The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on October 7, 2003, at the claimant's request.

Issue

Whether or not the worker is entitled to benefits beyond September 30, 1997.

Decision

That the worker is not entitled to benefits beyond September 30, 1997.

Decision: Unanimous

Background

On September 3, 1997, the claimant filed a workers compensation claim for an accident that occurred on July 22, 1997 during the course of her employment as a dietary aide. On this date, the claimant slipped on a broken piece of linoleum while entering a walk-in freezer, whereby she went down onto her right knee and felt immediate pain in the centre of her lower back.

Following the accident, the claimant was treated by both a hospital physician and a chiropractor. The diagnosis rendered by the physician was a back strain and the treating chiropractor diagnosed the claimant with an acute lumbosacral sprain with concomitant muscle spasm. X-rays of the lumbar spine were also taken on September 25, 1997 which revealed mild spondylosis throughout the lumbar spine with slight disc space narrowing at L4-5 and osteoarthritis of the L4-5 and L5-S1 facet joints.

The claim for compensation was accepted by the Workers Compensation Board (WCB) and benefits were paid to the claimant up to September 30, 1997 when it was determined by the treating chiropractor that the claimant could return to work half days. The attending physician also agreed that the claimant could return to work by October 1, 1997 as it was felt that her back pain was much improved.

On October 9, 1997, the treating chiropractor contacted the WCB requesting that the claimant be assessed at the WCB as the claimant was experiencing extreme pain since returning to work. As a result of the request, the claimant was assessed by a WCB chiropractic consultant on November 4, 1997.

In a decision letter dated December 2, 1997, the claimant was advised that the WCB chiropractic consultant was unable to find any objective evidence of residuals from the July 22, 1997 compensable incident. Ranges of motion had been within normal limits and there were no neurological deficits noted. There were complaints of pain, but there was no objective medical evidence to support ongoing benefits. Based on these factors, it was determined that the claimant had essentially recovered from the effects of her work related accident of July 22, 1997. On December 11, 1997, the claimant appealed this decision to the Review Office.

On January 16, 1998, the Review Office confirmed that the claimant was not entitled to further benefits after September 30, 1997. Review Office was of the opinion that it had not been shown that the claimant's subjective symptoms of ongoing lower back pain after September 30, 1997 was causally connected to the work related accident in July of 1997.

Subsequent file information contained the results of a CT scan dated March 13, 1998. On July 27, 1998, Review Office advised the claimant that the CT scan results did not provide evidence of focal disc herniation at any level between L3 and S1 and that no change would be made to its earlier decision to deny benefits after September 30, 1997.

The case was again considered by Review Office on September 20, 2002, based on several new medical reports that were received from an orthopaedic specialist. Review Office concurred with the advice provided by a WCB orthopaedic consultant, which was obtained on September 19, 2002, that the claimant's multi-level osteoarthritis and degenerative disc disease of the lumbar spine were not a consequent of this accident. Review Office was therefore of the opinion that the claimant was not entitled to payment of wage loss benefits or the provision of services beyond September 30, 1997. In July 2003, the claimant appealed Review Office's decision and a non-oral file review was arranged.

Reasons

This case involves a dietary aide who slipped and fell at work, in July 1997, incurring an injury to her lower back. Her claim for compensation was accepted and benefits were paid accordingly.

Benefits were terminated as of September 30, 1997, as it was determined that she had recovered sufficiently to return to work. Her case was reconsidered on four separate occasions by Review Office which upheld the decision to end benefits each time. She has appealed those decisions to the Appeal Commission.

For her appeal to be successful, the Appeal Panel would have to determine that she continued to suffer a loss of earning capacity after September 30, 1997, as a result of the workplace injury. We were not able to make that determination.

We came to our conclusion by way of a file review, in which each panellist conducted a thorough review of the file and then came together to consider the issue before us.

We took note of the medical history of the claim, which is delineated in the "Background" section of this decision. In particular we noted that an x-ray, taken in September 1997, showed degenerative changes to her lower spine.

By late September, both the attending physician and chiropractor felt she was able to return to work, which she did on October 1. This, however, was not successful. Within a few hours of the first shift, she was complaining of considerable pain in her lower back.

The treating doctors were unable to discern the cause of her pain. After examination, on October 8, the chiropractor reported that all objective signs and tests conducted were essentially normal. He wrote that he was unable to determine the cause of her pain and flare-ups.

An examination by a board chiropractic consultant, on November 4, 1997, could find no objective signs and symptoms to support a link between her pain and the workplace injury.

A CT scan, done in March 1998, found mild disc bulging and mild degenerative changes at L3/4, L4/5 and L5/S1. No disc herniation was seen.

We took note of reports from an orthopaedic specialist seen by her in December 2001, March 2002 and May 2002. He reports that further diagnostic testing, including x-rays and an MRI, has been conducted. The testing further confirms the existence of mild degenerative changes and minor disc problems, as previously noted. There was no nerve root compression.

This specialist wrote further: "She has underlying pathology in the low back and might have had similar type of degenerative changes at the time of her injury."

The final medical report of note is one written by a WCB orthopaedic consultant, who wrote:

"The claimant has multilevel osteoarthritis and degenerative disc disease of the lumbar spine which cannot be explained on the basis of the one incident occurring July 22, 1997. They are ageing changes."

Based on our consideration of the foregoing evidence, we are unable to find any medical evidence which would support a causal link between her compensable injury and her ongoing lower back problems.

The claimant argues that since she had no pain prior to the compensable injury, the pain she now has must be related to the injury. However, it is our conclusion - on a balance of probabilities - that, due to pre-existing degenerative disc disease and osteoarthritis, her ongoing back pain was neither caused nor enhanced by her workplace injury. While it may have been aggravated by the accident, the aggravation had subsided by the end of September 1997. Thus, there was no loss of earning capacity beyond September 30, 1997.

Accordingly, the appeal is dismissed.

Panel Members

T. Sargeant, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

T. Sargeant - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 21st day of November, 2003