Decision #140/03 - Type: Workers Compensation

Preamble

A non-oral file review was held on October 14, 2003, at the request of a worker advisor, acting on behalf of the claimant.

Issue

Whether or not the worker is entitled to wage loss benefits beyond August 22, 2002.

Decision

That the worker is not entitled to wage loss benefits beyond August 22, 2002.

Decision: Unanimous

Background

During the course of his employment as a labourer/crew boss on August 21, 2002, the claimant began to experience numbness on one side of his face along with shaking, sweating and dizziness. The claimant indicated that he had been digging around a hydro pole at the time and that the ground was hard to dig. There were rocks around the pole which he had to dig out and lift out of the hole. The claimant was taken to a hospital for treatment by a co-worker. The diagnosis rendered was a possible transient ischemic attack (TIA).

On August 24, 2002, the claimant was admitted to a hospital emergency facility with left sided chest heaviness and pain with radiation into his left arm. Further details with respect to his entrance complaints and hospital stay can be found in the hospital admissions note dated September 2, 2002. The claimant was discharged from the hospital on August 26, 2002 with the diagnosis of "chest pain NYD (not yet diagnosed)".

A report was received from a specialist dated October 10, 2002 who provided the opinion that the claimant's symptoms "sound anginal. He also sounds as though he had a TIA."

In December 2002, the case was reviewed by a WCB medical advisor at the request of primary adjudication. The medical advisor was of the opinion that the possible diagnosis was ischemic heart disease with angina or transient ischemia attack. The medical advisor further indicated that the diagnosis was not related to the claimant's work as the claimant had underlying atherosclerosis with a number of risk factors. He stated that the claimant's work may have brought on his symptoms but there was no cause and effect. He also stated, "time loss depends on resolution of symptoms but is related to underlying disease, not work activities."

On January 13, 2002, the claimant was advised by primary adjudication that the WCB was unable to accept his claim for the difficulties he experienced on August 21, 2002. Primary adjudication stated that there was insufficient evidence to support a relationship between the claimant's difficulties and his work duties. On January 31, 2003, a worker advisor appealed this decision to Review Office. It was the worker advisor's position that the claimant's pre-existing heart condition had been aggravated by his August 21, 2002 work duties, which in turn caused the difficulties he experienced.

In a decision dated February 28, 2003, Review Office determined that the claim was acceptable, however, wage loss benefits were only payable for August 22, 2002 as it was felt that any loss of earning capacity beyond that date was due to the claimant's underlying condition. Review Office stated, in part, there was evidence that the claimant left the hospital on August 22, 2002 and returned home as he felt well enough to do so. Review Office was of the opinion that this confirmed that the acute bout of angina had expired and thus the WCB's responsibility had ended. Any ongoing problems in the upcoming days beyond August 22, 2002 were due to the claimant's underlying condition, which had been tentatively diagnosed as transient ischemia attack producing angina.

On April 14, 2003, Review Office was asked by the claimant's worker advisor to consider a report submitted by the treating physician dated April 10, 2003. The worker advisor was of the opinion this report supported the fact that the claimant continued to suffer from the aggravation to his pre-existing condition and that he was not fit to perform his work duties as of August 23, 2003. It was also the claimant's belief that the April 10th report supported his hospitalization on August 24, 2002 for similar symptoms thus continuing the effects of the August 21, 2002 aggravation.

In a response to the worker advisor dated May 15, 2003, Review Office indicated that it was in agreement with the medical opinion provided by the physician. However, the fact that the claimant should not be allowed to return to work until the investigation was complete was not a compensable scenario, i.e. the time frame involved in completing the tests to arrive at a definitive diagnosis was preventative medicine and Review Office felt it would indeed be wise for the attending physicians to keep the claimant from his labour duties until the definitive diagnosis had been reached. Review Office summarized its position that the WCB was only responsible for the acute exacerbation of the underlying condition. It was the underlying condition that was responsible for the conservative measures being implemented by the physicians, that kept the claimant from work. It was not the accident of August 21, 2002 as the effects of that temporary aggravation would have ended by August 22, 2002.

On June 12, 2003, the worker advisor appealed Review Office's decision that the claimant was not entitled to wage loss benefits beyond August 22, 2002. A non-oral file review was then scheduled.

Reasons

As the background notes indicate, the claimant presented at a hospital emergency ward two days following his initial attack with left sided chest heaviness and pain with radiation to his left arm. According to the hospital's admission note, the claimant was "quite vague about the chest pain and the symptoms seemed to change each time you asked him". The claimant was treated with aspirin and nitro spray, which provided some relief of his pain. Over the course of the first day of admission, he continued to experience periodic chest pain that responded to nitro sprays. He was continued on intravenous Heparin until the second day at which time he had been chest pain free for 24 hours. The claimant stated that he was feeling well and he decided to go home. He did not attend an appointment for a CT angiogram, which had been scheduled for the following day.

After thoroughly reviewing the file, the weight of evidence has led us to conclude that the claimant's continuing problems beyond August 22nd, 2002 were, on a balance of probabilities, as a consequence of his non-compensable underlying condition, which appears to have been diagnosed as a transient ischemia attack and possible angina. In this regard, we attached considerable weight to certain comments expressed by a treating physician in her letter of April 10th, 2003 to the claimant's worker advisor.

"Based on available information and based on your definition of enhancement, I can not say that Mr. [the claimant's] pre-existing heart condition was permanently and adversely affected by performing his August 21st duties. Firstly, Mr. [the claimant] did not have a firm diagnosis of ischemic heart disease prior to his visits on August 21, 2002. Secondly, during his hospital visit and hospital stay, there was no evidence of cardiac damage done based on the lab tests or EKG's."

We find in accordance with the weight of evidence that the claimant's acute exacerbation of transient ischemic attack and possible angina had resolved by the time he was discharged from his hospital visit on August 22nd, 2002. We further find that the worker is not entitled to wage loss benefits beyond August 22, 2002. 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 1st day of December, 2003

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