The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A non-oral file review was held on December 20, 2005 at the worker's request.

Issue

Whether or not responsibility should be accepted for the knee surgery and subsequent time loss from work.

Decision

That responsibility should not be accepted for the knee surgery and subsequent time loss from work.

Decision: Unanimous

Background

The worker was climbing stairs during her employment activities on July 24, 2004 and tripped on a step. She stated that she fell on both knees and twisted her right knee. On September 28, 2004, the Workers Compensation Board (WCB) accepted the claim based on the following diagnosis: "Soft tissue injury to right knee/possible meniscal tear."

On January 19, 2005, the worker underwent an arthroscopy. The operative report stated, "…mild chondromalacia of the patella. There is severe medial patellofemoral and medial impingement. Medial meniscus intact. There is severe damage to the medial femoral condyle with approximately grade 4 damage. We continued with shaving of the medial femoral condyle and partial synovectomy…The patient requested injection of the left knee due to chronic pain and this was done."

On February 7, 2005, a WCB case manager referred the case to the WCB's healthcare branch to comment on whether or not the January 19, 2005 surgery was related to the compensable injury. Along with the request was a note from the case manager which stated that the doctor who performed the surgery was not aware that this was a WCB claim.

In a letter to the treating surgeon dated February 9, 2005, the WCB medical advisor stated, "…we were unaware of this surgery preoperatively and, on reviewing your operative report, it is evident that this lady had no medial meniscal tear but rather exhibited significant pre-existing disease in the form of chondromalacia, primarily of the medial femoral condyle as well as some involvement of the patella. …this claim cannot be accepted as a financial responsibility of the WCB, as all pathology encountered did not represent having a causal relationship to the compensable injury but rather to pre-existing disease within the knee joint."

On February 22, 2005, the case manager determined that the worker's knee difficulties were not related to the compensable injury but were due to degenerative changes. As a result, the WCB was unable to accept responsibility for wage loss benefits or treatment.

In a letter to the WCB dated March 8, 2005, the treating physician noted that the worker was adamant that her problem started after an injury at work. He outlined his view that the worker's chondromalacia patellar was asymptomatic prior to her injury. He stated that trauma was a potential etiology for chondromalacia.

In a letter to the treating physician dated March 15, 2005, a WCB medical advisor stated that he would not change his position regarding the etiology or causation of the worker's problem despite the reported asymptomatic knee pre-injury.

In a report to the worker dated April 26, 2005, the orthopaedic surgeon stated "I believe it is quite true that the findings of the arthroscopy dated in January were more that of a chronic than an acute damage. It is therefore very difficult to state with absolute conviction that this was purely due to your fall although I am convinced that the fall had aggravated the underlying processes."

On August 12, 2005, Review Office considered the case based on an appeal submission by the worker dated June 2, 2005. Review Office confirmed that no responsibility could be accepted for surgery and subsequent time loss from work or related medical aid expenses. After reviewing all file information, Review Office was of the opinion that the medical evidence did not support a relationship between the compensable injury and the subsequent arthroscopic findings. On September 28, 2005, the worker appealed Review Office's decision and a non-oral file review was arranged.

Reasons

The issue before the Panel was whether responsibility should be accepted for knee surgery and subsequent time loss from work. For this appeal to be successful, the Panel would have to find that the worker's knee surgery and her subsequent time loss were related to her compensable injury of July 24, 2004. We were not able to make this finding and provide our reasons as follows.

Worker's Submission:

The worker in her appeal letter of June 2, 2005 indicates that she had no previous problems with either of her knees and was of the opinion that only after the fall on the stairs at work that her problems arose.

Medical Information on file:

The worker saw an orthopedic specialist on November 23, 2004 following a referral from her family physician. He suspected a medial meniscus tear and recommended an arthroscopy. Surgery was performed on January 19, 2005 which showed pre-existing chondromalacia, severe medial patellofemoral and medial impingement. Approximately grade 4 damage to the medial femoral condyle was noted on the surgical report. No medial meniscus tear was found.

A medical advisor at the WCB on February 9, 2005 reviewed the operative report and wrote to the orthopedic specialist denying WCB responsibility for the surgery. He noted the reported pathology did not show a relationship to the worker's compensable injury but instead to the pre-existing disease in the knee joint.

On March 8, 2005 the worker's treating physician in a letter to a WCB medical advisor states "Mrs. [the worker] has ongoing knee problems. She is adamant that this problem was started after an injury at work."

The orthopedic specialist in a letter to the worker on April 26, 2005 states "I believe it is quite true that the findings of the arthroscopy dated in January were more that of a chronic than an acute damage. It is therefore very difficult to state with absolute conviction that this was purely due to your fall although I am convinced that the fall had aggravated the underlying processes. I therefore abide by Dr. [WCB medical advisor's] decision in this case."

Analysis:

From our review of the file details, the worker's letters, and the medical documentation, the Panel notes that the worker's claim was initially for both knees. The worker in her correspondence states that her knees up until the date of the July 2004 accident had been asymptomatic. While she had surgery on the right knee, she did request and receive an injection to her left knee at the time of surgery indicating on a balance of probabilities that her left knee had also been symptomatic from a chronic degenerative condition.

Our review of the operative report clearly showed a chronic pre-existing degenerative problem that ultimately required surgical intervention. We have placed considerable weight on this report in arriving at our decision. We also note the orthopaedic surgeon's comment to the worker concluding that the arthroscopy demonstrated a chronic versus an acute condition.

Decision:

The Panel finds that the worker's knee surgery and subsequent time loss was not related to her compensable injury but instead to a pre-existing degenerative condition. We also find there was no enhancement of her condition. The Panel finds no basis to overturn the Review Office decision and therefore denies the worker's appeal.

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 10th day of January, 2006