The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on August 5, 1999, at the request of a worker advisor, acting on behalf of the claimant. The Panel discussed the appeal on August 5, 1999.

Issue

Whether or not responsibility should be accepted for the CT scan of the claimant's left forearm and subsequent time loss from work on November 6, 7, 10 and 11, 1997, in relation to the compensable injuries of October 14, 1997 or October 16, 1997.

Decision

That responsibility should be accepted for the CT scan of the claimant's left forearm and subsequent time loss from work on November 6, 7, 10 and 11, 1997, in relation to the compensable injury of October 14, 1997.

Background

The claimant filed two compensation claims for injuries she sustained while employed as a licensed practical nurse. On October 14, 1997, the claimant and a co-worker were manually lifting a patient when she developed lower back and left forearm pain. On October 16, 1997, the claimant was kicked by a patient and sustained multiple trauma to her left chest and shoulder, neck, and mid/lower back.

On October 24, 1997, the treating physician diagnosed the claimant with a soft tissue mass in the left forearm and a myofascial strain of the lower back. The claimant was then referred for a CT scan of the left forearm on October 29, 1997, and the findings revealed a soft tissue lipoma. Subsequent reports showed that the claimant developed a severe allergic reaction to the CT dye contrast and as a result missed time from work between November 6th and 11th, 1997.

On December 22, 1997, a plastic surgeon indicated that while the diagnosis of lipoma was likely correct, a definitive biopsy was indicated and a tentative surgery date was set for January 30, 1998.

A Workers Compensation Board (WCB) medical advisor reviewed the case on January 16, 1998. The medical advisor commented that the diagnosis of lipoma may be correct however the tumor was not the result of the compensable injury. He felt that the tumor would have been present prior to the compensable injury although it may only have become apparent afterwards. It was also felt that the proposed surgery was not the WCB's responsibility.

On February 2, 1998, Claims Services determined that the claim for injury occurring on October 14, 1997, was not acceptable. Claims Services was of the view that the lipoma was not caused by the October 14, 1997, accident nor was it aggravated by the accident. Based on medical information received, Claims Services indicated that the tumor was present prior to the date of accident and therefore responsibility for treatment or for the proposed surgery would not be accepted.

A surgical report, dated January 30, 1998, concluded the following: "...the procedure performed is excision of a herniated lipoma through the deep muscle fascia, in the intermuscular septum. While this tumor is developmental in origin, it's herniation was not (sic) doubt traumatic."

On March 13, 1998, Claims Services wrote to the claimant indicating that its initial decision had not changed and that responsibility would not be accepted for wage loss or medical treatment. Claims Services stated, in part, "Upon discussion with our medical advisors, it is our opinion that the lipoma pre-existed October 14, 1997, the date of your injury and that surgery would have been required nonetheless. It is therefore, our opinion that the accident of October 14, 1998, did not form the basis for any time loss nor for the surgery performed."

The case was considered by Review Office on March 24, 1998, following receipt of an appeal from the claimant. The Review Officer determined that the claim for compensation was acceptable and that responsibility would be limited to the CT scan and associated time loss. The Review Officer was of the opinion that the compensable accident produced a defect in the muscle fascia where upon the pre-existing, long standing lipoma became visible and obvious. The subsequent surgery was the direct result of the pre-existing lipoma. The lipoma was not affected by and its treatment not related to the compensable accident.

A submission was received from the employer's advocate, dated June 3, 1998 requesting Review Office to reconsider its earlier decision. The advocate questioned whether or not the claimant actually injured her arm on October 14, 1997, as she had reported a back injury only on the date of accident.

Following the receipt of signed statements from the claimant as well as the Program Director of Medicine and Surgery, Review Office determined that wage loss benefits and /or medical aid should not have been paid for the claimant's left forearm problem which resulted in a CT scan on October 27, 1997, and an allergic reaction to the CT contrast dye. Review Office acknowledged that the claimant sustained injuries involving her lower back, left chest, left shoulder, neck and mid back in the work-related accidents on October 14th and 16th, 1997. The claimant first noticed swelling of her left forearm about 4 days after the latest of these work-related accidents although available evidence did not indicate that the accidents at work had actually resulted in trauma to the left forearm area. Review Office found that there was speculation about a cause and effect connection between the left forearm problem and the accidents at work, and that predominant evidence did not actually support this connection before the scan results became known on October 29th which ultimately established a diagnosis of lipoma. Review Office was satisfied the weight of evidence showed that the lipoma did not likely result from either of these accidents at work and that benefits should not have been paid.

On March 24, 1999, a worker advisor submitted argument to Review Office that on a balance of probabilities, the pre-existing lipoma was aggravated or enhanced by the compensable injury. In support, the worker advisor made reference two medical reports, dated March 10th and 15, 1999, along with the January 30, 1998, operative report. By letter, dated April 9, 1999, Review Office confirmed that the claimant was not entitled to benefits. On May 3, 1999, the worker advisor appealed Review Office's decision and an oral hearing was held on August 5, 1999.

Reasons

As the background notes indicate, the claimant injured her lower back and left forearm while lifting a patient. The medical evidence confirms that the claimant had an asymptomatic soft tissue lipoma located on her left forearm on the flexor surface prior to her compensable accident. Shortly following her incident, the claimant underwent a CT examination of the left forearm which eventually led to the diagnosis of a lipoma. According to the treating surgeon's patient history, "There was no pain or numbness associated with this mass, nor is (sic) there any weakness." The claimant developed an allergic reaction to the CT contrast dye which resulted in her time loss from work.

In arriving at our decision, we placed considerable weight on the following body of evidence:

March 10th,1999, letter from the attending physician - "Mrs. [the claimant] was diagnosed with a lipoma which herniated through the soft tissues of her forearm to the surface during her lifting incident at work. This mechanism of herniation can be confirmed by the fact that the mass was never visible or palpable prior to her accident at work and it was immediately palpable after her injury."

March 15th, 1999, letter from the treating plastic surgeon to the worker advisor - "It is difficult to give an opinion based on the balance of probabilities as to whether Ms. [the claimant's] condition was related to her workplace injury. I believe that if we take the history that she gives at face value, that being that prior to the injury she had no pain and no mass and that subsequent to what she perceives as an injury caused by lifting, she developed a mass and pain that we must deduce that there is causal relationship. While the lipoma was not caused by the injury, its herniation most probably was. It was this herniation that was painful at the time.
... there was a pre-existing condition that was aggravated or enhanced by a workplace injury as there must have been an underlying fatty tumor or lipoma present which had been undiagnosed and asymptomatic prior to her injury."

We find, based on the preponderance of evidence, that responsibility should be accepted for the CT scan of the claimant's left forearm and subsequent time loss from work on November 6th, 7th, 10th and 11th, 1997, in relation to the compensable injury of October 14th, 1997.

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 31st day of August, 1999