted in his report of December 15, 2000 that the claimant was doing much better overall. He no longer had any headaches. The claimant still had neck pain but it was much reduced from previous. The claimant was discharged from treatment.
  
  
• during a telephone conversation on December 18, 2000, the claimant informed his adjudicator that he disagreed with the WCB's decision to reduce his chiropractic treatment frequency as he was still attending his chiropractor 3 times per week. The adjudicator informed the claimant that the WCB would unlikely approve the purchase of a home traction unit which was prescribed by his chiropractor. The claimant subsequently appealed these decisions to Review Office. On February 16, 2001, Review Office upheld primary adjudication's decision that responsibility should not be accepted for further chiropractic treatment and that the claimant should not be provided with a cervical traction unit.

In April 2002, the claimant wrote to the WCB requesting reconsideration of the WCB's decision that he had recovered from the effects of his compensable injury and that he was capable of returning to his pre-injury duties. The claimant indicated that he can't do even light work because of tingling, pain and numbness in his left arm and shoulder. In support of his position, two reports were submitted from an occupational health physician dated January 9, 2002 and from a physiatrist dated March 26, 2002.

On January 9, 2002, the occupational health physician assessed the claimant and noted "myofascial trigger points in infraspinatus and subscapularis that contribute significantly to his arm symptoms of referred pain tingling." The physician further stated: "This condition is the result of his work injury, he was quite fit and without shoulder problems prior. Certainly subscapularis is directly related to his anterior shoulder dislocation given its location. He has not recovered in his shoulder region in particular with painful activity restrictions limiting his ability to work."

The physiatrist's report of March 26, 2002, addressed to the occupational health physician, stated, in part, as follows: "At this time, I agree with you that he has chronic pain symptoms associated with major physical and functional impairment with inability to return to work requiring physical labour. His prognosis for return to work is good, following treatment. I will re-evaluate his left shoulder for any type of instability or impingement secondary to the previous shoulder dislocation, but at this time it is my opinion that his problems relates directly to ligamentous and myofascial trigger points with sensitized spinal segments."

Prior to considering the claimant's appeal, Review Office sought the advice of a WCB orthopaedic consultant on May 2, 2002. In a response dated May 9, 2002, the consultant stated, "Dr. [the physiatrist's] findings and recommendations are at odds with Dr. [the WCB chiropractic advisor's] findings and recommendations on Nov. 8/2000. It has never been established that the claimant 'dislocated' the left shoulder until the C.I. nor did it require a reduction at the hospital. In my opinion the file does not indicate the need for further ongoing active treatment as a result of a C.I. occurring 22 mos. prior."

On May 31, 2002, Review Office determined that the claimant's current left shoulder complaints were not related to his July 13, 1999 accident. Review Office noted that when the claimant was examined in February 2000 there were no significant findings with respect to the left shoulder. There was minimal mention of left shoulder complaints between then and January 2002. Review Office considered that the evidence did not support the contention that the left shoulder problems the claimant sought treatment for in early 2002 were a sequela of his July 1999 accident. It followed that he did not have a loss of earning capacity related to that accident and therefore no entitlement to wage loss benefits. In June 2002, the claimant appealed this decision to the Appeal Commission and an oral hearing was arranged.

Following the hearing held on July 25, 2002, the Appeal Panel requested further information from the claimant's family physician as well as from his orthopaedic surgeon. On September 3, 2002, the claimant was provided with copies of all the reports that were obtained and was asked to provide comment. On September 30, 2002, the Panel met to render its final decision.

Reasons

As the background notes indicate, the claimant injured his left shoulder and neck when he was unloading a truck and a roof brace tipped over striking the claimant's left shoulder area. On February 1st, 2000, a WCB medical advisor examined the claimant and recorded the following findings in his examination notes:

"On the current clinical examination there was no significant findings with respect to the left shoulder. There was essentially a full range of shoulder movement and only minor discomfort produced at the end of abduction. There was no evidence of any impingement, rotator cuff involvement, any soft tissue or other structural involvement to the left shoulder, currently. The injury to the left shoulder appears to have resolved."

Prior to making any decision in this case, we contacted the claimant's treating physician requesting that he furnish us with a narrative report outlining his treatment of the claimant's left shoulder difficulties. In a letter dated August 28th, 2002, he advised as follows:

"Thank you for your letter regarding the above named patient of mine whom I have known since Nov 13, 1979. I saw Mr. {the claimant] on May 11, 2001 first time in that year with the complaint of soreness in the left side of the body. He said he wanted to help a friend doing a drywall and following that, he had felt pain in his back and he has been taking cyclobenzapine 10 mg at bedtime. On examination, left scapular area was very tender. This extended to left deltoid and left trapezius and there was some degree of muscle atrophy (disuse atrophy).

On May 29,2001, I saw him again and he said, he was able to move the left arm but left shoulder was painful.

He came back to see me in Oct. 04, 2001. On examination, neck movement was full. Left shoulder and arm movements were within normal limits. There were no neurological signs.

On Feb 18 2002, he returned to complain of painful left shoulder. On examination left shoulder movement was full except diminished left external rotation due to stiffness and disuse.

In summary, therefore, this gentleman had complained of pain in the left shoulder radiating to left arm, left forearm and left hand which he attributes to his previous injuries ie dislocation of left shoulder. This has subsided but got agravated (sic) by helping his friend in dry walling in May 2001."

It should be noted that x-rays taken on the day of the injury were read as normal with "no evidence of fracture or dislocation". We find, on a balance of probabilities, that the claimant's left shoulder complaints are not causally related to the July 13, 1999 compensable accident. The preponderance of evidence strongly suggests that the claimant's continuing left shoulder difficulties are a consequence of an intervening non-compensable event. Accordingly, 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 7th day of October, 2002