The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on December 7, 2004, at the request of a worker advisor, acting on behalf of the worker.

Issue

Whether or not responsibility should be accepted for the worker's prescribed medication as being required in relation to the July 17, 2001 compensable injury.

Decision

That responsibility should not be accepted for the worker's prescribed medication as being required in relation to the July 17, 2001 compensable injury.

Decision: Unanimous

Background

On July 17, 2001, the worker injured his lower back region during the course of his employment as a truck driver. The Workers Compensation Board (WCB) accepted the claim for compensation including prescription medications.

On March 30, 2004, the worker was advised that the WCB would no longer be reimbursing him for medication prescriptions. The case manager noted that following a review of the file information in September 2003, it was determined that the worker's current prescribed medication did not relate to his compensable accident of July 17, 2001 but was prescribed due to his pre-existing degenerative changes in his lumbar spine.

Following review of the above decision, the worker contacted his case manager on April 7, 2004. The worker commented that he was taking Morphine which was prescribed to him after the WCB requested an assessment at the Pain Clinic. The worker also commented that his general practitioner was of the opinion that his ongoing difficulties were related to the compensable accident and not to pre-existing conditions as he was working up until the time of his accident.

On April 8, 2004, the attending physician advised the WCB that the worker was taking MS-Contin to control his low back pain which resulted from his July 17, 2001 injury.

The worker's case manager asked a senior WCB medical advisor to review the attending physician's report of April 8, 2004. The case manager noted that the WCB had requested a Pain Clinic assessment and that the treating physician ultimately recommended the MS-Contin medication for the worker. He asked the medical advisor for his opinion as to whether the WCB should accept responsibility for the medication as related to the compensable injury. In a response dated April 28, 2004, the senior medical advisor commented that use of MS-Contin may be appropriate but the need for this related to his pre-existing disease and not to the compensable injury.

On May 4, 2004, the WCB advised the worker that his MS-Contin medication which was prescribed to him by his general practitioner was initially recommended by the physician at the Pain Clinic. Based on this information, it was felt that the MS Contin medication was prescribed as a result of his pre-existing degenerative disc disease of the lumbar spine and not as a result of the injuries sustained at the time of his July 2001 accident.

In a submission to the WCB dated August 31, 2004, a worker advisor referred to a report from the worker's general practitioner dated August 25, 2004. The worker advisor stated that within the report, the doctor acknowledged that the worker had long standing degenerative disease in his lower spine but also concluded that the workplace injury of July 17, 2001 had significantly enhanced this pre-existing condition resulting in the need for increased levels of the MS-Contin medication. Based on this conclusion, the worker advisor asked the WCB to reconsider its decision of March 30, 2004.

On September 15, 2004, a WCB senior medical advisor reviewed the general practitioner's report dated August 25, 2004 and commented that the use of MS-Contin was due to the worker's use of anti-coagulants, otherwise the worker might still use Tylenol.

The WCB informed the worker advisor that no change would be made to the earlier decision dated March 30, 2004. The case was then forwarded to Review Office for further consideration.

On October 18, 2004, Review Office confirmed that responsibility could not be accepted for the worker's prescribed pain medication for his lumbar spine. Review Office outlined its position that it agreed with the opinion which was expressed by the WCB senior medical advisor and with the decisions reached by the case manager involved with the case.

On October 21, 2004, the worker advisor appealed Review Office's decision of October 18, 2004. The worker's position was that his need for increased medication was still the result of his workplace accident. The worker felt that he had not recovered from his accident and that his pre-existing condition was enhanced. On December 7, 2004, a non-oral file review took place to consider the worker's appeal.

Reasons

We were asked to determine whether responsibility should be accepted for the worker's prescribed medication. To make this determination we must decide whether the prescription is for a condition which arises from the worker's July 17, 2001 workplace injury. We found that the prescription is not required as a result of the July 17, 2001 workplace injury and that the WCB should not accept responsibility for payment of the prescribed medication.

We have considered all the information on the claim file and have concluded, on a balance of probabilities, that the worker's prescription for MS-Contin medication is not due to the July 2001 workplace injury but rather is required to deal with the effects of the worker's pre-existing condition which has been diagnosed as severe and progressive degenerative disease of the lumbar spine.

In arriving at this determination, we attach significant weight to the following:

• Diagnostic tests demonstrate that the worker suffers from a degenerative disease of the lumbar spine. The tests include the initial x-ray performed on July 23, 2001, a further x-ray on September 20, 2001, a CT scan performed on January 31, 2002, and a second CT scan performed on July 23, 2003. None of these reports noted any disc herniation or compression fracture.
  
  
• The worker's general practitioner confirmed that the worker has had long standing problems related to degenerative disease in his lumbar spine. He noted in a report dated August 25, 2004 that the worker "…has long standing degenerative disease of his lumbar spine which has been symptomatic to varying degrees over time. He was controlled on Tylenol 3 for many years, using 2-4 tablets per day."
  
  
• The senior medical advisor's opinion of April 28, 2004:
  
  "He has severe degenerative disease of his spine - possibly due to a relationship with inflammatory bowel disease. He has chronic back pain for which Pain Clinic recommended long acting analgesics - MS Contin. This may be appropriate but the need for this relates to pre-x disease and not to the C.I. [compensable injury]."
  
  
• The senior medical advisor reviewed the file and noted in a memo dated September 15, 2004 that:
  
  "This man is 65 yrs. old +. He has severe & progressive degenerative disease of his lumbar spine. There are no changes in his x-rays to indicate any specific structural damage resulted from C.I.. His symptoms are bound to progress with time."
  
  The medical advisor also commented that he could not identify evidence of any enhancement of his pre-existing condition as directly related to his workplace injury.

As we found that the prescription is not due to the workplace injury, the appeal is denied.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 6th day of January, 2005