The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on January 27, 2004, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this appeal on January 27, 2004 and on February 20, 2004.

Issue

Whether or not the worker is entitled to wage loss benefits beyond May 11, 2001.

Decision

That the worker is not entitled to wage loss benefits beyond May 11, 2001.

Decision: Unanimous

Background

On June 20, 2000, the claimant sustained a workplace injury to her right hip and low back when she turned around to administer some medication to her client.

On June 21, 2000, the claimant attended a chiropractor for treatment. The diagnosis rendered was lumbosacral subluxation complex with radioculoneuralgia.

The claimant attended her family physician on June 29, 2000. The diagnosis rendered at this time was lumbar spondylosis with acute muscle spasm and nerve root irritation.

The claim was accepted by the Workers Compensation Board (WCB) and benefits were paid to the claimant commencing June 21, 2000.

In August 2000 the claimant underwent a CT scan which demonstrated a mild central disc bulging at L5-S1 with no encroachment on the thecal sac or nerve roots.

On August 22, 2000, the claimant was assessed by a neurologist who could not find any objective neurological deficits on examination. He noted that the sensory deficits in the claimant's left leg were mostly subjective and very non-anatomical. An MRI was suggested.

On September 27, 2000, an MRI of the lumbar spine was carried out. The results demonstrated moderate to severe degenerative narrowing of the L5-S1 intervertebral disc with broad posterior disc bulging somewhat greater on the left. The disc bulge contacted the left S1 nerve root prior to its lateral recess but there was no convincing evidence of displacement or compression of the left S1 nerve root.

On October 23, 2000, the claimant sought treatment from a neurosurgeon. The following are his comments following his assessment of the claimant: "Chronic lumbar sprain. The MRI scan of the lumbosacral spine that she brought along showed significant degenerative changes as well as an L5-S1 disc bulge but not significant disc protrusion nor spinal stenosis."

Subsequent medical information consisted of progress reports received from the attending physician along with the results of a functional capacity evaluation performed on January 31, 2001. The claimant was also assessed by a WCB medical advisor and his examination findings and results are contained in a report dated January 31, 2001. Essentially, the medical advisor concluded that the claimant had recovered from the effects of her compensable injury and that she could return to her pre-accident duties.

On February 14, 2001, the claimant was advised by primary adjudication that she was considered recovered from the effects of her injury and that wage loss benefits would be paid to May 11, 2001 inclusive and final. On October 17, 2001, a worker advisor appealed this decision and submitted further medical information from the claimant's attending physician dated August 9, 2001 and from a physiatrist dated July 30, 2001 for consideration.

Following consultation with a WCB medical advisor on November 21, 2001, the claimant was informed that it was still the WCB's position that she suffered from degenerative changes and that the decision of February 14, 2001 would remain unchanged.

On April 15, 2003, the worker advisor referred to a medical report dated November 26, 2002 prepared by the treating neurosurgeon. Based on this report together with the previous opinions expressed on August 9, 2001 and July 30, 2001, the worker advisor contended that there continued to be a cause and effect relationship between the claimant's low back symptoms and her June 20, 2000 compensable injury of a lumbar sprain/strain.

Prior to considering the above appeal, Review Office sought the advice of a WCB orthopaedic consultant. His response to questions posed by Review Office is dated June 10, 2003.

On June 13, 2003, Review Office made the determination that the claimant was not entitled to wage loss benefits beyond May 11, 2001. Review Office believed that the weight of medical information did not support the worker's contention that she continued to be disabled as a result of the insignificant accident that occurred on June 20, 2000. In November 2003, a worker advisor appealed Review Office's decision and an oral hearing was convened.

Following the hearing on January 27, 2004, the Appeal Panel requested additional information be obtained from the claimant's treating physician. On February 2, 2004, all interested parties were provided with copies of the new medical information and they were invited to provide comment. On February 20, 2004, the Panel met to render its final decision.

Reasons

Although we took into consideration all of the evidence in arriving at our decision, we preferred to attach more weight to the following body of evidence.

• September 24, 2001 MRI lumbar spine - There is moderate to severe degenerative narrowing and desiccation of the L5-S1 intervertebral disc. The remainder of the lumbar intervertebral discs are normal in height and signal intensity. At the L5-S1 level, there is broad posterior disc bulging somewhat greater on the left. There is no convincing evidence of focal disc herniation. There is no evidence of central spinal stenosis. The disc bulge contacts the left S1 nerve root prior to its lateral recess but there is no convincing evidence of displacement or compression of the left S1 nerve root. There is no other evidence of disc herniation, spinal stenosis or nerve root compression at any of the other imaged levels. No other abnormality is identified.
  
  
• January 2, 2002 letter from neurosurgeon to attending physician - "She has no signs of nerve root tension in the legs at this stage; neither has she any signs of nerve root conduction disturbances. X-rays of the lumbar spine demonstrate marked degenerative changes at the L5-S1 level associated with a slight retro listhesis. The disc at the L4-5 level is also slightly narrowed but the other levels are normal. The claimant's present complaints are related to degenerative changes associated with posterior facet changes at the L5-S1 level. However, this lady has marked degenerative changes and this pathology could influence her quality of life to such a degree that a lumbosacral fusion would be the only appropriate treatment for this condition."
  
  
• March 13, 2002 X-ray lumbar spine - Impression: Lower lumbar degenerative disc disease and facet OA [osteoarthritis].
  
  
• June 10, 2003 a WCB orthopaedic consultant's memorandum to file in which he responded to questions posed by a review officer:
  
  
  1. What do you believe to be the most probable diagnosis for the injury sustained by the worker on June 20, 2000? "This is not a 'hip' problem. Unlikely to have sustained any significant trauma with the described mechanism of injury."
     
     
  2. Please indicate whether or not you believe the worker had recovered from the effects of her compensable injury by the time her benefits were discontinued in May 2001? "Yes. Her M.D. suggested R.T.W. [return to work] at time of his exam 9/9/00. Neuro exam Aug 22/00 was negative. Dr. [WCB medical advisor] advised R.T.W. at time of his exam Jan 31/01."
     
     
  3. Does the worker continue to suffer from the effects of her June 20, 2000 injury at work? "No. She has x-ray, CT & MRI evidence of pre-existing D.D. disease at L5-S1 which was not materially affected by the described CI."

We find based on the preponderance of evidence that the claimant's current and ongoing problems are not, on a balance of probabilities related to her compensable injury but rather to her degenerative disc disease. Therefore, we further find that the claimant is not entitled to wage loss benefits beyond May 11th, 2001. 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 22nd day of March, 2004