Decision #08/99 - Type: Workers Compensation

Preamble

An Appeal Panel review was held on November 23, 1998, following receipt of an appeal from a union representative, acting on behalf of the claimant. The Panel discussed this case on November 23, 1998, and January 5, 1999.

Issue

Whether the MRI findings of February, 1998 are the consequence of the claimant's compensable accident of June 9, 1997; and

Whether the claimant is entitled to benefits under Subsection 4(1) of the Act, for the consequences of these MRI findings.

Decision

That the MRI findings of February, 1998 are not the consequence of the claimant's compensable accident of June 9, 1997; and

That the claimant is not entitled to benefits under Subsection 4(1) of the Act, for the consequences of these MRI findings.

Background

While employed as a labourer on June 9, 1997, the claimant was carrying a box of bolts down a flight of stairs when he felt pain in his lower back after placing the box of bolts on the floor. The claimant did not miss time from work as a result of the incident but was placed on modified duties by his employer.

File documentation revealed that the claimant was referred for physiotherapy treatments and was assessed by an orthopaedic specialist on September 17, 1997. In a report dated September 24, 1997, the specialist noted that the claimant was having some difficulty with his back and pain in his legs. It was noted that the pain was mainly in the legs rather than the back. The specialist made reference to the injury occurring on June 7, 1997 (sic) and noted that at that time the pain was mainly to the right side of his low back. The specialist went on to indicate that he was going to arrange for a CT myelogram as the claimant was noted to have a decreased right knee jerk and he was not sure whether the claimant had a higher lumbar disc protrusion.

The next report from the orthopaedic surgeon dated October 28, 1997, indicated that the CT myelogram was attempted however the radiologist was unable to get into the canal. Arrangements were then made for the claimant to undergo an MRI. The specialist commented that the claimant still had pain going into his legs.

On November 10, 1997, a WCB medical advisor reviewed the file. He stated there were no clinical signs to warrant a myelogram or an MRI and that the claimant was fit for work.

On January 10, 1998, the orthopaedic surgeon wrote to the family physician indicating that the claimant had a CT scan performed on December 9, 1997. The surgeon reported that the CT scan demonstrated a small central disc protrusion at the L3-4 level. There was also congenital narrowing at L4. The surgeon made reference to his original examination findings where the claimant had a decreased right knee jerk and stated that this would be consistent with the patient having a lesion, i.e. a disc at the L4-5 level. The surgeon concluded the report by stating that he was waiting for the claimant to have the MRI exam scheduled for February 27, 1998, prior to considering any back surgery.

On January 28, 1998, a WCB medical advisor commented that the MRI was appropriate in view of the failed myelogram.

On February 27, 1998, the claimant underwent an MRI examination of the lumbar spine. On March 14, 1998, a WCB medical advisor provided primary adjudication with his opinion that the CT demonstrated significant pre-existing facet degenerative changes and congenital narrowing of the spinal canal. The medical advisor also stated that there was a small left L3-4 disc herniation which was likely an incidental finding and not clinically significant because the claimant had signs and symptoms on the opposite side.

In a letter dated April 14, 1998, Claims Services determined that the WCB was not accepting further responsibility with regard to ongoing medical treatment or prescription medication. Claims Services was of the opinion based on the medical advisor's comments that the claimant's current problems were now due to a non-compensable, pre-existing condition. On April 27, 1998, the claimant appealed this decision and the case was referred to the Review Office for further consideration.

On May 15, 1998, the Review Office determined the following:

    "That the claimant's MRI findings in February 1998 are not (on a balance of probability) the result of an accident arising out of and in the course of employment, and particularly the claimant's work-related accident on June 9, 1997; and

    That the claimant is not entitled to benefits under section 4(1) of the Act, for the consequences of these MRI findings."

When reaching the above decisions, the Review Office stated that by the time the claimant underwent MRI studies in February 1998, the predominant medical evidence showed that his lower back symptoms were probably the result of diverse congenital and degenerative changes at multiple levels of the lumbar spine. The Review Office did not believe that the effects of these congenital and/or degenerative changes in the lumbar spine entitled the worker to benefits. In particular, there was no evidence found to show that these problems were either caused or enhanced "by accident arising out of and in the course of employment." The Review Office stated the claimant's lower back symptoms between June 9, 1997, and February 1998, were not consistent with a left-sided disc herniation at L3-L4. The Review Office was satisfied that the claimant's left central disc herniation at L3-L4 was more likely than not an incidental finding which pre-dated the accident at work in June 1997.

In August 1998, a union representative for the claimant appealed Review Office's decision and requested a non-oral file review. On November 23, 1998, the Appeal Panel reviewed the entire case which included a submission from the employer dated October 19, 1998.

Subsequent to the non-oral file review, the Appeal Panel requested that the WCB's Claims Services branch obtain a sworn statement from the claimant concerning the incident of June 9, 1997. On December 11, 1998, a signed statement from the claimant was obtained and it was forwarded to all interested parties for comment. On January 5, 1999, the Panel met to render its final decision on the issues under appeal.

Reasons

The issues in this appeal are whether the MRI findings of February, 1998 are the consequence of the claimant's compensable accident of June 9, 1997; and whether the claimant is entitled to benefits under subsection 4(1) of The Workers Compensation Act (the Act), for the consequences of these MRI findings.

The relevant sections of the Act in this appeal are subsection 4(1) which provides for compensation for personal injury by accident arising out of and in the course of employment and subsection 27(1) which provides for medical aid benefits.

Subsection 4(1) states:

Compensation Payable out of Accident Fund
4(1)

"Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment is caused to a worker, compensation as provided by this part shall be paid by the board out of the accident fund, subject to the following subsections."
Subsection 27(1) states:

Provision of Medical Aid
27(1)

"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."

We reviewed all the evidence on file and in our opinion the weight of the evidence, on a balance of probabilities supports a finding that the MRI findings of February, 1998 are not a consequence of the claimant's compensable accident of June 9, 1998 and therefore the claimant is not entitled to benefits for the consequences of the MRI findings. In reaching this conclusion we placed weight on the following evidence:

  • The Workers Report of Injury dated June 23, 1997 and signed by the claimant, indicates that on June 9, 1998 while carrying a heavy box down a flight of stairs and placing it on the ground, the claimant felt pain in his lower back;
  • An x-ray report ordered by the claimant's attending physician and dated July 4, 1997 reveals no significant bone, disc, or joint abnormality and that the disc spaces remain preserved;
  • A physiotherapy report dated July 4, 1997 indicates a diagnosis of lumbar mechanical back strain;
  • An orthopaedic surgeon indicates in a report dated September 24, 1997 that the claimant was injured in June 1997 while carrying a heavy box and at the time of the injury had pain mainly in the right side of his low back;
  • The first indication of radicular pain is recorded on September 17, 1997, when the claimant is seen by an orthopaedic surgeon who notes that the claimant's pain was now mainly in his legs rather than his back and that the pain did not go distally into his legs, but rather into the thighs, more right than the left. The surgeon also notes that the right knee jerk is present but markedly diminished;
  • In a report dated November 28, 1998, the attending physician indicates that the claimant's right leg pain is greater than the left;
  • An MRI report dated February 2, 1998, indicates congenital narrowing of the central spinal canal throughout the lumbosacral spine. At the L2-3 level there is congenital narrowing causing a moderate central spinal stenosis. At the L4-5 level there is congenital narrowing of the spinal canal and mild facet degenerative changes bilaterally which results in at least a moderate central spinal stenosis. At L5-S1, there is congenital narrowing resulting in at least moderate spinal stenosis. At these levels there is no evidence of a disc herniation or nerve root compression. At L3-4 there is mild narrowing and desiccation of the intervertebral disc with a small broad shallow disc bulge with a suspicion of a left paracentral disc herniation;
  • A WCB medical advisor reviewed the file and the MRI results and reports on March 14, 1998, that the claimant has a significant pre-existing condition with facet degenerative changes and congenital narrowing of the spinal canal. He indicates that the small L3-4 disc herniation is likely an incidental finding and not clinically significant as the claimant's signs and symptoms were on the opposite side;
  • We note that the claimant did not miss any time from work except for attendance for physiotherapy treatment in July and August and that he has continued to do his regular duties with some accommodation by his employer and had no formal medical work restrictions.

We accept the medical findings that the signs and symptoms immediately following the compensable injury were in the claimant's low back and then subsequently several weeks after the accident were predominantly in his right leg which is inconsistent with the small left paracentral disc protrusion revealed by the MRI at L3-4. We find the disc protrusion at L3-4 was an incidental finding, not clinically significant or related to the accident of June 9, 1997.

In summary, we find that the MRI findings of February, 1998 are not a consequence of an accident arising out of and in the course of employment and are not related to the accident of June 9, 1997. The claimant is not entitled to benefits for the consequences of the MRI findings. Therefore the claimant's appeal is denied.

Panel Members

D.A. Vivian, Presiding Officer
A. Finkel, Commissioner
R. Frisken, Commissioner

Recording Secretary, B. Miller

D.A. Vivian - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 13th day of January, 1999

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