Decision #104/99 - Type: Workers Compensation
An Appeal Panel review was held on July 7, 1999, at the request of the claimant. The Panel discussed this appeal on July 7, 1999.
Whether or not the symptoms experienced by the claimant for which treatment was sought on May 30, 1998 are related to the compensable injury of March 27, 1998.
That the symptoms experienced by the claimant for which treatment was sought on May 30, 1998 are not related to the compensable injury of March 27, 1998.
On April 23, 1998, the claimant completed a Workers' Report of Injury or Occupational Disease due to multiple contusion/abrasion soft tissue injuries which he sustained at work on March 27, 1998. According to the claimant's report, while walking between the service centre and the store, he tripped and fell on loose sand and gravel which resulted in abrasions to the right side of his head, right knee and hand, stiffness in the neck, bruising to the right shoulder and hip, and accelerated blood pressure. The Employer's Report of Injury or Occupational Disease completed on April 6, 1998, provided a similar description of the accident as had been provided by the claimant.
A doctor's first report was received at the Workers Compensation Board (WCB). This report was completed by a medical practitioner from a walk-in clinic on April 29, 1998 and reported the following:
- claimant fell on March 27, 1998 sustained superficial lacerations on the right forehead, left wrist, right knee. A sore right shoulder was also reported;
- subjectively, the claimant presented with a sore right shoulder;
- on examination, the physician noted superficial abrasions on the right temporal area, right knee, left wrist with a bruise on the right shoulder with good range of movement.
- the physician reported that he was the first treating physician and did not recommend any time loss from work.
The claim was accepted as a no time loss accident by the WCB on May 13, 1998.
In mid June, 1998, a chiropractor's first report was received at the WCB. According to this report, the claimant was assessed by a chiropractor on May 30, 1998. The claimant presented with complaints of severe pain in the neck with radiating symptoms into the left arm and fingers. Cervical ranges of movement were reported as non-existent with severe swelling and point tenderness. The chiropractor considered the claimant to be totally disabled effective May 30, 1998, for a period of two to three weeks. An x-ray examination of the claimant's cervical spine taken on May 30, 1998, suggested discopathy at C5 and 6 with an altered cervical lordosis.
In a telephone conversation on June 18, 1998, the adjudicator spoke with both the claimant and the employer. The claimant advised that subsequent to the accident on March 27, 1998, he continued to work but his shoulder became progressively worse. On the recommendation of a co-worker, the claimant went to see a chiropractor for treatment of his shoulder complaints. Since May 30, 1998, the claimant reported missing some time from work. The employer advised that the claimant had reported the accident of March 27, 1998, right away and since that time, he had been complaining of a sore shoulder.
At the request of the treating chiropractor, the WCB arranged for the claimant to be called in and assessed by a WCB chiropractic consultant. The examination was scheduled for July 16, 1998. Based on the examination, the chiropractic consultant expressed the opinion, that as a result of the March 27, 1998, compensable accident, the claimant developed a "T4 syndrome" which was slowly resolving. It was recommended that the claimant be examined by the WCB's neurologist and arrangements were made for this to take place on July 23, 1998. Based on the neurological assessment, the WCB's neurology consultant expressed the opinion that the claimant presented with a left C7 nerve root compression syndrome. He stated however, that there was no direct relationship between this neurological problem and the initial injury which involved predominantly the right side of the body.
In the interim, the WCB received a progress report from a second medical practitioner covering an examination of the claimant on July 9, 1998. The physician reported persistent difficulties with the claimant's left scapular area with limited endurance for employment activity. Physiotherapy was recommended. A second report was received from the medical practitioner covering an assessment of the claimant on August 18, 1998. In that report, the physician indicated the claimant was improving slowly but the continued left hand and arm numbness was a concern. The physician asked that a WCB medical advisor contact him to discuss the matter. The physician also indicated that he disagreed with the findings and comments of the WCB's neurology consultant with respect to the relationship of the claimant's symptoms to the compensable accident of March 27, 1998.
The WCB's neurology consultant telephoned the claimant's family physician on September 9, 1998 and following is an excerpt of that telephone conversation:
- treatment recommendations for the C7 nerve-root compression syndrome was discussed and it was suggested, as the claimant was improving, that surgery should not be undertaken.
- the physician was advised that the file documentation clearly stated that the initial injury involved the claimant's right shoulder and not the left. Therefore, the claimant's left neck and shoulder symptoms, consistent with the current diagnosis of left C7 nerve-root compression, had occurred at a later time.
- the family physician stated he would clarify matters with the claimant and would then send in a further report to the WCB if indicated.
By letter dated September 15, 1998, the adjudicator advised the claimant that a cause and effect relationship between the initial workplace accident and the current symptoms experienced could not be established. Accordingly, the WCB stated that it was unable to accept responsibility for the payment of wage loss benefits and medical treatment.
On September 22, 1998, the family physician submitted a letter to the WCB which was further to his telephone conversation with the WCB's neurologist on September 9, 1998. In the letter, the physician reported that the claimant was seen on April 2, 1998, four days after his fall of March 27, 1998, and at that time, the chart notes state the claimant gradually developed left sided thoracic, upper back, and left hand symptomotology. It was the physician's opinion that the claimant did present with left sided symptoms only a few days after the compensable event.
In response to the letter, the adjudicator reviewed the claimant's file in further detail and wrote to the physician to advise that there would not be any change in the WCB's decision to deny responsibility for the claimant's complaints.
The claimant then established an appeal with the WCB's Review Office who on November 9, 1998, advised that Primary Adjudication's decision to deny responsibility in this case was being upheld. In reaching this conclusion, Review Office stated the following:
- "...It is nine weeks later when he sees a Chiropractor that he now describes difficulty experienced on the left side involving severe pain in the neck radiating into his left arm and fingers.
Review Office have considered all of the information submitted particularly the comments of the board's Chiropractic Consultant and Neurological Consultant. Review Office is satisfied that the injuries sustained on March 27, 1998 involve the right side of the claimant's body and, no injuries were sustained to the left side. The claimant is receiving treatment for difficulty he experiences on the left side of his body involving the left arm and shoulder, and most specifically the left side of his back in the region of T4 to T7..."
The claimant completed an application to appeal on May 5, 1999 requesting consideration by an Appeal Panel with respect to the relationship between his left side complaints and his compensable accident of March 27, 1998. The Appeal Panel convened a non-oral file review on July 7, 1999.
The issue in this case is whether or not there is a cause and effect relationship between the initial workplace accident of March 27, 1998 and the treatment provided to the claimant after May 30, 1998.
The relevant subsections of the Workers Compensation Act (the Act) in this appeal are subsections 27(1) which provides for medical aid benefits and 39(2) which provides for the duration of wage loss benefits.
Subsection 27(1) states:
Provision of medical aid
- 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.
Subsection 39(2) states:
Duration of wage loss benefits
- Subject to subsection (3), wage loss benefits are payable until
(a) the loss of earning capacity ends, as determined by the board; or
(b) the worker attains the age of 65 years.
We reviewed all the evidence on file and find that the weight of the evidence, on a balance of probabilities, supports a finding that the symptoms experienced by the claimant for which treatment was sought on May 30, 1998 are not related to the compensable injury of March 27, 1998. In coming to this finding we noted the following evidence:
- the employer's report of injury dated April 1, 1998 indicates the injuries reported included the right shoulder, hand, knee and the right side of the forehead and states:
"Associate was crossing grassed divider between Auto Centre and Store when he stubbed his foot in loose sand, and fell forward, landing on right side of his body. Sustained abrasions to right forehead, Palm, Knee, Bruised Right Shoulder and small cust. (sic)."
- the worker's report of injury dated April 23, 1998 in the section entitled "state all injuries sustained" indicates that the injuries sustained included abrasions to right head, stiffness in neck, excellerated (sic) blood pressure, bruising to right shoulder and hip and abrasions to right knee and hand. Also we note in the section entitled " body parts injured (indicate R or L)" the claimant indicates right shoulder/hand/knee/head;
- in a Doctor's First Report dated April 29, 1998 an attending physician who examined the claimant on the day of the accident at a Walk-In Clinic indicates that he was the first treating physician and also indicates under objective findings a superficial abrasion on right temporal area, right knee, left wrist and a bruise to the right shoulder. The attending physician states:
" Apparently he fell on March 27, 1998 sustaining superficial laceration on (R) forehead, (L) wrist, (R) knee also he was complaining of (R) sore shoulder."
- there are indications on file, as recorded in a WCB memorandum dated June 18, 1998, that although the claimant did not miss any time from work he complained specifically about shoulder problems to his co-workers from the date of the accident;
- in a report dated June 5, 1998 a chiropractor indicates that he first saw the claimant on May 30, 1998. The chiropractor also indicates that he was not the first treating practitioner as the claimant had been seen first by a " Doctor at [location] walk-in. At that time the chiropractor notes severe pain in the neck, radiating into left arm and fingers and diagnoses cervical/dorsal sprain/strain and spinal joint dysfunction associated with subluxation degeneration complex;
- chiropractic x-rays taken May 30, 1998 indicate that the disc spaces of C5 and 6 are narrowed and there is minor luschka joint sclerosing at C6 and record an impression of a C5-6 discopathy;
- in a WCB memorandum to file dated June 30, 1998 we note the following evidence given by the claimant to an adjudicator:
" Approximately three weeks after the accident his symptoms switched from the right side to the left."
" The claimant confirmed that he had not seen a dr between March 27 and May 30, 1998."
- the claimant was subsequently seen by an attending chiropractor on July 8, 1998 who indicates in part decreased cervical ranges of motion and that dermatomes decreased C6 &C7 left;
- the claimant was examined by a WCB chiropractic consultant on July 16, 1998 who confirms through the claimant's history that the claimant had landed on his right side at the time of the accident and had sustained abrasions to his forehead and right knee; that right shoulder pain had gradually got better; and that approximately three to four weeks after the accident the claimant had noted a gradual increase in mid back pain with numbness in his left arm. The chiropractor was of the impression that the claimant may have a "T4 syndrome" related to the compensable event. We note, however that the chiropractor states:
" In order to rule out any possibility of underlying neurological problem I recommend an examination by the neurologist at WCB."
- the claimant was examined by a WCB neurologist on July 23, 1998 who confirmed from the claimant's history that the claimant had fallen on his right hip, head and shoulder and that the main brunt of the pain was in his right shoulder and that about three weeks afterwards had started to develop left shoulder and mid back pain and that the claimant had commenced seeing a chiropractor at the end of May primarily for left sided neck and shoulder pain. The neurological consultant finds the neurological examination to be entirely normal except for the findings in the left arm and shoulder;
- the WCB consultant neurologist concluded that:
" His history and findings are consistent with a left C7 nerve root compression syndrome which is resolving in terms of pain though he has still persistant neurological impairment. This is not causing him any disability.
" His diagnosis is a left C7 nerve root compression syndrome. There is no direct relationship of this neurological problem to his initial injury which involved predominantly the right side of his body and has since resolved. The lack of a direct relationship is evidenced by the fact that his injuries were right sided and his current symptoms involved the left arm. There is also a significant time interval between his injury and the onset of his disc compression syndrome, ie. several weeks. Indeed he did not see his chiropractor until the end of May, some two months after the initial injury."
We note that the claimant's family physician in his report dated September 22, 1998 states that he assessed the claimant on April 2, 1998 at which time symptoms affecting the left side were apparently noted. We find this to be inconsistent with the evidence on file which strongly suggests predominantly right sided abrasion/contusion injuries sustained at the time of the accident.
We take specific note of the consistent history provided by the claimant to the WCB's adjudicator, chiropractic consultant and neurology consultant which clearly states that the difficulties associated with the claimant's left arm developed approximately two to four weeks post accident. This is also in our view consistent with the chronological and clinical record as revealed by the file documentation. We place the greatest weight on the WCB's neurology consultant's report covering his examination of the claimant on July 23, 1998 with respect to his findings, diagnosis and etiology in that we find this evidence provides a consistent and rational explanation of the claimant's signs and symptoms which is supported by evidence on file as outlined.
Therefore based on the weight of the evidence, on a balance of probabilities, we find that the symptoms experienced by the claimant for which treatment was initially sought on May 30, 1998 are not related to the March 27, 1998 compensable injury. The claimant's appeal is therefore denied.
D. A. Vivian, Presiding Officer
A. Finkel, Commissioner
M. Niekamp, Commissioner
Recording Secretary, B. Miller
D. A. Vivian - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 15th day of July, 1999