The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A file review was held on February 16, 2006 at the request of a union representative, acting on behalf of the worker.

Issue

Whether or not there is a relationship between the injury of September 2003 and the worker's current symptoms.

Decision

That there is a relationship between the injury of September 2003 and the worker's current symptoms.

Decision: Unanimous

Background

On September 19, 2003, the worker was working in the course of her employment as a floral clerk when a two hundred pound dolly struck her right heel.

Although she experienced right heel pain and swelling, she continued to work at her full time regular duties. By November 3, 2003, as her right heel symptoms had not resolved, she attended at her family physician who diagnosed her with right Achilles tendonitis.

On January 28, 2004, the Workers Compensation Board (hereafter the "WCB") accepted the worker's claim for compensation and medical aid benefits were paid.

The worker continued to work full time. She also continued to seek medical treatment, which is summarized as follows:

• On February 16, 2004, the worker began physiotherapy treatment which lasted until April 15, 2004. The physiotherapist diagnosed the worker with scar tissue thickening and an inflamed Achilles tendon;
  
  
• On March 9, 2004, the family physician prescribed an orthotic insert for the worker's shoe;
  
  
• On March 16, 2004, the family physician found the worker to have a thickened tender Achilles tendon;
  
  
• On March 26, 2004, the family physician found the worker's right Achilles tendon swollen and tender;
  
  
• On June 16, 2004, another physician (hereafter "the physician") reported that the worker complained of swelling and tenderness in the right Achilles tendon and back and knee pain when she wore the orthotic prosthesis. The physician recommended local padding, safety boots, x-ray and a depo-medrol injection;
  
  
• On July 15, 2004, the physician found tenderness and swelling on the lower edge of the right Achilles tendon;
  
  
• On August 9, 2004, the worker was referred to a sports medicine specialist who noted that the worker had tenderness over the medial Achilles attachment at the proximal calcaneus with minimal swelling. He diagnosed her with chronic Achilles pain. He recommended a home program of physiotherapy and laser treatment;
  
  
• On November 3, 2004, the physician found tenderness on the Achilles tendon at insertion. The worker reported some relief with laser therapy;
  
  
• On November 30, 2004, the physician found some tenderness on the left side of the Achilles tendon and calcaneus;
  
  
• On February 2, 2005, the family physician found a thickened tendon and a tender insertion of the right calcaneus;
  
  
• On March 4, 2005, the sports medicine specialist found a tender Achilles and thickening tendon;
  
  
• A November 10, 2005 medical report from an out-of-province physician diagnosed her with chronic Achilles tendonitis and bursitis.

Given the worker's persistent right heel complaints, the case manager consulted a medical advisor to the WCB for his opinion.

The WCB medical advisor was uncertain as to whether the worker's ongoing complaints were related to her compensable injury, even though the symptoms were chronologically related. On September 30, 2004, he wrote, in unabbreviated form:

"The diagnosis and its relation to the compensable injury is still not clear. Chronic Achilles pain is stated in the [sport medicine specialist's] report. I do not think that the method of injury would cause her symptoms to be this protracted. I cannot definitively relate her on-going symptoms to the compensable injury at this time. Physiotherapy and home exercises is appropriate but as stated above its relationship to the compensable injury is questionable."

On the basis of this opinion, the case manager stopped the worker's benefits. The worker disputed the basis for case manager's decision, pointing out that that the swelling in her right heel is in the exact same spot as where the dolly hit her on September 19, 2003.

The case manager reiterated her decision in writing on February 23, 2005. This decision was appealed to the Review Office. In a decision dated June 29, 2005, the Review Office upheld the case manager's decision.

It is this decision that the worker appeals.

Reasons

Worker's position

It is the worker's position that her persistent right heel symptoms are related to her September 19, 2003 compensable injury. In support of her position, she relies on the fact that she did not suffer any prior or subsequent injury to her September 19, 2003 compensable injury.

Employer's position

It is the employer's position that the worker's ongoing symptoms are not related to her compensable injury. In support of its position, it relies on the following:

• The worker continued to work full time after September 19, 2003 and did not seek medical attention until November 3, 2003;
  
  
• Physiotherapy treatment appears to have been forestalled until such time as the WCB approved the worker's claim;
  
  
• Achilles tendon injuries can have multiple causes, including an increase in hill climbing. As the worker moved to British Columbia in mid to late 2005, this could account for her current symptoms.

Analysis

Subsection 4(1) of The Worker's Compensation Act provides that compensation shall be paid to a worker when she suffers personal injury by accident arising out of and in the course of employment.

In the case before us, the WCB accepted the worker's claim as a compensable injury on January 28, 2004. The issue before us is whether the worker's current right heel symptoms are related to the September 19, 2003 compensable injury.

Though the worker's recovery has been prolonged, we find that the evidence on file indicates that the worker's ongoing symptomatology is causally related to her compensable injury.

Her reporting to her medical practioners is consistent as from November, 2003. There is no indication of any resolution of, or any change in her symptoms as a result of her move to British Columbia or as a result of any secondary or alternative source or event.

For these reasons, we find on a balance of probabilities, that there is a relationship between the right heel injury of September 19, 2003 and the worker's current symptoms.

Panel Members

L. Martin, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

L. Martin - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 27th day of March, 2006