The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on July 29, 2003, at the request of a worker advisor, acting on behalf of the claimant.

Issue

Whether or not the claimant's ongoing right knee problems are related to the effects of the compensable injuries occurring on December 12, 1983 or November 21, 1995.

Decision

That the claimant's ongoing right knee problems are not related to the effects of the compensable injuries occurring on December 12, 1983 or November 21, 1995.

Decision: Unanimous

Background

While employed as a sheet metal journeyman on December 12, 1983, the claimant tripped on carpet and twisted his right leg, landing on his right knee. In a December 16, 1983 report, an orthopaedic surgeon stated that the claimant's left knee was entirely normal and that the right knee showed a definite laxity of a partial tear of the medial collateral ligament. The Workers Compensation Board (WCB) accepted the claim and benefits were paid between December 13, 1983 to May 2, 1984 when the treating orthopaedic surgeon determined that the claimant had no atrophy of the thigh and no swelling or effusion of his knee.

On November 21, 1995, the claimant incurred a second twisting injury to his right knee while employed as a micro computer technician. The accident occurred when the claimant was pushing a two-wheeled dolly around a corner. The diagnosis rendered by the family physician, according to a memo dated December 5, 1995, was a 2nd degree strain of the medial collateral ligaments of the knee and a torn medial meniscus. On March 12, 1996, surgery was performed to the right knee which revealed a tear of the posterior half of the medial meniscus and grade 3 chondromalacia.

A WCB medical advisor made the following comments after a review of the file on July 29, 1996:

"The partially meniscectomy should have resolved the meniscal tear which in my opinion was the pathology resulting from the C.I. [compensable injury]. The chondromalacia (pre-existing) still persists and will continue to do so probably permanently but I have no reason to think that the C.I. had any long term effect on the condition. Therefore the ongoing symptoms and functional compromise now relate entirely to pre-existing and not to the effects of the C.I.".

On August 1, 1996, a WCB adjudicator wrote to the claimant confirming that it was the WCB's position he had recovered from the effects of his compensable knee injury and that his ongoing difficulties were related to a pre-existing condition (i.e. chondromalacia).

In April of 1997, a WCB medical advisor reviewed the file information and was asked by primary adjudication to comment on whether or not the degenerative changes in the claimant's right knee were related to his 1983 accident. In a memo dated April 24, 1997, the medical advisor replied, in part, "A medial collateral ligament tear and laxity, as described in a narrative report on 16/12/83 and the persistence of accompanying pain according to the memo dated 10/5/84, could, possibly, lead to chondromalacia of the medial compartment of the R knee."

A WCB orthopaedic consultant reviewed the case on December 9, 1997. The consultant stated, in part, "In my opinion it has not been substantiated that his degenerative changes in the Rt knee are a result of his MCL (medial collateral ligament) injury in 1983." The claimant was then examined by a WCB orthopaedic consultant on January 16, 1998.

On March 20, 1998, a WCB adjudicator confirmed that it was the WCB's position that the claimant's right knee difficulties did not relate to either his 1983 or 1995 compensable injuries.

On November 16, 1998, a worker advisor, acting on behalf of the claimant, appealed the above decision and provided the WCB with a report from an orthopaedic specialist dated October 6, 1998. The orthopaedic specialist was of the opinion that the claimant's right knee difficulties were related to his 1995 compensable injury.

Prior to considering the appeal, primary adjudication referred the case to a WCB orthopaedic consultant to provide an opinion with respect to the recent report received from the treating orthopaedic specialist. His response to primary adjudication is dated December 18, 1998.

On January 19, 1999, primary adjudication wrote to the worker advisor indicating the orthopaedic consultant's opinion that the information provided by the treating orthopaedic specialist did not establish a cause and effect relationship between the claimant's present condition with the 1995 work related injury.

On November 8, 1999, the worker advisor provided additional information from the treating orthopaedic specialist dated May 8, 1999. Following consultation with a WCB orthopaedic consultant on February 10, 2000, primary adjudication informed the worker advisor that no change would be made to its previous decisions. The case was then forwarded to Review Office for consideration.

In a March 3, 2000 decision, Review Office determined that the claimant's ongoing right knee problems were not related to the effects of the compensable injuries occurring on December 12, 1983 or November 21, 1995. Following consultation with the WCB orthopaedic consultant assigned to Review Office, Review Office was unable to establish that the claimant's ongoing right knee difficulties were resultant from either of his compensable right knee injuries and were most likely due to degenerative changes in the knee. Review Office therefore determined that the claimant had no further entitlement to benefits or services with respect to his ongoing right knee problems.

On October 25, 2002, the worker advisor requested Review Office to reconsider its decision of March 3, 2000. In a response dated January 14, 2003, Review Office determined that no change would be made to its previous ruling of March 3, 2000. On May 12, 2003, the worker advisor appealed Review Office's decision and a non-oral file review was arranged.

Reasons

As the background notes indicate, the claimant was treated for a partial tear of the medial collateral ligament of his right knee as a result of a compensable incident occurring on December 12^th, 1983. On November 21^st, 1995, he sustained a second compensable accident, which ultimately necessitated surgical treatment for a right knee medial meniscus tear. At the time of the March 12^th, 1996 surgery, the claimant was noted to have degenerative changes involving the patella and medial compartment.

An orthopaedic consultant to the WCB examined the claimant on January 16^th, 1998. He recorded the following comments in his examination notes:

“The claimant sustained a relatively minor injury to the right knee joint in 1983…from which he made a full recovery.

The injury to the right knee in November 1995 at best may have been the cause of a degenerative tear of the medial meniscus for which the board accepted responsibility for surgical treatment.

The delayed recovery and continued symptoms arise out of degenerative changes in the patellofemoral and medial compartments identified at surgery. These degenerative changes did not arise out of the work related injury of 1983 and are the continuing cause of his symptoms and are not the responsibility of the Workers Compensation Board.”

Prior to making a decision, Review Office requested its orthopaedic consultant to provide an opinion as to why he felt the degenerative changes in the claimant’s right knee were/were not related to the 1983 and the 1995 compensable injuries. We note in particular the consultant’s response contained in a memorandum dated March 3, 2000.

“The claimant was treated for a partial tear of the medial collateral ligament of the right knee as a result of a CI occurring December 12, 1983. Partial tears of the medial collateral ligament usually heal successfully with no residual instability. It was reported in May 1984…that the claimant made a full recovery with no residual ligamentous laxity and therefore this is most unlikely to lead to the development of degenerative changes within the knee joint. It is suggested the claimant had no further difficulty until the CI occurring November 21, 1995 at which time on subsequent surgery March12, 1996, he was noted to have the degenerative changes involving the patella and medial compartment. This degree of change would not have developed in this short period of time. Diagnosis subsequent to the CI of November 21, 1995 was a tear of the medial meniscus.

It has been noted by Dr. [treating orthopaedic surgeon] that a torn medial meniscus occurring as a result of trauma subsequently requiring excision and subsequently over a period of years can lead to the development of degenerative changes. It is also recognized that chronic ligamentous instability of the knee due to ligamentous laxity as a result of a tear can also lead to the development of degenerative changes within the knee joint. However, there is usually a history of ongoing instability problems and symptoms.

In my opinion, it has not been established that the partial tear of the medial collateral ligament the claimant sustained in 1983 has led to the subsequent degenerative changes within the claimant’s right knee joint. The file indicates the claimant made a complete recovery from that injury with no indication of ongoing problems with the knee until the CI occurring in 1995.”

After having considered all of the evidence, we are more inclined to attach greater weight to the foregoing opinions. As such, we find that the claimant’s ongoing right knee problems are not, on a balance of probabilities, related to the effects of the compensable injuries occurring on December 12, 1983 or November 21, 1995. 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 15th day of September, 2003