The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker had two wrist injuries. Both injury claims were accepted and benefits were paid. Subsequently it was determined that the worker required surgery on his wrist. This appeal is primarily concerned with whether the recommended surgery is related to the workplace injuries or a pre-existing condition. The Workers Compensation Board (WCB) found that the surgery is needed as a result of a pre-existing condition. The worker appealed the decision.

An appeal panel hearing was held on June 14, 2006, at the request of a worker advisor, acting on the worker's behalf. The panel discussed this appeal following the hearing on June 14, 2006.

Issue

Whether or not responsibility should be accepted for the worker's right wrist problems and associated surgery of October 28, 2005.

Decision

That responsibility should not be accepted for the worker's right wrist problems and associated surgery of October 28, 2005.

Decision: Unanimous

Background

On September 21, 2004, the worker sustained injuries to his right ankle, forearm and wrist during the course of his employment as a pasture rider. The WCB accepted the claim for compensation and benefits were paid.

The worker underwent x-rays of his right wrist on September 21, 2004. The radiological report indicated "A lucent line transverses the proximal cortex of the scaphoid suspicious for a fracture through the waist of the scaphoid…" The impression was "Suspected scaphoid fracture."

On December 16, 2004, an occupational therapist indicated that the worker was seen for a custom splint regarding scaphoid non union. She noted that the worker fractured his scaphoid bone four years ago and re-broke it again one year ago. The worker was awaiting surgery.

File documents show that the worker has a prior compensation claim for a right wrist injury that occurred on May 17, 2001. A review of the file revealed that x-rays of the right wrist were taken on May 23, 2001 and showed an old un-united fracture involving the proximal pole of the scaphoid. There was some sclerosis of the proximal pole. An ossific density was found along the dorsal aspect of the wrist on the lateral view which likely represents an old triquetrum fracture. There was no definite evidence of an acute process.

Further x-rays of the right wrist were taken on July 5, 2001 and were compared to the x-rays taken on May 23, 2001. The old united fracture involving the waist of the scaphoid was again identified. There was sclerosis and cystic formation within the proximal pole of the scaphoid. The appearance was reported as being consistent with avascular necrosis. Joint space narrowing was present in the radial carpal joint laterally which was consistent with osteoarthritic changes. There were no other significant changes identified.

In a report dated June 21, 2005, an orthopaedic specialist stated the following:

"The problems in his right wrist started back four years ago while at work on a ranch. He fell and fractured his scaphoid. He was treated in a cast; however; the patient had the cast removed prematurely due to discomfort. Over the past year, the patient has noticed increasing pain in his wrist when performing certain activities such as doing calf roping. He was informed by a doctor that he had a bone chip in his wrist and was referred here for excision of this bony fragment."

Following his examination of the worker's wrist, the specialist stated,

"…this is not simply a matter of excising a bone chip. We have indicated to the patient that he has degenerative arthritis secondary to a scaphoid and nonunion. We informed him that attempting to heal the scaphoid at this point would not work and that his best option surgically for the alleviation of pain would be a scaphoid excision and four-corner fusion."

A WCB medical advisor reviewed the file information on September 19, 2005 and stated the following:

"The dx [diagnosis] for the claimant's wrist pain is non union of a scaphoid fracture with some avascular necrosis. On a balance of probabilities, this is a pre-existing condition and not related to this compensable injury.

Reasoning:

• X-rays taken for this injury showed a non-union of a scaphoid fracture with evidence of avascular necrosis. This would not have occurred with the September 2004 injury in that time frame.
• Claimant mentioned he had injured his wrist four years previously and a claim from May of 2001 was reviewed. At this time, x-rays showed an old fracture at the scaphoid with avascular necrosis already. Again, this x-ray appearance would not have come from the May 2001 injury.
• X-ray findings in 2001 and 2004 are similar and the injury of 2004 appears to not have changed the status of this fracture.

Any treatment of the fracture would not be related to the compensable injury but rather pre-existing."

In a decision by Rehabilitation and Compensation Services dated October 3, 2005, it was confirmed to the worker that the WCB was unable to relate his upcoming surgery to the workplace injury of September 21, 2004. The position taken by the WCB was that the underlying pathology in his right wrist (non-union of a scaphoid fracture with some avascular necrosis) predated his September 2004 injury. It was noted that x-rays taken in 2001 of the right wrist also showed an old fracture on his scaphoid and that this x-ray finding would have had to occur prior to 2001.

A submission was later received from a worker advisor in which she appealed the WCB's decision of October 3, 2005. Enclosed with the submission was a report from the worker's specialist dated December 1, 2005.

On January 21, 2006, the worker's case manager wrote to the worker advisor, indicating that it was the opinion of a WCB medical advisor that the new report from the worker's specialist did not provide information to relate the worker's ongoing right wrist difficulties and the surgical procedure of October 18, 2005 to the workplace injury. As a result, no change could be made to the October 3, 2005 decision. On January 26, 2006, the worker advisor appealed this decision to Review Office.

On February 9, 2006, Review Office confirmed that no responsibility should be accepted for the worker's right wrist problems or associated surgery of October 28, 2005. Review Office felt that the worker had recovered from his 2001 soft tissue injury by the time he had experienced his work injury on September 21, 2004. It found no clinical, radiological or other evidence to support that the 2001 right wrist injury was enhanced by the 2004 work injury. In March 2006, the worker advisor appealed Review Office's decision and a hearing was arranged.

Reasons

Worker's Position and Evidence at Hearing

The worker was represented by a worker advisor who made a presentation on behalf of the worker. The worker answered questions posed by his representative and the panel.

The worker, a pasture rider, described his 2001 workplace injury. He advised that his horse was bucking and that this caused his right hand to hit the saddle horn. He sought medical attention, his hand was x-rayed and he was told by the treating physician that he fractured his hand. He was also told that he had an old fracture. The worker advised that he could not remember any previous injury to his hand. The worker also told the panel that prior to the 2001 injury he had no problems with his hand. After the 2001 injury the worker said he had pain in right hand "once in while" and that it "was getting a little on the stiffer side".

The worker described his 2004 workplace injury. He was riding his horse around a dugout when the horse wiped out causing the worker to hit the ground and slamming his hand into a rock. X-rays were taken and he was told that he had a cracked bone. After the 2004 injury he advised that when using a rope he had a sharp pain and was less accurate.

The worker advised that he had surgery in 2005 and since then has not had pain in the wrist and has better rotation.

The worker advisor noted the worker's evidence that he did not have any right wrist symptoms prior to 2001. She submitted that, on a balance of probabilities, given the combined effects of the 2001 and 2004 compensable injuries, there is a cause and effect relationship between the worker's prior workplace injuries and his ongoing right wrist symptoms and the surgery. The worker advisor acknowledged that "… we do not have any medical support of an enhancement…"

Analysis

For the appeal to be successful the panel must find a relationship exists between the worker's wrist problems and associated surgery and the worker's workplace injuries. The panel is not able to reach this conclusion. The panel finds, based on a consideration of all the evidence and on a balance of probabilities, that the worker's wrist problems and surgery are not related to the workplace injuries.

The treating specialist diagnosed the worker's condition as "degenerative arthritis secondary to a scaphoid and nonunion". The surgery, which is the subject of this appeal, was performed in October 2005 and involved a scaphoid excision and four-corner fusion of the right wrist.

In determining whether there is a relationship between the workplace injuries and the surgery the panel notes that x-rays taken of the worker's right wrist in 2001 shortly after the May 17, 2001 injury revealed an old ununited fracture of the scaphoid. An x-ray report dated July 5, 2001 states:

"Right Wrist:
The present study is compared with recent radiograph of May 23/01. Again identified is an old ununited fracture involving the waist of the scaphoid. Sclerosis and cystic formation are noted within the proximal pole of the scaphoid. The appearance is consistent with avascular necrosis. Joint space narrowing is present in the radial carpal joint laterally, consistent in appearance with osteoarthritic changes. No other significant changes are noted."

The panel also notes that an x-ray report taken on October 20, 2004 after the 2004 injury identifies a likely non-union of an old scaphoid fracture.

The panel places significant weight upon the opinion of the WCB medical advisor set out in a memo dated September 19, 2005. The medical advisor opines that the non-union of the scaphoid is a pre-existing condition and that any treatment of the fracture would not be related to the compensable injury.

The panel also notes that the WCB orthopedic consultant, after reviewing the file commented on February 7, 2006 that there is no relationship between the surgery and the workplace injuries and that "The condition of the Rt wrist pre-existed any of the work related injuries & was developing OA prior to the initial work related injury of May 17/01."

The worker's appeal is declined.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Kosc

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

Signed at Winnipeg this 8th day of August, 2006