Decision #57/03 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on April 15, 2003, at the claimant's request. The Panel discussed this appeal on April 15, 2003.

Issue

Whether or not the worker is entitled to chiropractic treatment beyond December 29, 1999; and

Whether or not the worker's neck and back complaints as of July 10, 2000 are related to the compensable injury of August 2, 1999.

Decision

That the worker is not entitled to chiropractic treatment beyond December 29, 1999; and

That the worker's neck and back complaints as of July 10, 2000 are not related to the compensable injury of August 2, 1999.

Decision: Unanimous

Background

The claimant filed a claim for compensation benefits with respect to a work-related injury that occurred on August 2, 1999. On this date, the claimant tripped and fell, striking her knee, hands, breast, chin and shoulder onto the sidewalk.

On August 3, 1999, a chiropractor reported that the claimant complained of pain in her neck, back, leg and chin and that she had significant reduction in range of motion of her lumbar/cervical spines. No x-rays were taken as the claimant was pregnant. The diagnoses rendered were multiple abrasions/contusions and cervical and lumbopelvis subluxation. The chiropractor also advised that the claimant had multiple WCB claims related to neck injuries. The Workers Compensation Board (WCB) accepted the claim and paid wage loss benefits commencing August 4, 1999.

With respect to the claimant's previous neck difficulties, the claimant had been examined by a WCB chiropractic advisor on July 22, 1999 as a result of a work related injury that occurred on April 28, 1999. The claimant exhibited full ranges of motion in her cervical and lumbar spines. The chiropractic advisor was of the opinion that the claimant suffered from a mild cervical thoracic strain/sprain type of injury and that treatment should involve increasing her exercise activities.

The claimant was involved in a motor vehicle accident (MVA) on August 18, 1999 and a complete claim file was obtained from Manitoba Public Insurance in this regard.

On August 31, 1999, the WCB confirmed that chiropractic treatment would be accepted for a maximum of 14 weeks to November 8, 1999 inclusive and final.

In late September 1999, the claimant advised the WCB that her chiropractor had given her the okay to try a graduated return to work program. The employer, however, was unable to accommodate the claimant with light duties.

On December 13, 1999, the claimant was advised that the WCB would continue to issue full wage loss benefits up to the date that she delivered her baby.

In a memo dated December 14, 1999, a WCB chiropractic advisor noted that when he examined the claimant in July 1999 there were no objective findings and that ongoing therapy was terminated. The claimant had two other claims involving her neck, chin and upper back. The chiropractic advisor felt that the claimant had received sufficient therapy given the nature of her injury. He was not convinced there was a direct relationship to the claimant's ongoing problems and the compensable injury.

In further correspondence dated December 22, 1999, an additional six weeks of chiropractic treatment was authorized by the WCB up to December 20, 1999 as the attending chiropractor noted that the claimant was having ongoing symptoms.

The claimant delivered her baby on December 30, 1999 and wage loss benefits were paid to December 29, 1999 inclusive and final.

On March 8, 2000, the claimant wrote to the WCB indicating that she was still experiencing problems with her neck from the incident at work. Primary adjudication in turn, requested a narrative report from the treating chiropractor, which was later received and dated May 25, 2000. The chiropractor noted that the claimant continued to experience ongoing neck pain with associated cephalgia and that her ongoing symptom complex was a result of her August 2, 1999 incident and was not as a result of the August 18th MVA.

On June 2, 2000, the WCB determined that the claimant had essentially recovered from her work injury based on the history of injury, diagnosis, expected symptom duration, subsequent investigations, current clinical findings and the time that had passed. As a result, no change would be made to the previous decision to end WCB responsibility as of December 29, 1999.

In July 2000, a worker advisor requested a more detailed explanation of the above decision. In a response dated September 18, 2000, primary adjudication noted that the claimant had been given a letter from her employer on July 22, 1999 addressing its concern over excessive sick time since the April 1999 neck injury. The claimant was asked to put a plan in place by August 3, 1999 which would address her own medical needs and the needs of the organization. On this same day, the claimant attended a call-in examination at the WCB. The examination results showed that the claimant had full range of motion, mild tenderness and subjective complaints of mild discomfort. The claimant was instructed to continue with her daily exercises and remain as active as possible.

Primary adjudication made reference to various reports on file received from the treating chiropractor and from the claimant's attending physician. In particular, primary adjudication noted that when the claimant was assessed on July 26, 2000 for a prenatal check up, the claimant requested six months off work due to neck pain. The attending physician felt this was excessive and did not authorize the time off work. When seen again by this same physician on October 15, 2000, the claimant was advised that she had significantly improved and could return to work without restrictions. The May 25, 2000 report from the treating chiropractor noted left sided difficulties. He indicated that the claimant's lower back pain had completely resolved and the neck pain was the main complaint. From the medial information on file, primary adjudication was unclear as to how the current left sided decrease in range of motion related to the claimant's right sided injuries of August 2, 1999.

Primary adjudication concluded that although the claimant had experienced some symptoms, it felt that her current complaints were no longer related to her injury of August 2, 1999. No loss of earning capacity due to her August 2, 1999 injury had been established.

In May 2001, the Review Office received an appeal submission from the claimant dated April 28, 2001. Included with her submission was a letter from an occupational health physician dated March 7, 2001.

In a decision dated May 11, 2001, Review Office determined that as of July 10, 2000, it could not relate the claimant's subjective complaints of neck discomfort to the compensable injury of August 2, 1999.

Review Office did not authorize chiropractic treatment beyond December 30, 1999 as the claimant had months of treatments that were adequate for the injury she sustained on August 2, 1999. With respect to the mechanics of the accident, Review Office felt that such an incident would not produce a whiplash motion that would create significant damage to the soft tissue structure surrounding the claimant's cervical area.

There was no loss of earning capacity as of July 10, 2000 (the expected return to work date after maternity leave) in relation to the August 2, 1999 injury. Taking into consideration the length of time since the August 1999 incident and all that had transpired in the year between the date of accident and the end of her maternity leave, Review Office felt that a cause and effect relationship did not exist between the subjective complaints of discomfort and the original injury.

In February 2003, the claimant appealed Review Office's decision and requested an oral hearing. A letter by the treating chiropractor dated November 18, 2002, was submitted to the Appeal Panel for consideration. On April 15, 2003, an oral hearing took place at the Appeal Commission.

Reasons

With respect to the second stated issue, we find that the worker's neck and back complaints as of July 10th, 2000 are not related to her compensable injury of August 2nd, 1999. In a letter to the WCB dated May 25th, 2000, the treating chiropractor advised that "there has been resolution of Ms. [the claimant's] lower back pain." There was no evidence presented at the hearing to suggest that there were any ongoing back problems. In fact the claimant testified that her back was symptom free. "I mean I guess a sore back every once in awhile, but I don't think any more so than any normal person. So if I understand your question correctly, no, there's no ongoing things to middle or lower back."

As to the claimant's neck difficulties, we attached considerable weight to the evidence of an occupational health medical specialist, who examined the claimant on March 7th, 2001. In a letter bearing the same date to a family physician, he reported as follows:
     "On examination Ms [the claimant] stands 5' 7" in height, weighing 200 pounds. She is right hand dominant. She does have a forward head posture with moderate cervical kyphosis and a compensatory head tilt that would contribute to posterior neck muscle loading and static strain. The left shoulder is held slightly lower than the right, but there is no shoulder rounding or scapular winging. She has good range of motion in rotation, lateral flexion, and flexion and extension of the neck as well as inter motion of the shoulders.
     She does have an underlying postural condition in the neck and head that predisposes her to muscle sprain. I discussed with her postural retraining and the usefulness of other, more active therapy besides chiropractic directed at muscle tissues themselves which I encouraged her to consider in the future, such as athletic therapy."

We find that the claimant's neck problems are, on a balance of probabilities, postural in nature and that this condition is non-compensable and unrelated to the compensable injury of August 2nd, 1999. Accordingly, the claimant is not entitled to chiropractic treatment beyond December 29th, 1999. Therefore 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 14th day of May, 2003

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