The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on December 3, 1998, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed this case on December 3, 1998.

Issue

Whether the claimant is entitled to further benefits after August 14, 1997, due to the effects of her work related accident in August 1996.

Decision

That the claimant is entitled to further benefits from August 14, 1997, to March 13, 1998, due to the effects of her work related accident in August 1996.

Background

While employed as a home care assistant on August 7, 1996, the claimant injured her right hip and leg when the client she was working with fell on top of her. The diagnosis reported by the attending physician was a sprained right hip. The claim was accepted by the Workers Compensation Board (WCB) and the claimant received benefits up to August 14, 1997, when it was determined that she had recovered from the compensable injury. The following is a brief summary of file documents leading up to the discontinuation of benefits:

• on August 9, 1996, an orthopaedic specialist examined the claimant with regard to her back and both hips. The specialist indicated that lumbosacral spine x-rays were basically within normal limits. The diagnosis was a sprained right hip. On September 6, 1996, the specialist indicated that the right hip was improving but he was not certain whether the pain was coming from the lower back and radiating to the right lower limb. Lumbar spine movements were considered normal.
• a Chiropractor's First Report dated October 1, 1996, diagnosed a right hip sprain. Chiropractic treatments were recommended and instituted.
• on October 2, 1996, the treating orthopaedic specialist stated that the claimant complained of pain in the right lower back in the area of the right sacroiliac joint radiating to the right buttock.
• a WCB medical advisor commented on October 7, 1996, that the claimant had prior complaints that sounded like sciatica in early June 1996. This pre-dated the injury event. He considered the claimant possibly had a strain superimposed on back pain. The hip should now be improved. The claimant would benefit more from physiotherapy than chiropractic treatment.
• between September 18, 1996, and March 1997, the claimant received physiotherapy treatments directed towards the low back and right hip.
• on March 7, 1997, a CT scan of the lumbar spine revealed no abnormality at L3-L4. At L4-L5 there was mild diffuse disc prominence. No focal disc protrusion, nerve root compression, or spinal stenosis was identified.
• on April 15, 1997, the claimant was examined by a WCB medical advisor who recommended further testing, i.e. bone scan and nerve conduction studies. The medical advisor commented that the examination was inconsistent and that the claimant presented with 3/5 Waddell signs.
• June 11, 1997, nerve conduction studies showed no clinical evidence and very subtle electrophysiologic evidence of a lumbar radiculopathy.
• on July 24, 1997, a CT of the pelvic/right hip displayed no fracture or other significant bone abnormality.
• in a memo, dated August 7, 1997, a WCB medical advisor commented that in view of the negative findings he expected the claimant had recovered from her injuries and he could not explain any reason for ongoing difficulties.
• August 7, 1997, an orthopaedic specialist reported that based on clinical examination and EMG findings there was some evidence of a mild right-sided sciatica, which should improve with time. The specialist indicated that if the claimant was still significantly disabled she should be assessed by an orthopaedic surgeon or a neurosurgeon who dealt with spine problems on a regular basis.

On August 8, 1997, Claims Services determined, based on the weight of evidence including a diagnosis of the injury, expected symptom duration, clinical findings and the elapsed time, that the claimant had recovered from her compensable injury. As a result, benefits ended August 14, 1997. This decision was appealed by the claimant on September 5, 1997.

In a decision, dated September 19, 1997, the Review Office determined that the claimant was not entitled to further benefits after August 14, 1997. The reasons outlined by the Review Office stated in part:

"...the claimant's work-related accident caused a soft tissue strain to the right hip region. Review Office does not find that there has been clinical findings to support a more significant diagnosis, or an unexpected complication of this strain injury. Further, Review Office does not consider the medical reports, prior to August 1997, have shown objective clinical findings to support either the claimant's ongoing symptoms or her contentions of disablement from work."

The worker advisor appealed the Review Office's decision and submitted on October 21, 1998, additional medical reports from January, 1998, through to November 1998. On December 3, 1998, an oral hearing was held at the Appeal Commission.

Reasons

The Review Office decision of September 19th, 1997, deals only with the claimant's hip difficulties which resulted from the compensable injury and not her back difficulties. The medical evidence clearly points to these back problems very early on in the file's history. In a letter to the attending physician from an orthopedic consultant, dated September 6, 1996, the specialist reported as follows: "Mrs.[the claimant] is improving with her right hip. Again, I am not certain if the pain is coming from the lower back and radiating to the right lower limb." After a follow up examination a few weeks later on October 2nd, 1996, the consultant advised that the claimant attempted a return to work, however, she could not continue working. "She complains of pain which seems to be in the right lower back in the area of the right sacroiliac joint radiating to the right buttock. There is tenderness over the right S.I. joint."

Since the termination of her benefits in August 1997, the claimant was referred by her treating physician to several medical specialists from whom she continued to receive ongoing treatment for her various difficulties. A neurologist examined the claimant on January 20th, 1998, and found that her sacral iliac spine revealed profound tenderness of the sacral iliac region particularly in the Gainslen's test as well as in the figure four test. He reached the conclusion that "Overall this lady had no evidence of a lumbar spinal lesion but has some fairly clear evidence of tenderness and irritation of the right sacral iliac joint and on that basis I believe her problem is right sided sacral ileitis. This is suggested by the fact that her pain isn't really altered very much by non-NSAID agents."

The claimant was later examined and assessed by a physician specializing in sports medicine and rehabilitation on March 11th, 1998, with regards to symptoms she was having in relation to her right hip and back region. In his opinion, the claimant had "... symptoms and signs in keeping with sacroiliac joint dysfunction." However, the clinical findings did not indicate to him a significant impairment of function.

Based on the weight of evidence, we are able to conclude that the claimant's back difficulties resulting from the compensable injury continued up to at least March of 1998. We find that the claimant's back difficulties had, on a balance of probabilities, sufficiently resolved by March 13th, 1998, to allow her to resume the duties of a home care attendant. Accordingly, the claimant would be entitled to further benefits from August 14th, 1997, to March 13th, 1998.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 14th day of January, 1999