The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An appeal panel hearing was held on April 26, 2006. The worker appeared and provided evidence to the panel. He was represented by a worker advisor.

Issue

Whether or not the worker's back problems are related to the March 17, 2003 compensable injury.

Decision

That the worker's back problems are not related to the March 17, 2003 compensable injury.

Decision: Unanimous

Background

Reasons

Claim History

On February 25, 2005, the worker filed a claim with the Workers Compensation Board (hereafter the "WCB") for medical and wage loss benefits stemming from spinal stenosis which he says is related to his March 17, 2003 workplace accident.

The WCB accepted that a workplace accident did occur on March 17, 2003. However, it took the position that the workplace accident only caused the worker to suffer a musculoligamentous strain which had since resolved. The subsequent spinal stenosis suffered by the worker was not accepted.

This position was upheld by Review Office on December 23, 2005. It is this decision that the worker appeals.

Background

On March 17, 2003, the worker was opening a 300 pound overhead door when it fell back down toward him. He held it up for a second or two before he fell backward.

The worker immediately felt hip pain - more so on the right than the left - radiating into his legs, down to his knees. He went to his family physician who diagnosed him with osteoarthritis in the hips and underwent a course of physiotherapy. On April 26, 2004, he complained of pain going more into the left hip and left leg than the right.

An x-ray of his lumbosacral spine revealed narrowed discs and osteophytes at all discs between T12 and L4. It also revealed sclerosis of the L2-3 and L3-4 facet joints consistent with degenerative change. His family physician noted that degenerative changes did exist at the L5-S1 in 1984.

An x-ray of the left hip on September 27, 2004 was normal.

The worker continued to be symptomatic. He went to another doctor at the PanAm Sports Clinic who noted four years of hip pain. He diagnosed him with sacroiliac radicular pain and osteoarthritis of the hip.

The worker also saw a chiropractor who ultimately referred him to a sports medicine specialist who ordered a CT scan.

The CT scan was done on October 12, 2004. It revealed scoliosis convex left and degenerative disc space narrowing at the L2-3, particularly on the right side. It also revealed endplate ridge osteophyte formation resulting in moderate central canal stenosis. There was no associated disc lesion or foraminal narrowing. Severe central canal stenosis was found at the L3-4.

An MRI on January 6, 2005 confirmed central spinal stenosis, most marked at L3-4 and prominent at L2-3. It also revealed possible nerve root compression. A subsequent electrodiagnostic examination by a neurologist later confirmed SI radiculopathy with bilateral involvement showing greater impact on the left with evidence of potential root involvement at the L5 and L4.

On June 6, 2005, the worker underwent an L2, L3 laminectomy and an L2, L3 and L4 instrumentation of bone grafting. The worker's symptoms improved but left leg weakness and numbness in the foot remained.

The Issue and the Worker's Position on the Issue

As indicated previously, the WCB declined responsibility for the worker's spinal stenosis. It took the position that this condition was degenerative in nature and that the workplace accident played no role in it. In coming to this decision, the WCB relied on the medical opinion of a WCB orthopaedic consultant.

The worker urges the panel to accept the opinion of his sports medicine specialist over the opinion of the WCB orthopaedic consultant and find that his 2005 back problems are related to his Mach 17, 2003 compensable injury.

He says that this position is consistent with a prior asymptomatic back, the mechanism of injury and the continuing symptomatic back complaints since March 17, 2003.

Analysis

The worker's accident of March 17, 2003 is central to his appeal. To accept the worker's appeal, we must find that the mechanism of his injury is consistent with his development of spinal stenosis. We are unable to make that determination.

The workplace accident has been described in various ways:

• The worker's February 25, 2005 claim with the WCB describes the workplace accident as follows:
  
  "While opening a heavy wooden overhead door (shipping/receiving door off loading dock, about 300 lbs or more made of ¾ inch plywood), when I pushed the door up, I didn't push it hard enough, and it didn't go all the way up, it came down with me underneath it, and my hands reached up in the air, and caught the door coming back down, holding on, stopping the door from going down or hitting me. I felt pain in my hip, my legs, all the way down to the knees."

• In a telephone conversation with a WCB staff representative on April 28, 2005, the worker further explained the mechanics of the March 17, 2003 accident:
  
  "when door started to come down he was standing, he reached his arms up over his head as the door came down on his arms and tried to hold the weight of the door, the full weight of the door came down on his arms and caused him to bend his knees with the weight, eventually he stop (sic) trying to hold it up and fell back on his butt."

• A February 28, 2005 medical report from the worker's chiropractor relates the accident as follows:
  
  "He stated an overhead door came down quickly across low back/also repetitive carrying of fridges/stoves aggravated."

• An August 15, 2005 medical report from the worker's sports medicine specialist writes:
  
  "In review of the claimant's file, there was no documentation of previous low back or radicular leg complaints/symptoms prior to his early 2003 workplace injury. That injury consisted of a heavy door dropping on his head, applying an axial load to the spine."

At the hearing, we questioned the worker about the mechanism of his injury. The worker's evidence was essentially that it all happened so quickly and that he could not recall exactly how the accident unfolded. He was however able to provide the following information:

• The door weighed approximately 300 pounds;
• It dropped from approximately 9 or 10 feet above the floor;
• He tried to catch the falling door with his arms outstretched;
• The door did not hit his head;
• He moved his head backwards to avoid being hit on the head;
• His arms came down with the door to about his nose or chest area;
• He moved away from the door toward his right;
• He landed on some pallets which were to his left. He sat on them more than fall on them;
• The entire process lasted approximately 2 seconds;
• He continued to work up until 2005 but limited his lifting.

Regarding the spinal stenosis, the medical reports are clear that the worker's spinal stenosis is degenerative in nature.

The worker's sports medicine specialist takes the position however that the spinal stenosis was likely enhanced as a result of his workplace accident. He explains this opinion as follows:

"In discussing the biological plausibility regarding the claimant's accident mechanism leading to an enhancement of the pre-existing condition of spinal stenosis, unfortunately, I do not know the exact mechanism and movements involved with his injury, and as such, my explanation will be based on the premise that there was an axial load supplied through the patient's spine/vertebral column while the door hit his head with element (sic) of a probable lateral/rotary moment to the lumbar spine…It should be remembered, that the biological plausibility does assume an axial load in extension though the lumbar spine or an axial load with side flexion/rotation through the lumbosacral spine."

The WCB orthopaedic consultant took a different view of the mechanism of injury. He found it to be more consistent with a flexion type of strain. After a review of the worker's file he opined on May 8, 2005 as follows:

"The overall impression of this claim is that there was a pre-existing condition of severe lumbar disc degeneration arising out of structural scoliosis. In addition, there was the natural history of the development of spinal stenosis associated with shallow disc herniation, left at D12-L1, right at L2-3 and right at L3-4 based on imaging studies at 18 months and 22 months post-injury. The diagnosis of the workplace injury was a probably quite severe musculoligamentous strain. There is no evidence that the workplace injury aggravated or enhanced the pre-existing condition of lumbar disc degeneration and lumbar spinal stenosis for which surgery is being proposed."

In weighing the evidence, we find on a balance of probabilities that the workplace accident did not cause the worker an enhancement of his spinal stenosis. We agree with the WCB orthopaedic consultant's diagnosis of a severe musculoligamentous strain.

As initially reported by the worker, the door came down toward him. He tried to hold it but eventually fell back. The worker's evidence at the hearing was consistent with this initial report. He clearly stated that he was not hit on the head, contrary to what his sports medicine specialist wrote. He also stated that he did not land on the floor. What differed in his evidence is the 'twisting' motion to the right. This evidence was not presented to the worker's case manager when he initially reported the claim. There is also no evidence of a twisting injury in the medical reports, with the exception of the worker's sports medicine specialist's report.

Though the worker says that he was asymptomatic before the accident and continued symptomatic thereafter, the evidence is clear that the worker was already suffering from degenerative changes to his back in 1984.

On the basis of the foregoing, we find that the worker's back problems are not related to the March 17, 2003 compensable injury. The worker's appeal is therefore denied.

Panel Members

L. Martin, Presiding Officer
R. Koslowsky, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

L. Martin - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 8th day of June, 2006