Decision #19/06 - Type: Workers Compensation
Preamble
A non-oral file review was held on January 25, 2006, at the worker's request.Issue
Whether or not responsibility should be accepted for chiropractic treatment in relation to the September 19, 2001 compensable injury.Decision
That responsibility should not be accepted for chiropractic treatment in relation to the September 19, 2001 compensable injury.Decision: Unanimous
Background
On September 19, 2001, the worker fell 4 to 5 feet off a truck deck while in the course of his employment. He suffered a severe comminuted fracture to his left distal tibia and fibula and required surgery.The Workers Compensation Board (WCB) accepted the worker's claim for compensation and benefits were paid commencing September 20, 2001.
On January 8, 2002, one of the Knowles' pins used to stabilize the distal fragments was surgically removed. Further surgery was performed on May 17, 2002 to remove the fibular plate and screws from the lateral aspect of his ankle joint.
A WCB impairment awards medical advisor assessed the worker on September 24, 2003 and determined that he was entitled to a 13% permanent partial impairment (PPI) award for cosmetic impairment and loss of range of motion in the ankle. On October 17, 2003, the worker was offered a one time payment in recognition of this 13% PPI award, which he accepted.
Two other pins were surgically removed on December 9, 2004 and on January 4, 2005, the treating orthopaedic surgeon reported that the worker was doing well with his left leg and that the wound had almost completely healed.
On February 2, 2005, the worker advised a WCB case management representative that his surgery went fine and that he was walking without any pain.
The worker called a WCB case management representative on March 10, 2005 to advise that he was seeing a chiropractor for back problems. He said that the pain symptoms came on gradually and occur after walking. The pain travels up the spine to the neck and also causes headaches. His chiropractor felt that these symptoms were related to his compensable injury. The worker therefore asked the WCB to cover the costs associated with his chiropractic treatment.
In an April 6, 2005 report, the treating chiropractor diagnosed the worker with cervical, dorsal and lumbar spinal joint dysfunction associated with vertebral subluxation degeneration complex, secondary to pelvic imbalance caused by an anatomical deficiency of 31 millimeters in the left leg.
On April 21, 2005, a WCB chiropractic consultant reviewed the file information at the request of primary adjudication and opined that the worker's neck and back symptoms were not related to the compensable injury.
In a decision dated April 27, 2005, a WCB case manager denied the worker's request for chiropractic care on the basis that the neck and back symptoms were not related to the compensable injury. The worker appealed this decision on June 27, 2005, stating that "Since my accident & surgery, the limp I developed has progressively worsened. My left leg is now 31 mm shorter than the right. This affects how I walk and is causing my neck & back problems." In support of his position, the worker submitted a report from the treating chiropractor dated June 27, 2005. In this report, the treating chiropractor opines that the worker's fracture to the tibia and fibular caused a 1/1/4 inch deficiency in the worker's left leg, which in turn caused him to develop an abnormal gait. The gait caused stresses and wearing in the low back and hips which caused the worker to develop back and neck symptoms.
The WCB chiropractic consultant reviewed this new report and maintained his opinion that the worker's back symptoms were not related to the compensable injury given the good recovery from the fracture and lack of reported back symptoms.
On September 1, 2005, the Review Office upheld the April 27, 2005 decision that no responsibility should be accepted for chiropractic treatment on the basis that there were no objective medical findings or subjective complaints of neck or back symptomatology between September 19, 2001 and March 2005. It is this decision that the worker appeals.
Reasons
Compensation for medical aid is governed in part, by subsections 4(1) and 27(1) of The Workers Compensation Act (the "Act"), which provide as follows:Therefore, to be compensable, personal injury must arise by accident arising out of and in the course of employment.Compensation payable out of accident fund
4(1) Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment (emphasis added) is caused to a worker, compensation as provided by this Part shall be paid by the board out of the accident fund, subject to the following subsections.
Provision of medical aid
27(1) The board may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident (emphasis added)
In the case before the panel, the worker submits that his back and neck problems result from the accident he suffered at work. It is his position that his compensable injury, a comminuted fracture to the left tibia and fibula, caused his left leg to shorten by 31 millimeters. This shortening caused him to limp, which created stress and wearing in his lower back which caused him to develop neck and back symptomatology. The worker relies on his treating chiropractor's reports of April 6, 2005 and June 7, 2005.
In reviewing the medical evidence, the panel is unable to accept this position.
The worker's compensable injury was a comminuted fracture to the distal tibia and fibula occurring September 19, 2001. He was seen and treated by his orthopaedic surgeon from the date of his accident to January 4, 2005. The history of the worker's surgical interventions is noted in the background. However, in addition to these surgeries, the worker was seen by his orthopedic surgeon on multiple occasions over this three year time span. Regular reports of these visits were sent by the orthopedic surgeon to the worker's family physician. None of these reports makes any reference to a shortening of the leg nor, more generally, to any back or neck complaints. Further, while the treating orthopaedic surgeon's reports make some reference to a "slight limp", there is no indication that the limp was thought to be a problem or a possible precursor to back and/or neck problems. The orthopedic surgeon opined in fact, as late as January 4, 2005, approximately two months before the worker's reported back and neck complaints, that the worker was doing well with his left leg.
Therefore, given the lack of medical evidence supporting a relationship between the back and/or neck symptoms and the compensable left leg injury of September 19, 2001, the panel is unable to grant the relief sought by the worker.
Accordingly, the worker's appeal is denied.
Panel Members
L. Martin, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Miller
L. Martin - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 1st day of February, 2006