Decision #25/03 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on February 6, 2003, at the employer's request. The Panel discussed this appeal on February 6, 2003.

Issue

Whether or not the WCB should accept responsibility for the claim beyond December 15, 2000.

Decision

That the WCB should accept responsibility for the claim beyond December 15, 2000.

Decision: Unanimous

Background

While performing the duties of a service technician on July 21, 2000, the claimant reported having sustained injuries to his left knee and leg when he fell off of a step ladder and landed with his left leg under his buttock.

Initial medical information revealed that the claimant was seen at a hospital emergency facility following the accident and was diagnosed with a contusion to the left leg together with muscular pain in his left thigh. A Doctor's First Report dated July 26, 2000, noted that the claimant incurred a strained left knee and ligament after falling from a ladder onto a concrete floor. An x-ray report of the left knee dated July 31, 2000, showed no bone or joint abnormality was present.

In a letter to the attending physician dated October 11, 2000, an orthopaedic surgeon concluded that the claimant had incurred an internal derangement of his left knee as a result of the accident. Arrangements were made for an arthroscopic assessment. Financial responsibility for this procedure was accepted by the Workers Compensation Board (WCB) and the claimant underwent an arthroscope of his left knee on November 10, 2000. The post-operative diagnosis recorded was "internal derangement left knee, arthroscopy negative."

On December 13, 2000, the orthopaedic surgeon documented that he had explained to the claimant about the negative arthroscopic findings and that the claimant was going to attempt a return to work on December 18th. Subsequent file records showed that the claimant returned to work on December 18th, but ceased working on January 9, 2001, because of increasing pain.

In a January 24, 2001 report, the orthopaedic surgeon diagnosed the claimant with pain in the left lower limb NYD (not yet diagnosed). Arrangements were made for a bone scan examination of both hips and knees to rule out any underlying pathology.

A bone scan examination was performed on February 7, 2001. The results revealed the following: "Mild hyperemia within the left knee suggests a soft tissue process. There is no evidence of bone pathology."

Following an examination by a WCB orthopaedic consultant on March 2, 2001, primary adjudication wrote to the claimant on March 13, 2001. The claimant was advised of the orthopaedic consultant's findings that there were no objective medical findings or any abnormalities found on x-rays. "The pain complaints you had were not localized as one would expect with a specific injury. Therefore no diagnosis was confirmed." As primary adjudication was unable to confirm a diagnosis for the claimant's ongoing complaints, it could not relate his current difficulties to the original accident. As such, it would not accept responsibility for the claimant's time loss or for his medical treatment.

On May 21, 2002, the claimant appealed the WCB's decision of March 13, 2001 and submitted additional medical reports dated December 10, 2001, April 10, 2002 and April 30, 2002 for Review Office's consideration.

After reviewing all of the available file evidence, Review Office concluded on June 7, 2002, that no responsibility would be accepted for any time loss incurred by the claimant or for medical treatment. Review Office acknowledged, however, that further investigations were pending (i.e. an MRI) and if the claimant and his doctor believed that the results could be related back to the claim, then the claimant could request further consideration by Review Office.

On August 30, 2002, Review Office considered the case again following receipt of the July 11, 2002 MRI results submitted by the claimant. The MRI results confirmed that the claimant had a herniated disc with nerve root involvement. Review Office opined that the MRI results were compatible with the July 21, 2000 work injury. "This is supported by the clinical findings provided in the subsequent medical reports immediate and following the accident, and by the two opinions offered by the board's medical advisor and consulting orthopaedic specialist to Review Office. There has been continuity in the claimant's signs and symptoms since the accident and in our view the claimant is still recovering from that injury." On October 4, 2002, the employer appealed the Review Office decision of August 30, 2002 and an oral hearing was convened.

Reasons

A thorough review of the evidence on file revealed that there definitely was continuity of complaints by the claimant with respect to his leg weakness, numbness and pain. These complaints were evident as early as July 26th, 2000. Eventually these symptoms were later attributed to an undiagnosed disc herniation in the lower back, which was positively confirmed by way of an MRI conducted on July 11th, 2002. We note in particular the following comments recorded by the radiologist:

"At the L5-S1 level, there is a small to moderate sized central and right paracentral disc herniation. The disc material contacts the right S1 nerve root, and there is some posterior displacement and suspect compression of the right S1 nerve root. The disc material contacts the left S1 nerve root without convincing evidence of compression of the left S1 nerve root. However, I cannot exclude some mild compression or irritation of the left S1 nerve root by the disc material. There is no significant compression of the thecal sac, or central spinal stenosis."

A WCB orthopaedic consultant was asked to provide an opinion with respect to there being a causal relationship between the MRI findings and the claimant's original injury. "Possibly. The initial mechanism of injury & immediate & early signs & symptoms would be atypical for a disc injury with radiculopathy."

Based on the weight of evidence we find that the mechanism of injury is entirely consistent with the claimant's diagnosis as confirmed by the MRI. Therefore, the WCB should accept responsibility for the claim beyond December 15th, 2000. Accordingly, the employer's appeal is hereby denied.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
L. Butler, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 21st day of February, 2003

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