Decision #82/99 - Type: Workers Compensation
Preamble
An Appeal Panel hearing was held on June 3, 1998, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on June 3, 1998, October 13, 1998, and April 27, 1999.
Issue
Whether the claimant was entitled to compensation benefits beyond September 12, 1996.
Decision
That the claimant is not entitled to compensation benefits beyond September 12, 1996.
Background
In April 1992 the claimant submitted an application for compensation benefits in relation to pain and soreness in his upper and lower back, pelvis and groin area as a result of driving a forklift over bumpy railroad tracks. The initial diagnosis was chronic musculoligamentous strain secondary to work related activities. Subsequent diagnoses noted on file were as follows: fibromyalgia, myofascial pain syndrome, chronic pain syndrome and somatoform pain disorder. The claim was accepted as Workers Compensation Board (WCB) responsibility and benefits were paid accordingly.
On September 3, 1996, the WCB determined that the claimant's current medical problems were no longer related to the compensable injury and temporary total disability benefits were paid to September 13, 1996, inclusive and final. The decision to terminate benefits was based on various medical reports noted throughout the file along with the following opinions expressed by WCB medical advisors:
- On July 23, 1996, the medical advisor from the WCB's Chronic Pain Unit reviewed a report from a registered psychologist and consultant dated July 9, 1996, and provided the following comments:
"...Based on my impressions at clinical interview, I asked for an MMPI #. The latter is consistent with a pre-existent personality disorder which would be associated with chronic psychological maladjustment. Pre-existing personality factors also play into his substance abuse issues. These traits have to be weighed in the context of the C.I. and physical diagnosis. Basically, this man gradually developed back pain over about one year. His extensive symptomatology is soft tissue in origin and fibromyalgia has recently been suggested. Therefore, weighing this diagnosis (soft tissue) with no clear precipitant against the pre-existing personality disorder I would advise that disability at present is related to pre-existing factors, not his C.I.".
- On August 2, 1996, a second WCB medical advisor reviewed the case and provided the following answers to questions that were posed to him by primary adjudication:
"It would appear the major problems preventing RTW (return to work) are 1) chronic pain 2) myofascial pain or fibromyalgia. The Chronic Pain would appear to relate to a pre-existing psychological disorder.
Fibromyalgia is not considered work related.
Myofascial Pain is unlikely to have resulted from C.I. based on the reported mechanism of injury
or non injury as no specific single event has been cited.
Therefore based on the above I would not feel any current problems can be related to the effects
of C.I. which by inference would indicate he has recovered."
Primary adjudication also asked the medical advisor to comment on whether any of the claimant's medical problems were the result of the compensable injury. The medical advisor responded "no" to this question.
On September 23, 1996, an advocate, representing the claimant, appealed the above decision to the Review Office along with two other issues.
In a decision dated April 18, 1997, the Review Office confirmed that the claimant was not entitled to payment of wage loss benefits beyond September 12, 1996. When reaching this conclusion, the Review Office stated its opinion that the claimant was no longer physically or psychologically disabled by reason of the April 9, 1992, compensable accident . It was noted that the compensable injury produced what had been described as a musculoligamentous strain secondary to the claimant's work related activities. The Review Office felt that most of the claimant's subsequent difficulties were related to medical problems not related to the CI but rather to pain focused syndromes, such as fibromyalgia and the like. The Review Office concluded that the claimant had recovered from the physical aspects of the compensable accident, that being the musculoligamentous strain.
On June 3, 1998, an oral hearing was held at the Appeal Commission to determine whether the claimant was entitled to payment of wage loss benefits beyond September 12, 1996. Following the hearing and after several discussions, the Appeal Panel requested and received further medical information and ordered the convening of a Medical Review Panel (MRP) which took place on February 24, 1999. All interested parties were provided with the MRP findings and results and were asked to provide rebuttal arguments. On April 27, 1999, the Panel met to render its final decision.
Reasons
The claimant through his advocate appealed the Review Office's decision of April 17th, 1997, wherein it was decided that the claimant was not entitled to payment of wage loss benefits beyond September 12th, 1996. The advocate's argument to Review Office stated in part the following:
"We accept that Mr. [the claimant] is experiencing emotional difficulties as a result of his chronic pain and his frustration at the lack of progress towards its resolution. However, the overwhelming weight of medical evidence points to the fact that Mr. [the claimant] is disabled for physical reasons which are a direct result of the compensable injury."
After an exhaustive review of the evidence in conjunction with the oral testimony at the hearing, we decided to request that a Medical Review Panel (MRP) be conducted pursuant to Section 67(3) of the Workers Compensation Act (the Act). In arriving at our decision, we attached considerable weight to the opinions expressed by the MRP Panelists. In particular, we note the responses to the following questions:
- Q. What was the most probable diagnosis of the claimant's injury(s) following his work-related accident in April 1992?
- myofascial pain syndrome
- fibromyalgia
- chronic pain syndrome
- somatoform pain disorder
A. His diagnosis with which the Panelists unanimously agree was Chronic Musculoligamentous Strain.
Q. Has the worker recovered from the effects of his compensable injury?
A. The Panelists agree that he has.
Q. Subsequent to the compensable injury the claimant was diagnosed as having developed a number of other medical conditions and without being restrictive the following have been referred to:
Is there a causal relationship (i.e. other than temporal) between any of these conditions and the work related injury?
A. The Panelists agree that the only causal relationship they are able to identify is temporal.
Q. What is the present diagnosis of the worker's condition and the etiology of the condition?
A. The Panelists agree that the conditions are best described as:
- 1. A Somatoform Pain Disorder.
2. Dependence on and overuse of codeine preparations. The etiology of these conditions is unclear but may be the result of personality traits causing a predisposition to this type of response.
Q. What relationship, if any, does the present diagnosis have to the original injury?
A. The Panelists are unable to discover any relationship with the original injury excepting the temporal relationship. The Psychiatric consultant's expressed opinion is that: In summary, one cannot say with any certainty what "caused" Mr. (the claimant's) Somatoform Pain Disorder to develop. However, one can say with relative certainty that many factors are involved, of which a temporal relationship is only one.
Q. If the claimant continues to suffer from the effects of his injury, what is the prognosis? Are there any treatment options which should be considered?
A. The Panelists are unable to state that the claimant continues to suffer from the effects of his injury.
Based on the foregoing, we find that there is no relationship between the claimant's present difficulties and the compensable injury of April 9th, 1992. The claimant has, on a balance of probabilities, fully recovered from the effects of his accident. Therefore, the claimant is not entitled to payment of wage loss benefits beyond September 12, 1996.
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 25th day of May, 1999