Decision #22/03 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on August 29, 2002, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on August 29, 2002 and again on January 27, 2003.

Issue

Whether or not responsibility should be accepted for medical treatment beginning January 3, 2001; and

Whether or not the worker is entitled to wage loss benefits effective January 3, 2001.

Decision

That responsibility should not be accepted for medical treatment beginning January 3, 2001; and

That the worker is not entitled to wage loss benefits effective January 3, 2001.

Decision: Unanimous

Background

On December 5, 2000, the claimant slipped and stumbled while carrying a test set over a snow packed and icy "spillway" and reported a sore and stiff lower back. The claimant advised that his injury was not disabling and that the pain subsided. He did not miss any time from work as a result of the accident.

In February 2001, the claimant advised a Workers Compensation Board (WCB) adjudicator that between December 5, 2000 and December 30, 2000 he experienced muscle spasms which he described as sharp pains in his back. He would rest and take a hot bath or shower and the pain would subside. The claimant denied any new injuries occurring either at home or at work and that his supervisor was aware of his muscle spasms.

When working on December 31st the claimant experienced a tingling/numbness feeling that went from his armpit to his big toe and spread across his belly button and the middle of his back. He did not think it was related to his back injury as he thought he was having a stroke or a heart attack. On January 3, 2001, the claimant sought medical attention and was advised by his physician that there was nothing much he could do for him and the claimant was prescribed muscle relaxants. He saw a second physician who referred him to a neurologist. The claimant was also receiving physiotherapy treatment once a week.

On February 27, 2001, a WCB medical advisor reviewed the file information, which contained correspondence from the attending physicians and physiotherapy reports. The medical advisor was of the opinion that the mechanism of injury described by the claimant was capable of causing a spinal injury, but the absence of any significant symptoms until a month following the injury was quite unusual. It was felt that the symptoms experienced by the claimant one month following the work place accident could not be related to the workplace injury. The medical advisor also noted a pre-existing condition found on x-ray examination dated January 3, 2001.

In a decision dated March 5, 2001, primary adjudication confirmed that it was unable to establish a cause and effect relationship between the claimant's December 5, 2000 work injury, and the change in his symptoms commencing December 31, 2000. Primary adjudication would therefore not accept responsibility for any medical treatment or wage loss costs associated with the claim.

On November 29, 2001, a union representative appealed the above decision to Review Office and presented new medical information submitted by the claimant's treating physician dated October 24, 2001. The treating physician advised that the claimant had been referred to a neurologist. Following an MRI examination the clinical diagnosis was a partial transverse myelopathy. The union representative felt that this diagnosis was consistent with the mechanism of injury and the December 5, 2000 work place injury. At Review Office's request, the case was referred back to primary adjudication to reconsider its decision based on this new medical information. If primary adjudication decided not to change its opinion, then case was to be referred back to Review Office for further consideration.

On January 23, 2002, primary adjudication wrote to the claimant's attending physicians and obtained the following information:
  • CT scan results of the thoracic and lumbar spines dated April 11, 2001.
  • MRI results of the thoracic spine dated June 8, 2001.
  • EMG results dated April 25, 2001.
  • report from the treating neurologist dated April 11, 2001.
On February 5, 2002, primary adjudication asked a WCB medical advisor to review the file information and to provide comments based on this new medical information. In a response dated March 1, 2002, the medical advisor stated the following:
"New info reviewed. The MRI is suggestive of a transverse myelitis at T5-6 level and the electrodiagnostic study of April 25/01 is consistent with a demyelinating neuropathy. These findings are more characteristic of demyelinating and inflammatory process, not of acute injury. I note that he did have a previous non-work related injury to his thoracic spine in 1995 as well. Not work related, in my opinion."
In a decision dated March 7, 2002, primary adjudication advised the union representative that no change would be made to its previous decision. The case was then referred to Review Office for consideration. Prior to considering the appeal, Review Office sought the medical advice of an orthopaedic consultant on April 9, 2002.

On April 12, 2002, Review Office determined that responsibility could not be accepted for any medical treatment beginning January 3, 2001 and that the claimant was not entitled to wage loss benefits. Review Office stated that the most probable diagnosis of the worker's condition commencing January 3, 2001 was a partial transverse mylopathy. This condition was generally accepted to be as a result of an inflammatory process. Review Office believed that it was unlikely the symptoms which came on so suddenly at the end of December and which led to medical treatment and time loss from work commencing January 3rd were not related to the accident of December 5, 2000. Review Office further stated, "The neurologist who saw this worker definitely believed the problem could have been from an inflammation. The CT scan and the MRI scan both have negated the possibility of a disc protrusion causing the worker's difficulty as originally speculated by the neurologist. The electrodiagnostic findings of delayed motor conduction bilaterally have also been read as being consistent with a demyelinating motor neuropathy. This is a rather rare condition and Review Office do not believe in this instance it was caused by the trauma that occurred on December 5, 2000." On June 18, 2002, the union representative appealed Review Office's decision and an oral hearing was arranged.

On August 29, 2002, the Appeal Panel decided that prior to rendering any decisions on the issues under appeal, that additional information obtained from the claimant's treating neurologist would be necessary. A report from the neurologist was later received dated December 11, 2002 and was distributed to the parties with a direct interest for comment. On January 27, 2003, the Panel met to render its decision and took into consideration final submissions received from both the claimant's union representative and his employer.

Reasons

File information reveals that the claimant underwent an MRI (magnetic resonance imaging) of his thoracic spine on June 8th, 2001. According to the radiologist's report, he concluded as follows: "Although not entirely specific, the appearance would be consistent with a clinical diagnosis of transverse myelitis."

A WCB medical advisor conducted a thorough review of the file on March 1, 2002. In a memorandum to file, he recorded the following comments:
"New information reviewed. The MRI is suggestive of a transverse myelitis at T5-6 level and the electrodiagnostic study of April 25/01 is consistent with a demyelinating neuropathy. These findings are more characteristic of demyelinating and inflammatory processes, not of acute injury."

We are satisfied based on the weight of evidence that the working diagnosis with respect to the claimant's condition has been confirmed as transverse myelitis. In addition, we note that the claimant did not report any trauma while he was at work on December 30th, 2000 when his symptoms began to manifest themselves. Finally, we attached considerable weight to the opinion expressed by the claimant's treating neurologist in a letter to the Appeal Commission dated December 11th, 2002 in which he stated:
"…Two-thirds of acute transverse myelitis episodes are idiopathic. Virus infections seem to trigger one-third of the cases of transverse myelitis in adults and at least half of the cases in children (Lipton and Teasdall 1973; Berman et al 1981). Transverse myelitis typically develops 3 days to 15 days after an upper respiratory infection (Paine and Byers 1953; Jeffery et al 1993). Generally speaking trauma is not a cause of this syndrome. I do not believe that the accident in December 5, 2000 caused this illness."

We find that the claimant's condition is not, on a balance of probabilities, related to his compensable injury of December 2000. Accordingly, responsibility for medical treatment beginning January 3rd, 2001 should not be accepted by the WCB. Given our decision with respect to the first issue, it necessarily follows that the second issue also fails inasmuch as the worker's loss of wages is not due to a compensable injury. Therefore, the claimant's appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
C. Monk, Commissioner

Recording Secretary, B. Miller

R.W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 18th day of February, 2003

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