Decision #86/99 - Type: Workers Compensation
An Appeal Panel review was held on May 21, 1999, at the request of a worker advisor, acting on behalf of the claimant.
Whether the claimant is entitled to wage loss benefits or to other benefits and services under the Act, between August 7, 1997 to January 9, 1998.
That the claimant is entitled to wage loss benefits and services under the Act, between August 7, 1997, to January 9, 1998.
In November 1996, the claimant filed a claim for workers compensation benefits in relation to a right foot condition which was eventually diagnosed as metatarsalgia. The claimant was awarded wage loss benefits for the period October 17, 1996, and March 23, 1997. For complete details surrounding the case, please refer to Appeal Panel Decision No. 184/97, dated August 27, 1997.
On March 24, 1997, the claimant returned to her regular duties as a hospital unit clerk but experienced further difficulties. In a statement, dated November 26, 1997, the claimant indicated that when she returned to work her foot was still sore and after one month she began to experience problems with her left knee as she was favoring her right leg. Then, her right knee started to bother her and the pain went into the right hip. The claimant advised that she was in constant pain 24 hours a day. While working 12 hour shifts she began to experience chest pain, weight loss, lack of concentration, depression and insomnia and suggested that all of these symptoms were due to chronic pain resulting from her metatarsalgia. The claimant indicated that she had consulted a cardiologist on August 7, 1997, and was taken off work by him due to stress.
At the request of primary adjudication, a Workers Compensation Board (WCB) medical advisor reviewed the case on December 12, 1997. Based on a review of medical reports throughout the file, the medical advisor was of the opinion that a good functional recovery had occurred which then allowed the claimant to return to work on March 24, 1997. The medical advisor expressed his opinion that there did not appear to be any medical information that would indicate a causal relationship between the June 1, 1996, compensable injury and the claimant's lay off from work in August 1997.
On February 5, 1998, the claimant attended the WCB offices for an assessment by a medical advisor in order to determine the claimant's present status, work, capabilities and restrictions. Following examination of the claimant's ankles, feet and hips, the medical advisor recorded the following:
- abnormal illness behaviour was not noted on the examination;
- the claimant pointed out that her ankle examination was not reflective of her condition six months ago when she first went off work and noted that it improved dramatically since that time.
- the examination demonstrated findings that were consistent with a synovitis of the right ankle. There was synovial thickening and tenderness of the synovia at the talofibular joint. The medical advisor commented that this diagnosis was most likely related to osteoarthritis and suggested further investigations be carried out.
- the claimant was capable of sedentary work.
Subsequent file documentation contained x-ray reports of the right hip, right ankle and right foot, dated March 9, 1998 and a bone scan, dated March 20, 1998. The x-rays and bone scan were then reviewed by an independent radiologist at the request of the examining WCB medical advisor. A report from the independent radiologist, dated April 27, 1998, indicated the following:
- there was no radiological evidence for osteoarthritis involving the ankle.
- there was a Type II accessory navicular on the right. These occasionally can be symptomatic and clinical correlation would be helpful.
- there were no abnormalities of the right hip, right elbow or both knees on the submitted examinations.
- there was no evidence for talo-calcaneal coalition, however a medial coalition often required a CT to diagnosis.
On April 27, 1998, the WCB medical advisor who examined the claimant on February 5, 1998, reviewed the radiologist's report as well as the x-rays and bone scan. The medical advisor was of the opinion that an explanation for the claimant's complaints and physical findings on examinations had not been established by examination or by diagnostic imaging. The medical advisor was of the opinion that a cause and effect relationship between the claimant's complaints and physical findings and her workplace was not evident.
The claimant underwent a CT scan of the right hindfoot on June 5, 1998. The report indicated no evidence to suggest a tarsal coalition of the talocalcaneal and calcaneal-navicular articulations. On June 19, 1998, a WCB orthopaedic consultant reviewed the CT scan report and agreed with the previous medical advisor that a cause and effect relationship between the workplace accident and present complaints was not established. Based on the above, the claimant was notified by primary adjudication that no responsibility could be accepted for any time loss or medical treatment subsequent to August, 1997.
On July 31, 1998, the case was considered by the Review Office following receipt of an appeal from a worker advisor, acting on behalf of the claimant. Following review of file documentation, the Review Office confirmed that the claimant was not entitled to wage loss benefits or other benefits and services under the Act, between August 7, 1997, and January 9, 1998. The Review Office considered the predominant medical evidence to indicate that the claimant's loss of earning capacity after August 1997 was probably a consequence of depression and anxiety, and that this problem did not originate because of a work-related accident.
The worker advisor appealed the Review Office's decision and a non-oral review took place on May 21, 1999. The worker advisor contended that the claimant had not recovered from the effects of her work related injury based on a report from the attending physician dated September 3, 1998.
The previous Appeal Panel concluded that the claimant's metatarsalgia arose out of and in the course of her employment. According to the claimant's treating orthopaedic surgeon, "Metatarsalgia is usually considered an over use problem secondary to prolonged standing or walking, often on hard surfaces and sometimes with inappropriate shoe wear. As such the condition could be exacerbated by her employment but not necessarily entirely caused by it."
We find as a fact that the claimant had, on a balance of probabilities, recovered from the further aggravation of her metatarsalgia by the end of January 1998. In arriving at this conclusion, we note the claimant's comment to a WCB medical advisor that her condition improved dramatically after she went off work. Also, we attached significant weight to an opinion of a WCB medical advisor which is contained in a memorandum, dated April 27th, 1998:
"An explanation for Ms. [the claimant's] complaints and physical findings on examination has not been established by examination or by diagnostic imaging. A cause - effect relationship between Ms. [the claimant's] complaints and physical findings and her workplace is not evident, in my opinion."
It should be pointed out, as well, that this medical advisor had conducted a physical examination of the claimant approximately two months earlier.
In conclusion, we find the claimant is entitled to wage loss benefits or to other benefits and services under the Act between August 7, 1997 to January 9, 1998. However, based on the evidence, any further problems beyond this date are not related to the 1996 compensable injury.
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 3rd day of June, 1999