Public Decisions | The Appeal Commission

Decision #136/02 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on June 13, 2002, at the request of the claimant. The Panel discussed this appeal on several occasions, the last one being October 30, 2002.

Issue

Whether or not the claimant is entitled to the payment of wage loss benefits beyond March 29, 2000.

Decision

That the claimant is not entitled to the payment of wage loss benefits beyond March 29, 2000.

Decision: Unanimous

Background

On August 18, 1998, the claimant submitted a claim for compensation benefits with respect to a left knee injury that occurred during the course of his employment as a painter. On his application form for benefits, the claimant described the accident as follows:

"I was painting on the line when I reach (sic) to spray the bottom of a panel I twisted my left knee." The claimant further advised on his application for benefits that he had injured the same knee about six months previously when exiting out of the entrance door of a bus and twisting his knee on steel grates.

On August 20, 1998, the claimant spoke with a Workers Compensation Board (WCB) adjudicator. The claimant advised that about six months prior he twisted his knee when he was stepping out of a bus. He filled out an incident report at the time and his knee bothered him afterwards for about three months. With respect to the accident that occurred on August 10, 1998, the claimant said that he was painting a bus, that he was leaning forward and that he heard a crack. He stepped out with his left leg. The claimant advised that the line was going too fast for him and as he stepped out, he lost his balance. The claimant said he did not fall because he supported himself by grabbing the wall.

Following a telephone conversation with an employer representative on August 21, 1998 (who had no concerns about the accident or the claim), the claim was accepted by the adjudicator and compensation benefits were issued.

Further reports on file revealed the following:

on August 17, 1998, the attending physician noted that the claimant was tender in the region of the lateral aspect of the left knee joint. Flexion of the left knee joint and weight bearing was painful. The diagnosis was a soft tissue injury left knee joint.
the claimant was assessed by an orthopaedic surgeon on August 24, 1998. In his report dated September 1, 1998, the surgeon diagnosed the claimant with a lateral stress injury.
on August 26, 1998, the claimant was assessed by a third physician and his diagnosis was a possible meniscal tear.
an x-ray of the left knee dated August 26, 1998, revealed no abnormality.
in a September 9, 1998 report, a second orthopaedic surgeon felt that the claimant had sustained a left medial meniscal tear and a left knee arthroscopy was suggested. On October 5, 1998, the WCB authorized the left knee arthroscopy.
a left knee arthroscopy and patellar chondroplasty was performed on November 26, 1998. The post-operative diagnosis was a left knee chondromalacia of the patella.
a follow-up report by the treating orthopaedic surgeon dated February 25, 1999, noted that the claimant had locking, catching and grinding in the left knee. "Findings were one of mainly chondromalacia patella." The treatment plan was for an MRI scan to rule out any surgical lesions.
on March 24, 1999, the claimant was examined by a WCB medical advisor and his opinion concerning the claimant's left knee condition was noted as follows: "From the examination today and the arthroscopic finding, I believe the claimant is likely suffering from chondromalacia of the patella. Although I don't believe there is any meniscal problem, especially considering the fact that the arthroscopy specifically mentioned no meniscal tear, I believe a small meniscal tear may be one of the differential diagnoses in view of the examination findings. I believe it is reasonable to perform an MRI scan to sort out the diagnosis."
on May 6, 1999, the MRI scan noted Grade II chondromalacia patella.
on June 16, 1999, a physiotherapist provided the WCB with her summary report of the claimant's treatment dates and therapy program.
in a sworn statement dated June 29, 1999, the claimant described the August 10th accident as follows: "I had stepped and twisted towards my left to reach back when my left knee gave out and I fell landing on the ground striking my left knee."
on October 7, 1999, the orthopedic surgeon assessed the claimant with fairly severe patellar chondromalacia. Several treatment options were outlined.
on November 22, 1999 a physician from the Pan Am Sports Medicine Centre diagnosed the claimant with anterior knee pain left knee and locked left knee of unclear etiology. A diagnostic arthroscopy was recommended.
a WCB orthopaedic consultant assessed the claimant on January 21, 2000 with chrondromalacia left patella and left patellofemoral pain syndrome. The consultant also expressed concerns with the mechanism of the workplace injury. Reference was made to the accident description provided by the claimant in his sworn statement dated June 29, 1999 and the accident description that he provided to a WCB adjudicator on August 20, 1998. It was the consultant's opinion that it was "improbable that the findings on arthroscopy (the degenerative changes on the articular surface of the patella) would arise out of an indirect twisting injury to the left knee joint." The consultant also stated, "Further, even if there were a direct injury, I am not convinced that such changes would develop in the period of just over 3 months between injury and surgery, but there could be conflicting opinions on this."
on January 25, 2000, the physician from the Pam Am Sports Medicine Centre stated, in part, "The patient had a MRI, which did show a cartilage fracture in the undersurface of his patella with no evidence of meniscal pathology. He did have an arthroscopy done prior to this MRI and a patellar debridement was carried out and there was apparently no meniscal pathology. I still recommend diagnostic arthroscopy."
in a memo dated March 17, 2000, a WCB adjudicator documented that she discussed the case with the WCB's orthopaedic consultant. It was his opinion that the twisting injury resulted in a capsular strain/sprain of the left knee. The normal recovery period would be four months. The adjudicator also noted that at the time of the WCB call-in examination, it was the consultant's opinion that there was no longer a cause and effect relationship between the compensable injury and the findings on examination.
on March 21, 2000, a WCB medical advisor suggested that the chondromalacia of the left patella would be considered a pre-existing condition which had prolonged the claimant's recovery.

In a March 22, 2000 decision, primary adjudication opined that the claimant had sustained a strain/sprain injury to his left knee and that the weight of evidence did not support a cause and effect relationship between the compensable injury of August 10, 1998 and the claimant's ongoing symptoms. Primary adjudication determined that the claimant's ongoing knee problems were likely related to a pre-existing condition. The condition had not been caused or enhanced by the compensable injury and that the compensable injury was no longer contributing to the claimant's ongoing symptoms. This determination resulted in wage loss benefits being paid to March 29, 2000 inclusive and final. This decision was later appealed by the claimant to Review Office.

On April 14, 2000, Review Office considered a number of issues brought forward by the claimant. With respect to the issue of whether or not the claimant was entitled to wage loss benefits after March 29, 2000, Review Office was satisfied that the claimant was no longer disabled by reason of the original compensable injury, a twisting injury to the knee. Review Office noted that the claimant had pre-existing degenerative changes of chondromalacia patella of the left knee which was not the responsibility of the WCB. Review Office determined that time loss benefits after March 29, 2000 were not warranted. On April 8, 2002, the claimant appealed Review Office's decision and an oral hearing was arranged.

On June 13, 2002, an Appeal Panel hearing was convened at the Appeal Commission. Following discussion of the case, the Appeal Panel requested that additional information be obtained from the claimant's supervisor.

On July 16, 2002, the Panel met briefly in light of a signed statement that had been obtained from the claimant's supervisor dated June 24, 2002. At this time, the Panel determined that prior to discussing the case further, a signed statement would also be required from the claimant's foreman. A signed statement was later obtained from the foreman dated September 30, 2002 and was forwarded to the interested parties for comment. On October 30, 2002, the Panel met to render its final decision and took into consideration a submission from the claimant dated October 21, 2002.

Reasons

A thorough review of the evidence confirms that the claimant's continuing left knee difficulties are not, on a balance of probabilities, related to his compensable injury of August 10th, 1998 but rather, are related to his non-compensable pre-existing Grade II chondromalacia left patella. We further find based on the weight of evidence that the claimant's twisting injury is not consistent with a diagnosis of chondromalacia left patella and/or left patellofemoral pain syndrome. In addition, the evidence does not lead us to conclude that the compensable injury either aggravated or enhanced the claimant's pre-existing condition. Accordingly, the claimant is not entitled to the payment of wage loss benefits beyond March 29th , 2000. The 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 27th day of November, 2002

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