The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on September 15, 2004, at the request of legal counsel, acting on behalf of the claimant.

Issue

Whether or not the worker's ongoing back problems are related to his workplace injury.

Decision

That the worker's ongoing back problems are not related to his workplace injury.

Decision: Unanimous

Background

On December 11, 1999, while climbing down from a truck, the claimant lost his footing and felt a sharp pain in his right knee. Medical reports on file diagnosed the claimant with a right knee lateral meniscus tear and a lumbar mechanical back strain. The claim was accepted by the Workers Compensation Board (WCB) and benefits were paid accordingly.

Subsequent medical reports revealed that the claimant was treated for his knee condition. He was seen by a physical medicine and rehabilitation specialist (physiatrist) for his back complaints.

In a report dated October 9, 2000, the physiatrist outlined his clinical examination findings to show that the claimant had a left L4-L5 and L5-S1 facet joint traumatic strain with arthritis and left L5-S1 pseudo-radiculitis. There was no evidence of major disc herniation causing compression of the nerve root.

On October 30, 2000, the claimant was assessed by a WCB medical advisor with respect to his knee and back condition. In a memo dated November 9, 2000, the medical advisor stated "back examination did not establish any clear residual injury related to C.I. [compensable injury]."

A Review Office decision dated September 2001, determined that the claimant's ongoing loss of earning capacity was a consequence of his right knee condition.

In September 2001, the case was referred to the WCB's vocational rehabilitation branch to assist the claimant in finding suitable work that respected the permanent physical restrictions with regard to his right knee status.

On December 5, 2002, the claimant was lifting boxes during a workplace experience program when he developed pain in his left lower back. In a Doctor's First Report dated December 6, 2002, the treating physician diagnosed the claimant with a lower back strain. Treatment consisted of medication along with physiotherapy treatments to the back and left hip.

The claimant was assessed by a WCB medical advisor on March 10, 2003. Based on his clinical examination and review of the accident mechanics, the medical advisor reported that the claimant had sustained a lumbosacral strain injury. The medical advisor further noted that the claimant had improved significantly from his strain injury and was capable of increasing his modified work hours.

On March 10, 2003, x-rays were taken of the claimant's lumbosacral spine and left hip regions. The lumbosacral spine report revealed "…degenerative spurring anteriorly at L2-3 consistent with lumbar spondylosis." The left hip x-ray demonstrated no bone or joint abnormality.

In a letter to the claimant dated April 28, 2003, the WCB stated "…degenerative spurring is considered by the WCB to be a pre-existing condition. In order to accept this as related to your workplace injury, it has to be shown that this injury enhanced your condition. As mentioned previously, the nature of your diagnoses in 1999 and December 2002 have been back strains. This diagnosis is not usually associated with enhancing a pre-existing condition and therefore we cannot relate it to your workplace injury." Based on the weight of evidence, the WCB concluded that the claimant had recovered from his work injury and that it was unable to continue to cover medical treatment related to his back.

In a progress report dated November 17, 2003, the attending physician reported that the claimant was seen for lower back pain after he grabbed something at work and twisted his back. The diagnosis rendered was a lower back muscle strain.

In a memo to file dated November 17, 2003, a WCB case manager recorded that she had spoken with the claimant and he was returning to work tomorrow as he felt his "job was pretty light right now."

On December 1, 2003, legal counsel, acting on behalf of the claimant, asked the WCB to reconsider its position with respect to the claimant's back condition based on a report from an occupational health physician dated June 26, 2003. In this report, the physician stated, in part, "…his current symptoms relate to irritation of the sacroiliac joint as well as myofascial tenderness and hypertonus in the gluteal and lumbosacral muscles."

In a letter dated December 29, 2003, the WCB advised the claimant that his case had been reviewed by the WCB's healthcare branch and the WCB's opinion remained that his current symptoms and treatment suggested by the occupational health physician was unrelated to his compensable injury.

On April 16, 2004, Review Office confirmed that the claimant's ongoing back problems were unrelated to his compensable injury. Review Office felt there was insufficient evidence to support the contention that the claimant had not recovered from his workplace back strain/sprains, occurring on December 11, 1999, December 5, 2002 and November 14, 2003. On June 23, 2004, legal counsel appealed Review Office's decision on behalf of the claimant and a non-oral file review was arranged.

Reasons

The worker’s file was then referred to the WCB’s vocational rehabilitation services as he had permanent restrictions resulting from his ongoing right knee problems. On December 5, 2002, the claimant injured his left low back while lifting heavy boxes. This injury was diagnosed as a lower back strain. The claimant was subsequently examined by a WCB medical advisor on March 10, 2003. The medical advisor recorded the following comments in his examination notes:

“The claimant is seen today approximately 13½ weeks post-accident (date of accident: December 5, 2002) from a workplace experience placement that has resulted in a low back injury. Today’s clinical examination and review of the accident mechanics would support that the claimant has sustained a lumbosacral strain injury. The claimant himself feels that this injury represents a recurrence of a previous back injury while employed with [name of employer] that has been adjudicatively denied.

The claimant’s injury occurred while he was on a workplace experience placement through WCB Vocational Rehabilitation Services. The expected recovery for strain injuries is typically 4 to 6 weeks, and the claimant has already exceeded the expected recovery norms with this injury.

It is also the medical advisor’s opinion that the claimant has improved significantly from his strain injury and is capable of increasing his modified work hours. It is expected that the claimant will be sufficiently recovered within the next one to two weeks to be able to resume his pre-injury workplace status.”

On November 13, 2003, the claimant once again developed low back pain after grabbing a heavy object and twisting his back while trying to hold on to the object. He was diagnosed with a lower back muscle strain. This last incident was accepted by the WCB as being its responsibility. However, it was anticipated that this injury would be short term in nature and this in fact was the case. We note that there is no medical information on file to suggest that this injury is still in play. In addition, there is no medical evidence to support a finding that the claimant’s degenerative low back condition is in any way related to his several workplace injuries.

After each of his back strain incidents, the claimant was able to return to work. The preponderance of medical evidence confirms that the claimant’s primary ongoing difficulties centre on his right knee. We find that the worker’s ongoing back problems are not, on a balance of probabilities, related to his workplace injury. 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 21st day of October, 2004