Decision #90/05 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on April 12, 2005, at the request of a worker advisor, acting on the worker's behalf. The Panel discussed this appeal on the same day.

Issue

Whether or not the worker is entitled to wage loss benefits beyond August 15, 2003; and

Whether or not there is entitlement to reimbursement of medical aid expenses beyond November 25, 2003.

Decision

That the worker is not entitled to wage loss benefits beyond August 15, 2003; and

That there is no entitlement to reimbursement of medical aid expenses beyond November 25, 2003.

Decision: Unanimous

Background

On June 13, 2002, the worker was "mounting coils" when he reported an injury to his lower back. On June 14, 2002, the worker was diagnosed with a lumbar mechanical back strain. The claim was accepted by the Workers Compensation Board (WCB) and benefits were paid to the worker. Subsequent medical information revealed the following:
  • June 17, 2002 - x-rays of the lumbar spine revealed "…very minor grade I spondylolisthesis of L6 on S1 with isthmus defects suspected in the lowest lumbar vertebrae…".

  • June 27, 2002 - the treating physiotherapist diagnosed the worker with discogenic pain from L4-L5 with leg radiation and positive neurological signs.

  • August 28, 2002 - CT scan of the lumbar spine revealed "…mild facet joint degenerative changes. No disc herniation or nerve root compression identified at any image level."

  • October 2, 2002 - the worker was assessed by a WCB medical advisor. On a balance of probabilities, it was felt that the worker was likely suffering from mechanical low back pain with underlying degenerative arthritis.

  • December 2002 - arrangements were made for the worker to attempt a graduated return to work program with the accident employer. After two days, the worker's back pain increased and he experienced numbness in his left leg. On December 16, 2002, the treating physician suggested that the worker may be suffering from myofascial pain.

  • December 16, 2002 - bone scan results revealed "Normal tracer uptake within the thoracolumbar spine. No focal lesion is identified."

  • December 2002 - the worker began therapy with a counsellor. Up-dated reports concerning the worker's progress in therapy are on file dated January 6, 2003, February 27, 2003, April 7, 2003, June 5, 2003 and August 25, 2003.

  • February 18, 2003 - a WCB physical medicine and rehabilitation consultant (physiatrist) examined the worker. He noted marked pain-limiting behavior and a number of inconsistencies on examination. There was a non-organic basis to the worker's symptomatology including 4/5 Waddell signs, a non-anatomic neurological pattern, whole left lower extremity numbness, and no evidence of any neurologic involvement or nerve root compression. On the basis of this exam, the consultant stated there was no obvious physical basis for the worker's current low back pain complaints.

  • March 31, 2003 - a pain clinic physician commented that the worker may have a mechanical component to his pain, possibly related to facet and S1 joint irritation. Further laboratory tests were suggested.

  • On April 15, 2003, repeat bone scan revealed "Normal study. No evidence of active acute bone pathology."

  • April 21, 2003 - the worker commences another return to work program starting out at one hour per day.

  • June 4, 2003 - a neurologist reported that the worker's history was most consistent with mechanical lower back pain.

  • June 13, 2003 - the family physician stated that the worker's current diagnosis was mechanical back strain/myofascial pain. Suggestions were made for the worker to try a second hour of work in the afternoon at similar modified duties.

  • July 10, 2003 - a physiatrist's clinical impression of the worker was right L4-L5-S1 radiculitis with discogenic pain, spondylitic and mechanical low back pain, regional myofascial taut bands and trigger points and right sacroiliitis.

  • July 30, 2003 - CT scan of the lumbosacral spine revealed "Bilateral L5 spondylolysis".

  • October 24, 2003 - a WCB physiatry consultant reviewed the file information at the request of primary adjudication. The consultant stated that he was unable to provide a current diagnosis for the worker's reported ongoing symptoms. He stated there was no reported specific injury and there was no enhancement or aggravation of a pre-existing condition. The consultant saw no requirement for further treatment and no need for restrictions as there was no apparent diagnosis. It was suggested that the worker should be monitored for depression and to increase his home fitness activities for a return to full regular duties.
In a decision dated January 24, 2004, primary adjudication advised the worker that based on the weight of evidence, he was considered to be recovered from the effects of his work injury. Based on this decision, the worker was advised that no further responsibility would be accepted for his time loss from work beyond June 27, 2003 inclusive or for medical treatment or expenses beyond November 25, 2003. On September 3, 2004, a worker advisor appealed this decision to Review Office.

On November 14, 2004, Review Office determined that the worker was entitled to partial wage loss benefits from June 28, 2003 to August 15, 2003 inclusive and that he was not entitled to reimbursement for medical aid expenses beyond November 25, 2003. Based on the available medical information, Review Office concluded that the worker's compensable injury was most likely a muscular strain injury which could not reasonably account for his severe and prolonged disability. Review Office granted partial wage loss benefits to the worker to August 15, 2003 which was in keeping with the graduated return to work schedule outlined to the worker on June 21, 2003. On December 10, 2004, the worker advisor appealed Review Office's decision and an oral hearing was arranged.

On April 4, 2005, the worker advisor provided the Appeal Commission with a report by the attending physician dated April 1, 2005 for consideration.

Reasons

As the background notes indicate, the worker has advanced the argument that his ongoing current difficulties are related to the compensable injury. In support, he relies on several diagnoses that were outlined by his physiatrist in a letter to the attending physician dated July 10, 2003. "Clinically Mr. [the worker] has right L4-L5-S1 radiculitis with discogenic pain, spondylitic and mechanical low back pain with regional myofascial taut bands and trigger points. He has clinically right sacroiliitis."

With respect to the regional myofascial taut bands and trigger points (i.e., myofascial pain syndrome) diagnosis, we note that this condition was the subject of earlier specific clinical testing by a WCB physiatrist, the attending neurologist and a WCB medical advisor. None of these specialists found any clinical signs to confirm a diagnosis of myofascial pain syndrome. We note as well from the worker's evidence that he has not responded to traditional treatment for this condition.

The other outlined conditions are by in large neurological in origin and once again we note that the neurological findings were found to be and described as normal by a neurologist, a pain clinic specialist, a chiropractor, a WCB physiatrist and a WCB medical advisor. These clinical findings were further confirmed by a series of CT scans, bone scans, and MRI, which were ordered by the respective physicians to investigate a possible neurological cause as being the basis for his symptomatology.

After having considered all of the evidence, we find that the worker's ongoing symptomatology is not, on a balance of probabilities, related to his compensable injury. Therefore, the worker is not entitled to wage loss benefits beyond August 15, 2003. In addition, we further find that there is no entitlement to reimbursement of medical aid expenses beyond November 25, 2003 inasmuch as there is no compensable condition in play after August 2003.

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 1st day of June, 2005

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