Decision #04/04 - Type: Workers Compensation

Preamble

A non-oral file review was held on November 19, 2003, at the claimant's request.

Issue

Whether or not the worker is entitled to wage loss benefits beyond April 23, 2003.

Decision

That the worker is not entitled to wage loss benefits beyond April 23, 2002.

Decision: Unanimous

Background

In September 2001, the claimant contacted the call centre at the Workers Compensation Board (WCB) to report a lower back injury that occurred during the course of her employment as a laundry aide worker on August 23, 2001. On the day of the accident, the claimant attended her family physician for treatment and was diagnosed with a muscle strain to the lower back. The claim was accepted by the WCB and benefits were paid accordingly.

On September 6, 2001, x-rays were taken of the lumbosacral spine. The report revealed no bony abnormality.

In a progress report dated January 22, 2002, the attending physician noted that the claimant complained of right lower back pain when lifting weight more than 5 lbs. Objective findings revealed good range of motion in her lumbar spine. The claimant was considered capable of performing alternate or modified work which included no heavy lifting. The physician also commented that the claimant was going to be referred to an orthopaedic specialist for assessment.

On March 5, 2002, the claimant was advised by primary adjudication that there were no objective findings noted in her medical reports to support continued time loss from work. The claimant was considered to be essentially recovered from her workplace injury and therefore she was not entitled to further benefits beyond October 12, 2001.

In a letter to the WCB dated October 25, 2002, the claimant advised that her back and right hip were still very painful from the compensable injury and that she had been told by her orthopaedic specialist that she had a very rare type of osteoarthritis in her hip and pelvis region. The claimant therefore believed that she was entitled to WCB benefits from October 13, 2001 to July 27, 2002 inclusive.

On December 3, 2002, the claimant was advised by primary adjudication that it was still the WCB's position that she had recovered from the effects of her compensable injury and no further benefits were payable. On December 15, 2002, the claimant disagreed with this decision and the case was referred to Review Office. On January 24, 2003, Review Office referred the case back to primary adjudication for further handling as pertinent medical documentation provided by the claimant's treating physicians were missing from the file.

Subsequent medical reports revealed that the claimant underwent a bone scan as well as x-rays of the sacroiliac joints on August 12, 2002. In a report to the family physician dated October 10, 2002, the treating orthopaedic specialist noted that the claimant had sero negative arthritis which he did not think was related to an injury at work.

In a report dated May 7, 2003, the family physician provided the WCB with a summary of the dates on which he had seen the claimant between September 10, 2001 and April 15, 2003 along with his diagnoses and treatment plans on each visit.

On May 26, 2003, a WCB medical advisor was asked to review the case and to provide his opinion with regard to a diagnosis given the mechanics of the compensable injury. The medical advisor responded that the diagnosis was an aggravation of a pre-existing sacroiliac condition (mechanical low back pain). With respect to the impact of the compensable injury on the pre-existing condition and the duration of recovery, the medical advisor responded as follows, "Based on aggravation, a period of recovery of 6 - 8 weeks is reasonable. Any residual effects have to be attributed to pre-existing."

Following a review of the above medical reports together with the opinion expressed by the WCB medical advisor on May 26, 2003, primary adjudication wrote to the claimant on June 4, 2003. Primary adjudication determined that the claimant was suffering from an aggravation of a pre-existing condition given the mechanics of the injury and that any ongoing disability she experienced beyond October 12, 2001 would not be related to this claim. On June 9, 2003 and August 17, 2003, the claimant appealed primary adjudication's decision and the case was forwarded to Review Office for consideration.

On August 15, 2003, Review Office determined that the claimant was, in fact, entitled to payment of benefits until April 23, 2002. Review Office referred to a report by the treating orthopaedic consultant dated April 23, 2002, in which the specialist stated that the worker's difficulties were proven to be sero negative arthritis. Review Office therefore believed that the claimant was entitled to benefits up to and including April 23, 2002 when she was seen by the orthopaedic consultant. Benefits beyond April 23rd were not payable as the ongoing problem was considered to be due to the arthritic condition and not to the effects of the accident. On August 27, 2003, the claimant appealed Review Office's decision and a non-oral file review was then arranged.

Reasons

For the record, we would like to point out that there appears to be a typographical error with respect to the wording of the issue under appeal. The issue states wage loss benefits beyond April 23, 2003, whereas it should read wage loss benefits beyond April 23, 2002.

The claimant was originally diagnosed as having sustained a muscular strain of the low back. By the time of the termination of benefits, the claimant's continuing difficulties consisted of degenerative disc disease in her lumbosacral spine together with osteitis pubis. We find that the foregoing conditions were not, on a balance of probabilities, in any way related to the claimant's compensable injury.

In coming to the foregoing conclusion, we relied on and attached considerable weight to the following body of evidence:
  • April 23rd, 2002 letter from orthopaedic specialist to the treating physician - "This lady's problem is either mechanical or sero negative arthritis in nature. I reassured them that the x-rays are normal, there is no evidence of any disc protrusion. I think also we need to get a bone scan done on this lady because with persisting pain such as she has had, for such a long period of time, we need to rule out a sero negative arthritis."
  • August 12th, 2002 Bone scan - There is increased activity about the symphysis pubis which is characteristic of osteitis pubis.
  • October 10th, 2002 letter from orthopaedic specialist to the treating physician - "This lady has sero negative arthritis. I don't think this is related anything to an injury at work."
  • June 26th, 2003 screening assessment - "Myofascial dysfunction is noted through the lumbar spine, paravertebrals as well as the piriformis bilaterally and gluteal muscles. Hypertonus is noted through these areas with active trigger points present. In summary the biomechanical examination revealed articular and myofascial dysfunction of the lumbar spine consistent with the osteoarthritic changes reported."
  • June 27th, 2003 letter from treating rheumatologist to the treating physician - "[The claimant] has a history of mechanical back strain. Her anterior pelvic symptoms are more consistent with a diagnosis of osteitis pubis which certainly was confirmed on her bone scan.
After having considered all of the evidence, we further find that the worker is not entitled to wage loss benefits beyond April 23, 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 5th day of January, 2004

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