The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel review was held on July 13, 1999, at the request of a Worker Advisor, acting on behalf of the claimant. The Panel discussed this appeal on July 13, 1999.

Issue

Whether or not the claimant's current health problems are related to the 1986 compensable injury; and

Whether or not the claimant is entitled to further benefits in relation to his 1986 compensable accident.

Decision

That the claimant's current health problems are not related to the 1986 compensable injury; and,

That the claimant is not entitled to further benefits in relation to his 1986 compensable injury.

Background

On March 20, 1986, this worker was struck on the left side of his face by a piece of loose rock. Medical attention was sought on the day of accident and it was reported that the worker had some swelling of the left cheek and left side of his face. X-rays of the claimant's facial bones were performed and reported to be normal. The worker was discharged after 10 hours of observation and was said to be alert, fully orientated, walking well with no further dizziness.

The Workers Compensation Board accepted financial responsibility for the claim on April 2, 1986. Temporary Total Disability benefits were not paid to the claimant as he did not lose any time from work as a result of this accident.

On June 6, 1994, the claimant completed a Worker's Report of Injury or Occupational Disease due to difficulties that he was attributing to the 1986 compensable accident.

The claimant discussed his ongoing difficulties with an adjudicator at the Workers Compensation Board (WCB) on June 6, 1994. In that conversation, the claimant advised that subsequent to the March 1986 accident, he experienced episodes of numbness and had developed blood clots. He stated several weeks after the accident, he underwent surgery to remove blockages in the sinuses and received sick leave benefits for his absence from work during the period of convalescence. The worker indicated that he was working modified duties at a mine in Flin Flon. He indicated he was unable to work regular duties underground because of dizziness, blackouts, and memory loss. He related his ongoing problems to the 1986 compensable injury. The claimant expressed the opinion that he had never fully recovered from the compensable accident and that had seen a number of physicians including a psychologist for treatment.

In order to fully investigate the claim for a recurrence, the WCB asked that a signed declaration be obtained from the claimant. However, as the Field Representative from the WCB was unable to contact the claimant to make arrangements, no further action was taken on the file.

In June, 1997, the WCB received a report from the employer and the claimant's physician. The physician indicated that the claimant had been seen by various specialists with respect to dizziness, facial pain as well as a reported intellectual deficit. The employer advised that the claimant had been on modified duties for some time. The employer requested the WCB to advise whether the claimant's difficulties were related to the March 1986 compensable event. The WCB then arranged to obtain reports from the various physicians who had seen the claimant. These included family physicians, a neurologist, otolaryngologist and psychiatrist.

On December 2, 1997, a sworn statement was obtained from the claimant regarding his ongoing problems. In his statement, the claimant recounted the circumstances of his March 1986 injury and stated that ever since that time, he has experienced difficulties with his memory and blurred vision affecting the left eye. He also reported difficulty with balance and dizzy spells which began prior to the spring of 1994. The claimant indicated that he was claiming for lost wages since being moved to modified duties in 1996 as well as lost hours from work.

Medical information showed that the worker regularly attended for medical treatment for a variety of sinusitis problems between 1986 and 1996. There was an occasional mention of episodic left sided face pain in April 1986 and December 1986. Medical documentation showed that the worker's sinusitis problems were regularly treated prior to March 1986.

The otolaryngologist assessed the claimant on November 4, 1996. The claimant reported onset of problems with the left side of his face sometime in the fall of 1996 with episodes of dizziness since a fall in 1995. The episodes occur once or twice a week and last for one or two minutes. Based on the assessment of the claimant, it was suggested that a CT scan be obtained and as well, that the claimant be assessed by a neurologist.

The worker was seen by a neurologist on February 3, 1997. The neurologist reported that the CT scan results demonstrated gliosis in the right hemisphere, likely of long standing. The neurologist wondered whether the claimant's abrupt lapses in awareness would be due to seizures. He recommended that claimant have an EEG performed as well as an MRI. The results of the EEG were interpreted as being normal. The MRI demonstrated gliosis in the temporal lobe due to an old head injury. Metal fragments in the temporal lobe were also noted.

The claimant was assessed by a psychiatrist on March 26, 1991. The physician reported his impression that the claimant "is a man with mild mental retardation and some magical thinking." The psychiatrist suggested that the claimant be treated as someone with a somatoform disorder and recommended supportive/expressive psychotherapy.

In February and March 1999, the file was reviewed by a medical advisor, neurology consultant and psychiatry consultant at the WCB. Upon review, it was noted that the MRI had demonstrated a metal fragment inside the skull, yet there was no reported lacerations at the time of the compensable accident. This fact left one with the impression that the metal fragment must relate to some other episode of trauma. Based on the claimant's history as provided by the attending physician, the claimant's past history revealed a number of possible explanations for the current findings as well as the claimant's subjective complaints. Given the above, the WCB medical staff was of the opinion that it was unlikely the claimant's current problems could be attributed to the compensable event.

Following review of the medical information, as well as the sworn statement, an adjudicator advised the claimant on March 24, 1999 that a cause and effect relationship between the claimant's current problems and the 1986 compensable injury could not be established. Accordingly, responsibility for the recurrence claim would not be accepted as a WCB responsibility.

A Worker Advisor appealed the adjudication decision to Review Office on April 8, 1999. The Worker Advisor contended that the medical evidence on file was sufficient to establish a reasonable or probable cause and effect relationship between the worker's work-related accident in March 1986 and the various reductions in his earning capacity beginning some time in 1996.

The Review Office considered all available evidence in this case. On April 16, 1999, the Review Office stated that it did not consider the claimant's recent health problems and his reduced earning capacity to be the probable result of the work-related accident suffered in March 1986.

The Worker Advisor completed an application to appeal on May 10, 1999, requested a non-oral file review of the claimant's file by the Appeal Commission. An Appeal Panel was convened on July 13, 1999.

Reasons

As the background notes indicate, the claimant was struck on the left side of his face by some loose rock while he was working as a miner. The worker indicated to his treating neurologist that his memory has been bad since the accident and he described sudden lapses in memory or awareness. More recently the claimant began to experience problems with his balance.

An MRI of the brain conducted on April 21st, 1997, revealed evidence of remote trauma in the left temporal lobe including a small metal fragment in the superior aspect of the left temporal lobe medially. The file was reviewed by the WCB's neurology consultant on February 24th, 1999. We note in particular the following comments contained in a memorandum to file:

"The MRI demonstrates a metal fragment inside his skull. As there was no laceration at the time of the 1986 injury (i.e. no entrance site) this fragment must relate to some other episode of trauma. The force of such trauma would have to be significant and likely (more than the 1986 event) would have caused the gliosis (scarring). All things considered it is unlikely based on the described injury and early medical reports by Dr. [treating physician] that his temporal lesion was due to the 1986 injury. He has not been shown to have epilepsy based on EEG. \ Dx of temporal lobe epilepsy is not confirmed."

We find that the claimant's current difficulties are not, on a balance of probabilities, related to his compensable injury. The weight of evidence does not support a causal connection. Consequently, the claimant is not entitled to benefits with respect to his current health problems. Therefore, the claimant's appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
B. Malazdrewich, Commissioner

Recording Secretary, B. Miller

R. W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 5th day of August, 1999