The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on October 31, 2002, at the request of the employer's representative. The Panel discussed this appeal on October 31, 2002.

Issue

Whether or not the worker's ongoing back problems are related to the compensable injury of March 24, 2001.

Decision

That the worker's ongoing back problems are related to the compensable injury of March 24, 2001.

Decision: Unanimous

Background

While performing his occupational duties on March 24, 2001, the claimant twisted his lower back and felt a sharp pain with increased flexion when he assisted to lift a 200 lb. client. When seen for treatment on March 25, 2001, the attending physician diagnosed the claimant with a lower back strain. The physician noted that the claimant preferred to work and was advised to avoid excessive strain to the back and to stay off work if his pain became worse. The Workers Compensation Board (WCB) accepted the claim for compensation and no time loss from work was incurred by the claimant.

The next medical report from the attending physician was dated June 19, 2001. The physician reported "Physio. LBP (low back pain) from work injury. Appears to be muscular strain."

In a progress report of June 27, 2001, the physician noted subjective complaints of low back pain. Objective findings indicated full range of motion, neurological examination was normal and non-tender and straight leg raising was normal. In a further progress report of August 16, 2001, the physician diagnosed the claimant with a facet joint irritation and the claimant discontinued working.

In a memo to file dated September 5, 2001, a WCB adjudicator noted that a WCB medical advisor had reviewed the information on file. He decided that the claimant would be called in for an examination due to the time that had elapsed since the injury, the delay in lay-off, the recent change in diagnosis and the claimant's young age. A decision would then be made as to whether there was a cause and effect relationship between the compensable injury and the claimant's current symptoms.

The claimant was assessed by a WCB medical advisor on September 11, 2001. He believed that the claimant had suffered a low back strain which resulted in complaint of non-specific low back pain as of yet unknown origins. He was of the opinion that there were no objective findings to support a diagnosis of facet joint irritation. The claimant exhibited no worsening of his pain complaints on extension, but rather, complained more so in forward flexion which would go against this type of diagnosis. The claimant had some limitation in forward lumbosacral flexion but, it appeared to be primarily limited by his subjective self-reporting of pain, there being no objective findings to support any significant or ongoing disability in this regard. The medical advisor further commented that the claimant would be capable of performing modified duties in some capacity.

In an e-mail memo to the employer's representative dated September 11, 2001, a WCB adjudicator indicated that she met with the WCB medical advisor following the above examination and it was agreed that, on a balance of probabilities, the claimant's difficulties were related to his compensable injury. The WCB was therefore accepting responsibility for the claimant's time loss as of August 15, 2001 and appropriate treatment.

The WCB then made arrangements for the claimant to see a chiropractor for treatment. In a Chiropractor's First Report dated September 18, 2001, the chiropractor diagnosed the claimant with "?? internal disc disruption". The chiropractor also stated, "It is my impression that manipulative treatment would not be of benefit."

On November 2, 2001, the claimant underwent an MRI assessment. The findings revealed, "Mild central disc bulging at L5-S1."

The claimant was referred to an orthopaedic specialist to determine whether or not he required a discectomy or lumbar fusion. The claimant also underwent a Functional Capacity Evaluation on May 13, 2002.

On April 2, 2002, the employer's representative prepared a submission to Review Office commenting on the WCB's position that the claimant's ongoing back problems were related to a compensable incident that occurred on March 24, 2001. It was the employer's position that a chronological review of the facts from March 24, 2001 clearly contradicted any relationship. In support, the employer's representative submitted an opinion prepared by an independent orthopaedic consultant dated March 17, 2002.

On May 21, 2002, the claimant was reassessed by a WCB medical advisor. In comparing findings with the September 2001 examination, the medical advisor noted that the only change was that the claimant had a slight increase in forward lumbosacral flexion, which continued to produce pain complaints localized in the midline lumbosacral region. The medical advisor was at a loss to explain such findings given that the claimant had reasonable range of motion and rehabilitation pursuits by way of gym, swimming and exercise activity. The medical advisor hoped that the upcoming appointment with the independent orthopaedic specialist would shed new light on the possible mechanism for the claimant's complaints.

In a report dated June 25, 2002, the independent orthopaedic specialist, stated, in part, the following:

"MRI examination of the lumbar spine shows a very minimal disc at L5-S1 with minimal changes to the disc space. No other significant abnormalities are noted.

This gentleman has back pain. He does not have any radicular type symptoms. At this point, I cannot be specific about the exact source of his pain. I do not think that there are going to (sic) any tests of a diagnostic type that will add any specific value to trying to make a diagnosis as to the cause of this gentleman's pain…"

The claimant underwent a repeat MRI on July 12, 2002. The results revealed a shallow disc bulging at the L5-S1 level with little change noted from the previous MRI that was performed on November 3, 2001.

On July 6, 2002, the employer confirmed that the claimant had been cleared to resume his pre-accident duties effective August 2, 2002.

On August 9, 2002, Review Office determined that the claimant's ongoing back problems for which work restrictions had been imposed, were related to the March 24, 2001 work accident. Review Office outlined the following opinions that were expressed by various specialists on the file:

• WCB medical advisors felt that the accident of March 24, 2001 produced an internal disc disruption requiring job modification.
  
  
• the orthopaedic consultant contracted by the employer believed that the worker's injury of March 24, 2001 was a simple muscular strain from which a prompt recovery could be expected.
  
  
• the independent orthopaedic consultant who saw the claimant on June 25, 2002, stated that he was unable to be specific regarding the source of the worker's symptomatology.
  
  
• the opinion expressed by the WCB orthopaedic consultant to Review Office was that the signs and symptoms and duration of complaints were consistent with discogenic back pain due to an injury involving the L5-S1 disc on March 24, 2001.

Review Office acknowledged that there were contradictory medical opinions on file regarding the etiology of the worker's ongoing back complaints, but believed that the weight of evidence supported an ongoing relationship to the work injury of March 24, 2001. Review Office therefore denied the employer's appeal. On August 19, 2002, the employer's representative appealed Review Office's decision and an oral hearing was held on October 31, 2002.

Reasons

The employer brings forth this appeal challenging the relatedness of the worker's ongoing back problems to his compensable injury. According to the worker's report of injury form, the worker felt a sharp pain in his lower back while lifting a patient. The injury was diagnosed as a low back strain.

A WCB medical advisor following his examination of the claimant on September 11th, 2001 confirmed this diagnosis. "Following examination of the claimant today, I believe he has suffered a low back strain injury which has resulted in complaint of non-specific low back pain as of yet unknown origins. It is my opinion, there are no objective findings to support a diagnosis of facet joint irritation as evidenced by today's clinical examination." A WCB medical advisor once again examined the claimant on May 21st, 2002. We note in particular certain comments recorded in his examination notes: "Today's examination is compared to the previous one performed on the claimant in September of 2001, and it is noted that it is essentially unchanged, the exception being a slight increase in forward lumbosacral flexion, which however continues to produce pain complaints localized in the midline lumbosacral region."

At the request of a WCB medical advisor, the claimant underwent an MRI of his lumbosacral spine on July 12th, 2002. The radiologist reported the following findings:
     "At the L5-S1 level, there is shallow posterior disc bulging without definite evidence of disc herniation, spinal stenosis, or nerve root compression. There is no other evidence of disc herniation, spinal stenosis, or nerve root compression at any of the other imaged levels. No other lumbar spinal abnormality is identified."

File information confirms that the claimant performed modified duties after his returning to work in September 2001. He was unable to perform his regular duties as a paramedic at that time. The evidence further reveals that the claimant has undergone extensive physical rehabilitation by way of swimming, a home exercise program and gymnasium workouts. The performance of these activities over time has since allowed the claimant to return to work to full time paramedic duties on August 2nd, 2002.

We find based on the weight of evidence that the claimant's ongoing back problems are related to his compensable injury of March 24th, 2001. In addition, we further find that the claimant's work related injury had, on a balance of probabilities, resolved by the time that he returned to full time work.

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 November, 2002