Decision #97/03 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on August 14, 2002, at the claimant's request. The Panel discussed this appeal on August 14, 2002 and again on July 15, 2003.Issue
Whether or not the worker is entitled to payment of wage loss benefits and/or services beyond January 31, 2002.Decision
That the worker is not entitled to payment of wge loss benefits and/or services beyond January 31, 2002.Decision: Unanimous
Background
While employed as a healthcare aid on September 17, 2000, the claimant was helping a resident to the dining room when the resident flung herself into a nearby chair "still clutching my arm, pulling me down with her." The claimant reported an injury to her left shoulder.Medical information revealed that the claimant attended a local hospital for treatment on September 18, 2000. The claimant complained of tenderness in the insertion of the left rotator cuff, medial to the left scapula, ascending up into the base of her neck and swelling of the left arm. The diagnosis rendered was an "injured shoulder". A Doctor's First Report dated October 7, 2000, diagnosed the claimant with a soft tissue strain to the left shoulder. The Workers Compensation Board (WCB) accepted the claim and wage loss benefits were paid during the claimant's absences from work.
On January 26, 2001, the attending physician provided a narrative report concerning his treatment of the claimant between October 5, 2000 and January 4, 2001. The physician summarized that the claimant had a "non-specific shoulder strain with possible traction injury to the nerve roots related to her traction injury." The physician recommended that the claimant continue physiotherapy treatments and a referral was made to an orthopaedic surgeon and nerve conduction studies were ordered.
On February 9, 2001, the orthopaedic surgeon concluded that the claimant had left shoulder pain after an incident at work and she also had developed some neurological symptoms. Further testing was suggested. In the meantime, it was recommended that the claimant return to work on light duties and to continue with physiotherapy.
The results of a CT scan of the upper extremities dated April 25, 2001, revealed "Normal CT arthrogram left shoulder joint."
Nerve conduction studies were performed on May 3, 2001 and were analyzed as follows: "This electrophysiological study is considered to be within normal limits. There is no evidence of carpal tunnel syndrome, ulnar neuropathy, neurogenic thoracic outlet syndrome or a more proximal lesion in the left upper extremity."
In August 2001 and again in October 2001, a sports medicine specialist assessed the claimant. In a report dated October 13, 2001, the specialist reported that the claimant had evidence consistent with a glenohumeral subluxation secondary to multidirectional glenohumeral laxity. The compensable injury made this condition worse. The claimant also had some lower trunk brachial plexopathy with the original traction injury. The specialist felt that the claimant should continue with postural and scapular stabilizing exercises and a referral to a second orthopedic specialist was suggested for advice concerning shoulder stabilization procedures. The results of the orthopaedic specialist's findings are on file dated November 19, 2001.
On January 17, 2002, a WCB orthopaedic consultant reviewed the reports on file and concluded that the claimant's original work related injury was a soft tissue injury and that she had recovered from this injury. The consultant was also of the opinion that the claimant's present symptoms were due to her shoulder laxity which appeared to be a pre-existing condition. It was felt that the claimant could return to work with restrictions. On January 24, 2002, primary adjudication advised the claimant that wage loss benefits would be paid to January 31, 2002, inclusive and final, based on the opinion expressed by the orthopaedic consultant. On February 7, 2002, the claimant appealed the decision to Review Office.
In a decision dated February 15, 2002, Review Office determined that the weight of evidence did not establish a reasonable or probable cause and effect relationship between the claimant's compensable injury of September 17, 2000 and her ongoing difficulties that she was experiencing with her left shoulder. Review Office noted that the claimant sustained a soft tissue injury to her left shoulder as a result of the September 17th compensable accident and that she had undergone adequate treatment to assist in resolving this condition. There was no clinical evidence to support that she sustained any other significant injury. Review Office referred to the opinions that were expressed by WCB healthcare consultants that the claimant had a pre-existing condition known as mild bilateral laxity of the shoulders. Review Office concluded that the claimant had recovered from the effects of her compensable injury and was not entitled to further wage loss benefits and/or services beyond January 31, 2002. On May 28, 2002, the claimant appealed this decision to the Appeal Commission.
On August 14, 2002, an oral hearing was convened. Following the hearing and discussion of the case, the Appeal Panel requested additional information from the claimant's treating physicians and from her treating physiotherapist. The case was then to be referred to a Medical Review Panel (MRP) in accordance with Section 67(3) of the Workers Compensation Act (the Act). On February 3, 2003, a MRP was convened and the final report was forwarded to the interested parties for comment.
On February 19, 2003, the Panel met further to discuss the case and decided to have the claimant referred to an independent specialist for examination. On June 17, 2003, the report from the specialist was forwarded to the interested parties for comment. On July 15, 2003, the Panel met to render its final decision with respect to the issue under appeal.
Reasons
This case involves a health care worker who injured her left shoulder as a result of a workplace incident in September 2000. Her claim for compensation was accepted and benefits were paid accordingly.By January 2002, the board had determined that her ongoing problems with her shoulder were not related to her compensable injury and benefits were terminated. This decision was upheld upon reconsideration by Review Office. She then appealed that decision to the Appeal Commission.
For her appeal to be successful, the Appeal Panel would have to determine that her left shoulder problems are causally related to her workplace injury. We were not able to come to that determination.
In reaching our decision, we conducted a thorough review of the claim file, as well as holding a hearing, at which we heard testimony from the claimant. Subsequent to the hearing, the Panel sought further medical information. This included:
- Information from treating physicians and a physiotherapist;
- Examination by a Medical Review Panel; and
- Examination by an independent medical specialist.
In its report, the MRP noted the following:
- Tests conducted in April and September 2001 showed a normal CT arthrogram of her shoulder, with no evidence of rotator cuff tendon or labral tear; and a normal CT of the cervical spine, with no interdisc herniation or protrusion.
- The most probable diagnosis of this claimant's workplace injury was a soft tissue strain about the left shoulder.
- The MRP could find no evidence that she had a relevant pre-existing condition affecting her left shoulder and/or neck prior to September 2000.
- The panel could find no neurological or orthopaedic abnormality affecting her left shoulder or neck. The panel felt that there is "unexplained pain involving the soft tissues of the left shoulder and neck."
- The panel believed that "there is probably pain amplification."
- The only relationship between the current symptoms and the workplace accident is temporal. "The pain came about following the injury, but the propagation and prolongation are unexplainable."
- "The physical examination does not reveal a condition which would explain the pain complained of by [the claimant]. [She] is disabled because of her strong belief that her pain is disabling."
- "The Panellists would strongly suggest to [the claimant] that she resume employment …"
- "… for her ongoing shoulder discomfort, I cannot comment that her current problems are related to her claimable injury versus any of the recurrent popping episodes since any of which may have worsened the underlying structures to allow such recurrent subluxation to recur so frequently. As such, I cannot support restoration of income replacement on the basis of this injury."
- "… increasing her activity would have significant benefits both for mood, social reintegration, and her overall physical health. There are no medical contraindications to increasing work activity."
Accordingly, the appeal is dismissed.
Panel Members
T. Sargeant, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
T. Sargeant - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 3rd day of September, 2003