Decision #49/03 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held via teleconference on April 3, 2003, at the claimant's request. The Panel discussed this appeal on April 3, 2003.

Issue

Whether or not the worker is entitled to payment of wage loss benefits beyond June 6, 2000.

Decision

That the worker is not entitled to payment of wage loss benefits beyond June 6, 2000.

Decision: Unanimous

Background

While employed as a linesman-foreman on February 19, 1999, the claimant was working with a rock drill when it slipped and "I fell ahead, but my leg stayed, causing knee injury." Initial medical reports showed that the claimant was diagnosed with a left knee sprained ligament. On March 31, 1999, an orthopaedic surgeon suspected that the claimant had sustained a medial meniscus tear and mild laxity of the medial collateral ligament of the left knee. The Workers Compensation Board (WCB) accepted the claim and wage loss benefits were paid to the claimant effective February 26, 1999.

On July 8, 1999, the treating orthopaedic surgeon said he was awaiting the results of an MRI examination before treatment plans would be implemented. He thought that the claimant had significant bilateral injuries and would likely need bilateral arthroscopies.

An MRI assessment was performed on July 8, 1999. There were wide spread degenerative changes in both knees, with maceration of both lateral menisci. Appearances suggested small loose bodies within the right joint, which likely represented meniscal fragments. Bilateral large joint effusions were noted and there was evidence of an old MCL injury on the right.

In a September 1, 1999 report, the orthopaedic surgeon recommended surgery and he stated, in part, "I have no doubt that both of these injuries are acute and related to the previously described accident in question." On September 23, 1999, a WCB medical advisor authorized the left knee arthroscopy only as there was no information to suggest that the right knee had been involved in the accident. On September 28, 1999, the claimant underwent arthroscopies to both knees.

In a follow-up report dated November 10, 1999, the orthopaedic surgeon reported that the claimant had tears of both lateral menisci, which were related to his work injuries. The claimant also had significant effusions in the knee and the biopsy suggested a chronic inflammation. He had collateral ligamentous laxity and anterior cruciate laxity. Arrangements were made for physiotherapy and a knee brace.

On March 31, 2000, a WCB orthopaedic consultant examined the claimant and concluded that there was a continuing aggravation of the pre-existing degenerative condition in the left knee joint. Further x-rays and laboratory work were suggested before completing the report.

On May 5, 2000, the treating orthopaedic surgeon stated that both knees had very large effusions with quite remarkable crepitus, medial and lateral collateral laxity and anterior cruciate laxity. The surgeon was going to aspirate the knees and perform an injection of Depo Medrol.

In a May 23, 2000 memo, a WCB orthopaedic consultant commented that it was now 15 months since the workplace incident. He agreed that there had been an aggravation of pre-existing arthritis of the left knee and reluctantly accepted the torn lateral meniscus tear as a compensable event. However, the cruciate ligament abnormalities were not acceptable as work related (same findings found in the right and left, same as the lateral menisci). In the absence of any new medical information, the consultant was of the opinion that the aggravation no longer existed and that any workplace restrictions arose out of the pre-existing condition, and not the claim.

In a decision dated May 30, 2000, primary adjudication advised the claimant that wage loss benefits would be paid to June 6, 2000 inclusive and final. It determined that the claimant's problems were related to pre-existing degenerative changes in the left knee and that the identical situation was also present in the right knee. There was no evidence to support that the right knee was injured at the time of the compensable accident. The pre-existing condition in both knees was not caused nor enhanced by the compensable injury and the compensable injury no longer contributed to the claimant's ongoing symptoms.

On September 8, 2000, the case was considered by Review Office following receipt of an appeal from the claimant. The claimant advised the Review Office that he had had no problems with his knees before the accident and now, he could barely climb a small set of stairs. The claimant felt that he should be compensated for all the pain and suffering he had since the injury.

In its September 8th decision, Review Office stated that based on the accident description by the claimant and his employer, along with initial medical reports, the claimant did not sustain any type of acute injury to his right knee in the accident of February 19, 1999. Therefore, the findings noted on the MRI and arthroscopy in the right knee and to a large extent in the left knee, were not considered related to the compensable accident. Review Office said it could accept a limited time of aggravation to the right knee based on the claimant's favoring his left knee to some degree. Such an aggravation, however, would have ceased to exist prior to June 6, 2000.

Review Office agreed with the opinions expressed by both the orthopaedic consultant to Review Office and the WCB's orthopaedic consultant who examined the worker and concluded that the accident aggravation had now ended and that the claimant's ongoing problems were predominantly due to his pre-existing conditions. Review Office's decision was based on the criteria set out under policy 44.10.20.10 respecting pre-existing conditions.

On December 13, 2000, a worker advisor referenced the medical opinion expressed by the claimant's treating orthopaedic surgeon in a letter dated December 13, 2000 stating that the claimant had not recovered from the effects of his injury. The surgeon asserted that the claimant's injury was work related and that he was unable to return to his former employment as a direct result of the 1999 injury. The worker advisor believed that a difference of medical opinion existed and that a Medical Review Panel (MRP) was warranted and/or that the claimant was entitled to wage loss benefits beyond June 6, 2002.

Primary adjudication advised the claimant by letter dated February 16, 2001 that his request for an MRP was denied. At the worker advisor's request, the case was forwarded to Review Office and in a decision dated March 9, 2001, Review Office granted the request for an MRP under section 67(4) of The Workers Compensation Act (the Act). An MRP later took place on August 17, 2001.

In a further decision dated September 28, 2001, Review Office confirmed that the claimant was not entitled to payment of wage loss benefits beyond June 6, 2002. Review Office stated that the MRP's findings along with other evidence on file confirmed that the aggravation caused by this accident had ceased to exist prior to June 6, 2000. On January 26, 2003, the claimant disagreed with Review Office's decision and an oral hearing was held by teleconference on April 3, 2003.

Reasons

A Medical Review Panel (MRP) was convened pursuant to section 67(4) of the Act as there was an apparent difference of opinion with respect to a medical matter between the claimant's treating physician and a WCB medical advisor. The MRP consisted of a general practitioner and two orthopaedic surgeons. In addition, a radiologist was present as a consultant to the panel members.

In arriving at a decision with respect to the issue under appeal, we considered the evidence contained on the file as well as the MRP's findings. However, in the final analysis, we preferred to attach greater weight to the opinions expressed by the MRP. In particular, we took note of the following MRP findings:
  • The Panellists agree that there is evidence that Mr. [the claimant] sustained strained ligaments; mainly the lateral collateral ligament of the left knee in the injury of February 19, 1999.
  • The only objective finding reported during the first months after the injury, was seen in the x-ray of the left knee performed on February 20, 1999. This described the presence of a large effusion and also noted degenerative narrowing and spurring of the medial compartment.
  • The Panellists agree that there was aggravation of a pre-existing degenerative condition of the left knee at the time of the accident.
  • The Panellists agree that there is no evidence that Mr. [the claimant] injured his right knee as a result of the accident, which occurred on February 19, 1999.
  • The Panellists agree that there is no evidence that Mr. [the claimant's] right knee was injured indirectly or secondarily as a result of the left knee injury.
  • The Panellists agree that there is no relationship between the pre-existing condition in the right knee and the accident of February 1999.
  • The Panellists agree that the worker's current left knee condition is: Polyarthritis; Pseudolaxity of the ligaments of the knee; With regard to the menisci, the Panellists suggest that there is no evidence that the bilateral condition occurred at the time of the accident. The Panellists are of the opinion that Mr. [the claimant] probably had bilateral discoid menisci, which deteriorated over time.
  • The Panellists agree that Mr. [the claimant's] current condition of the left knee is due to seronegative polyarthritis. The Panellists do not agree that this condition is related to the accident.
  • The Panellists note that Mr. [the claimant] underwent bilateral arthroscopic surgery in the first instance on September 28, 1999.
  • It is noted in the record that on September 24, 1999, based on reports received by the Manitoba Workers Compensation Board, a Medical Advisor to the Workers Compensation Board agreed to the performance of "left knee arthroscopy".
  • The Panellists agree that this surgery was performed because of the continuation of the pre-existing inflammatory joint disease.
  • The Panellists agree that Mr. [the claimant] has recovered from the February 1999 accident. His current condition is due to pre-existing bilateral joint disease.
We find based on the preponderance of evidence that the claimant has, on a balance of probabilities, fully recovered from the effects of his compensable injury. In light of this conclusion, we further find that the claimant is not entitled to payment of wage loss benefits beyond June 6, 2000. 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 9th day of May, 2003

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