Decision #06/04 - Type: Workers Compensation
Preamble
An Appeal Panel hearing by teleconference was held on November 18, 2003, at the request of legal counsel, acting on behalf of the claimant. The Panel discussed this appeal on the same day.Issue
Whether or not the claimant is entitled to payment of wage loss benefits beyond August 30, 1999.Decision
That the claimant is not entitled to payment of wage loss benefits beyond August 30, 1999.Decision: Unanimous
Background
That the claimant is not entitled to payment of wage loss benefits beyond August 30, 1999."I was having pain in my wrist for about a week but on my last shift the pains were shooting up my arms and into my shoulders - the problem was coming from my spine and was created by riding a tractor at work - was getting jolts shooting up my spine from the tractor ride. There was no suspension on the seats or the tractor and we had to sit and wear seat belts".The diagnosis rendered by the family physician on June 8, 1999 was a spinal muscle spasm. The claim was accepted by the Workers Compensation Board (WCB) and benefits were paid to the claimant from April 8, 1999 through to August 30, 1999 when it was determined by primary adjudication that the claimant had recovered from the effects of his compensable injury. Primary adjudication relied on the following evidence in reaching its decision:
- April 15, 1999 - an orthopaedic specialist concluded that the claimant's musculoskeletal examination was within normal limits with the exception of slight stiffness of the cervical and lumbar spines which seemed "to be a personal condition" and a slight discomfort in the flexor carpi radialis. The specialist further commented that his examination did not detect the presence of a work related lesion.
- April 27, 1999 - a family physician and occupational medicine specialist noted that the claimant "…has muscle spasm in his neck and parascapular muscles with soft tissue pain as a result. This pain is radiating down into his arm. The symptoms and findings are in keeping with the jarring to his spine and neck associated with the travel into the worksite." The specialist completed his report by stating that the claimant should be fine to return to work following 5-6 physiotherapy treatments and non-steroidal anti-inflammatory medication.
- May 21, 1999 - a WCB adjudicator contacted the above specialist who indicated that the claimant was assessed on May 26, 1999. There were no objective findings. He suggested that the claimant could return to modified duties.
- June 22, 1999 - the family physician indicated that the claimant's back was assessed on June 16, 1999 and he had normal range of motion and he could not identify any tenderness. The physician diagnosed the claimant with ongoing back pain and an MRI was ordered.
- MRI examination of July 27, 1999 - "Mild degenerative changes with disc bulging, but no herniation and no evidence of nerve root compromise at L3/4 and L4/5 levels."
- August 11, 1999 - a WCB medical advisor examined the claimant and commented that the claimant "seems to have suffered from mechanical back pain. The MRI report does not suggest to me that there is any significant pathology there which relates to his workplace." The medical advisor further noted that the claimant examined rather well with respect to his strength and range of movement. He did not feel that the claimant currently suffered from an acute ongoing sequela of his reported injury.
On October 4, 1999, primary adjudication advised the claimant that the up-dated medical information had been reviewed by a WCB medical advisor and that no change would be made to its early decision that he had recovered from the effects of his compensable injury.
In a November 16, 1999 submission to Review Office, a worker advisor, acting on behalf of the claimant, appealed the WCB's decision that the claimant had recovered from the effects of his compensable injury. In support of her position that he had not recovered, the worker advisor made reference to the medical opinion expressed by an orthopaedic specialist dated October 25, 1999.
On December 3, 1999, Review Office determined that the claimant was not entitled to wage loss benefits beyond August 30, 1999. Review Office stated, in part, that multiple medical consultations failed to detect any evidence that the claimant's injuries were anything more than muscular strains and that there were inconsistencies in reported medical findings. Review Office felt that the claimant was adequately compensated for his muscular strain injury and that he was not entitled to benefits beyond August 30, 1999.
On September 21, 2000 and September 29, 2000, the worker advisor asked Review Office to reconsider the case based on new medical information which consisted of the following documents:
- Report by an orthopaedic specialist dated May 26, 2000;
- Report by a physiotherapist dated September 14, 2000;
- Outpatient Clinic Notes dated April 1, 2000;
- Hospital Emergency and Outpatient report and EMG report dated March 31, 2000; and
- A 9 page undated letter by the claimant.
In July 2003, a solicitor acting on behalf of the claimant, appealed Review Office's decision to deny benefits to the claimant beyond August 30, 1999. On October 28, 2003, the solicitor provided new medical information for the Panel to consider. On November 18, 2003, a hearing was held via teleconference at the Appeal Commission.
Reasons
This case involves a miner, who incurred an injury to his back as a result of a workplace accident in April 1999. His claim for compensation was accepted and benefits were paid accordingly.In August 1999, it was determined that he had recovered from the effects of his compensable injury and benefits were terminated. This decision was upheld upon reconsideration by Review Office, in December 1999. A second request for reconsideration, based on further medical evidence, was also denied. It is those decisions that he has appealed to the Appeal Commission.
For his appeal to be successful, the Appeal Panel would have to determine that he continued to suffer medical problems, as a result of his workplace injury, beyond August 30, 1999. We were not able to make that determination.
In coming to this decision, we conducted a thorough review of the claim file, as well as holding a hearing, via teleconference, at which we heard testimony from the claimant and his legal counsel.
The claimant was originally diagnosed as having "spinal muscle spasm". The claimant attributed his problems to the constant jarring incurred while riding in an unsuspended tractor on rough terrain in the mine. This caused him to have pains in his wrists which shot up his arms and into his shoulders. He subsequently attributed his shoulder and back problems to an earlier fall from a diamond drill.
As noted in the "Background" section, medical examinations did not indicate anything more than muscle spasm and soft tissue injury, from which he should recover in a relatively short time.
In August 1999, prior to the termination of his benefits, he was examined by a board medical advisor, who concluded that there was no "significant pathology there which relates to his workplace." He added that he "did not feel that the claimant currently suffered from an acute ongoing sequela of his reported injury."
The findings of the board doctor confirmed those of the various doctors who had examined the claimant over the previous few months. A number of medical practitioners - including a company doctor, the claimant's doctor, a physiotherapist and the board doctor - concluded that he had mechanical back pain, having suffered muscle spasm and soft tissue injury.
All noted that his objective signs were essentially normal, showing the expected improvement over the months from April to August. The claimant reported few subjective complaints in this period. For all intents, he was recovering from the compensable injury, at a normal rate.
We have given considerable weight to the opinion of the board advisor. We have found no medical evidence, subsequent to this examination, that would support a continuation of benefits.
We do note that an examination, on October 25, 1999, by an orthopaedic specialist reported a range of motion of only 50%, as well as subjective complaints of pain and tenderness, but with no evidence of discogenic lesion. However, there is no evidence that would suggest that this considerable increase in signs and symptoms resulted from his compensable injury.
We also note that what started as a claim for back and wrist problems expanded to include a number of other problems, such as: Reynaud's disease, carpal tunnel syndrome, gastro-intestinal problems, pain focus and a fracture of the T-7 vertebra. He complained of pains in various parts of his body, including: his arms, legs, lower back, upper back and hands.
In the ensuing years, the claimant has been examined by a number of physicians, in respect of his various medical problems. They have offered opinions as to diagnosis and cause. We have considered these in our deliberations. While we do not dispute their medical diagnoses, we find it difficult - on a balance of probabilities - to relate the claimant's later problems or his other medical conditions to the compensable injury.
An MRI scan of his lumbar and thoracic spine, conducted in June 2003, showed that he has "some mild multilevel degenerative disc disease within the thoracic and lumbar spine … no disc herniation at any level of the lumbar spine … no spinal canal stenosis."
It is very clear, from the medical evidence on file, as well as the claimant's testimony to the panel, that he does suffer from a number of debilitating conditions. We do not deny this. However, we are unable to conclude that any of his medical difficulties from August 1999 to the present are causally related to his compensable injury.
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 13th day of January, 2004