Decision #50/99 - Type: Workers Compensation
An Appeal Panel review was held on March 3, 1999 following receipt of an appeal from the worker. The Panel discussed this appeal on March 3, 1999.
Whether the claimant is entitled to a Permanent Partial Impairment (PPI) Award due to his right knee injury which occurred February 9, 1997.
That the claimant is not entitled to a Permanent Partial Impairment (PPI) Award due to his right knee injury which occurred February 9, 1997.
On February 18, 1997, the claimant completed a Worker's Report of Injury or Occupational Disease due to an injury sustained to his right knee on February 9, 1997 which occurred when he banged his knee on a corner of a transformer. Initially, the claimant did not miss any time from work however, over the few days following the incident, the claimant reported a worsening of knee pain which required that he be absent from work effective February 14, 1997.
The adjudicator at the Workers Compensation Board (WCB) spoke with the claimant regarding his knee injury on February 25, 1997. During that conversation, the claimant advised that he did not seek medical treatment until returning home to Alberta on February 14, 1997 as he felt the knee would improve on its own. The claimant stated that the employer was aware of the accident and the supervisor was aware that the claimant continued to experience knee difficulties after the accident occurred.
The WCB contacted the claimant's physician on February 28, 1997. The physician stated that the claimant may have torn a cartilage in the right knee and would likely be required to be absent from work for about six weeks. The physician also indicated that arrangements had been made for the claimant to be assessed by an orthopaedic surgeon.
The adjudicator approved the claim on March 3, 1997 and arrangements were made to provide the claimant with payment of wage loss benefits retroactive to February 14, 1997.
Although the initial report from the orthopaedic surgeon does not appear to have been received by the WCB, file documentation shows the claimant had an arthrogram performed on March 18, 1997. The results showed an incomplete tear involving the undersurface of the posterior horn of the medial meniscus with the lateral meniscus and both cruciates intact. Approximately 15 cc's of straw coloured fluid was removed from the knee joint. Due to continuing symptomatology involving the right knee, the claimant underwent surgical arthroscopy on May 13, 1997. The operative report covering the procedure stated the following in part:
- ....I could not detect and (sic) any undersurface tear of the medial meniscus. Synovial examination revealed a large amount of synovitis. A partial synovectomy was carried out to remove the perforated synovium.
On the suprapatellar pouch area, there was a large amount of scarred tissue. This was a very unusual findings (sic). This was all debrided. The patella revealed Grade II to Grade III chondromalacia type of damage on the proximal pole extending to the medial facette Involving (sic) about 75% of the patella. Some debridement was carried out, although not all the cartilage in the surface was removed...."
Post surgery, the claimant returned to the Orthopaedic Surgeon and was noted to have haemarthrosis of the right knee. In a report dated June 6, 1997, the surgeon indicated that the claimant had significant patellar lining damage and therefore, it was felt that the claimant would find it difficult working on crawl surfaces and going up and down stairs and ladders. The physician recommended the claimant be enrolled in a vocational rehabilitation program.
On June 27, 1997, the file was reviewed by WCB's Healthcare Management Services Department. Based on the file review, the medical advisor was of the opinion that the claimant had a grade III chondromalacia patella which was considered to be a pre-existing condition and not related to the compensable injury. The medical advisor also indicated that a meniscal injury was not noted at the time of the arthroscopic surgery however, a diffuse synovitis was observed. The surgeon then elected to resect the hyperaemic synovium which was now considered to be the likely source of the post operative bleeding into the knee joint.
Subsequent to the surgery, the claimant was referred for a course of physiotherapy treatment. However, as the claimant's response to treatment was not as expected, the WCB made arrangements for the claimant to be assessed by a WCB Orthopaedic Consultant which took place on October 7, 1997. Based on the examination findings the orthopaedic consultant expressed the opinion that the claimant sustained a contusion to the right knee as a result of the accident which gave rise to a post-traumatic synovitis. It was felt the claimant no longer required a supervised physiotherapy program and the claimant was encouraged to continue with graduated weight exercises on his own. With respect to a return to work, the orthopaedic consultant was of the opinion that the claimant was fit to resume light duties for a period of no more than six to eight weeks following which he should resume all regular activities.
In keeping with the recommendations of the WCB's orthopaedic consultant, arrangements were made for the claimant to return to work in a light duty capacity effective October 27, 1997. By November 25, 1997, the employer reported that the claimant was performing nearly all of his duties. On January 13, 1998, the employer called the WCB and advised that the claimant had quit his job on December 10, 1997 but at that time, was performing his full time regular duties.
The file was again reviewed by the WCB's orthopaedic consultant on June 25, 1998 to provide comment with respect to entitlement to a PPI Award. Based on this file review which included a recent report from the claimant's treating orthopeadic surgeon dated June 12, 1998, the board's consultant stated that any residual impairment would be related to the pre-existing condition. The consultant indicated that one blow to the knee occurring on February 9, 1997 would not lead to the extensive chondromalacia as reported at the time of the arthroscopic surgery. By letter dated July 16, 1998, the claimant was advised of the WCB's position that he had recovered from the effects of his compensable injury, that any impairment was felt to be related to the pre-existing condition and that restrictions were not required as a result of the injury.
The claimant disagreed with the position of the WCB and filed an appeal with the Review Office. By letter dated August 25, 1998, Review Office wrote to the claimant to advise that the decision of Primary Adjudication was being upheld. In their letter, Review Office stated the following:
- "The weight of evidence - mechanics of the incident, findings at surgery, and your subsequent course - indicates that you have recovered from the effects of your compensable injury. Your current symptoms are likely related to the pre-existing chondromalacia. This pre-existing condition was not caused or affected by the compensable accident. There is under the circumstances, no basis on which to extend further compensation."
As the claimant disagreed with the decision of Review Office, he filed an appeal with the Appeal Commission to address the issue relating to his entitlement to a PPI. Arrangements were made for a non-oral file review which took place on March 3, 1999.
The issue in this appeal is whether the claimant is entitled to a Permanent Impairment Award (PPI) due to his right knee injury which occurred February 9, 1997. The relevant subsections of The Workers Compensation Act (the Act) are subsection 60(2)(c) and (d) which gives the Workers Compensation Board (WCB) exclusive jurisdiction to determine certain matters including:
Subsection 60(2) states in part:
60(2) Particular Jurisdiction
(c) the existence and degree of disability by reason of any injury;
(d) the existence and degree of an impairment and whether it is the result of an accident;
In this appeal the claimant has requested a Permanent Partial Impairment Award (PPI) for the residual effects of his compensable injury of his right knee.
We reviewed all the evidence on file and find that the evidence, on a balance of probabilities, supports a finding that any impairment of the claimant's right knee is not a consequence of the compensable injury of February 9, 1997. In reaching this conclusion we find the following:
The claimant was injured February 9, 1997 when he banged his knee on the edge of a transformer at work. Initial medical reports record a twisting injury while walking at work. As a result of the reports of a possible twisting injury, a torn cartilage was suspected. The claimant's attending physician advised that an arthroscopic investigation was warranted. Authorization was provided by the WCB and the procedure took place on May 13, 1997.
The arthroscopic procedure of the right knee, as outlined in the operative report, revealed that there was a large amount of synovitis, the medial meniscus was intact, about 75% of the patella of the right knee was affected with grade II to grade III chrondromalacia, and there was a large amount of scarred tissue on the suprapatellar pouch.
Impairment awards are granted when there is a loss of range of motion or a loss of function which results from a compensable injury. While a 20 loss of range of motion of the right knee has been documented on file, we find that this is not related to, or the result, of the compensable injury of February 9, 1997. The injury documented on file was a bump/twist of the knee. Arthroscopic investigation revealed a structurally normal knee with significant degenerative changes involving 75% of the patella. The grade II to III chondromalacia pre-existed the compensable injury. We find that it is not related to the compensable injury given the severity of the condition and the minor nature of the compensable injury.
Consequently we cannot accept this appeal for an impairment award, as any impairment of the right knee, on a balance of probabilities, is related to the pre-existing condition and is not a consequence of the compensable injury of February 9, 1997. Therefore the claimant's appeal is denied.
D. Vivian, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner
Recording Secretary, B. Miller
D. Vivian - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 29th day of March, 1999