The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

This appeal involves a worker who injured his left knee at work on February 15, 2005. The claim was accepted and benefits were provided. Subsequently the WCB determined that the worker recovered from his left knee injury. In the meantime, the worker advised the WCB that his left knee injury caused him to develop a back injury. In this appeal the worker is asking the panel to find that he has not recovered from his compensable left knee injury. He is also asking the panel to find there is a relationship between the compensable knee injury and his back injury. Finally, he is seeking wage loss benefits during a defined period.

An appeal panel hearing was held on April 4, 2006, at the request of a union representative, acting on behalf of the worker. The panel discussed this appeal following the hearing on April 4, 2006 and again on June 1, 2006.

Issue

Whether or not the worker has recovered from the compensable left knee injury;

Whether or not there is a relationship between the compensable left knee injury and the worker's back complaints; and

Whether or not the worker is entitled to full wage loss benefits between August 14, 2005 and September 17, 2005.

Decision

That the worker has recovered from the compensable left knee injury;

That there is no relationship between the compensable left knee injury and the worker's back complaints; and

That the worker is not entitled to full wage loss benefits between August 14, 2005 and September 17, 2005.

Decision: Unanimous

Background

During the course of his employment as a service clerk on February 15, 2005, the worker tripped and struck the anterior portion of his left knee on the side of a rack. The Workers Compensation Board (WCB) accepted the claim based on the diagnosis of a left knee strain and the worker was provided with compensation benefits.

By March 17, 2005, the attending physician considered the worker capable of modified duty work while he awaited an MRI examination of the left knee. The MRI examination taken on May 30, 2005, was found to be normal and there was no evidence of a meniscal injury.

On June 14, 2005, the attending physician reported that the worker's left knee pain was getting worse and that he had difficulty finishing half day shifts. An orthopaedic consultation was suggested.

In a report dated June 21, 2005, an orthopaedic surgeon noted that the worker's range of motion in his left knee had improved since his injury but his walking tolerance was limited to 2-3 blocks. The worker complained of occasional giving way episodes within the knee, but no locking. The pain was primarily in the anterior medial aspect of the knee. At the conclusion of his examination, the orthopaedic surgeon could not define the etiology behind the worker's knee pain and was reluctant to perform arthroscopic surgery given the normal MRI examination.

In a progress report dated August 3, 2005, the treating physician noted that the worker was still experiencing pain and swelling in his left knee after working half days and that his back was becoming sore. By August 18, 2005, the worker was exhibiting increased low back pain with referral down his left leg to the lateral heel with paraesthesia. A WCB call-in examination was arranged.

On August 29, 2005, the worker was assessed by a WCB medical advisor and it was determined that further workplace restrictions were not recommended and that the worker could return to his regular duties.

In a decision dated September 15, 2005, the WCB case manager advised the worker that he was considered to have recovered from the effects of his compensable left knee injury and that a relationship could not be established between his compensable left knee injury and his current back symptoms. The WCB ended responsibility for wage loss benefits effective September 16, 2005. On October 27, 2005, a union representative appealed the decision and submitted that the worker's low back complaints were related to his compensable left knee injury.

On November 22, 2005, Review Office determined that the worker had recovered from his compensable left knee injury and that a relationship could not be established between his left knee injury and his back complaints. It also confirmed that the worker was not entitled to full wage loss benefits between August 14, 2005 and September 17, 2005. Review Office based its decisions on the normal MRI findings, the comments made by the worker's orthopaedic specialist on June 21, 2005 and the WCB medical advisor's examination findings of August 29, 2005.

Based upon an appeal submission by the worker's union representative dated November 29, 2005, an oral hearing was held on May 10, 2006. Following the hearing, the appeal panel requested additional information from the worker's attending physician. On May 17, 2006, the interested parties were provided with copies of the information that was supplied by the treating physician and were asked to provide comment. On June 1, 2006, the panel met further and considered a final submission from the worker's union representative dated May 23, 2006.

Reasons

Worker's Position

The worker attended the hearing with a union representative who made a presentation on the worker's behalf.

Regarding the worker's left knee injury, the representative submitted that the WCB erred in determining that the worker had recovered from this injury. He submitted that the WCB medical advisor and WCB staff did an incomplete analysis and relied solely on the report of the WCB medical advisor.

On the relationship between the left knee injury and the worker's back problem, the representative stated that the treating physician opined that the worker's back problem was probably due to his limping from the original knee injury. He noted that the worker began reporting lower back pain in August 2005. He referred to discussion papers prepared for the Workplace Safety and Insurance Appeals Tribunal [WSIAT] entitled "Limping and Back Pain" and "Symptoms in the Opposite or Uninjured Leg" in support of the worker's claim. He advised that it is the worker's position that the limp caused the back pain and that there is no evidence that the worker had a pre-existing condition.

The worker answered questions posed by the panel. The worker advised that in August 2005 he was unable to continue with the return to work program because of problems with his knee. He advised that at the current time, his knee is "okay" and that he would probably be able to work today with his knee. He stated that it improved over time but advised that he still has a slight limp.

The worker described the development of his back problem. He stated that he is unable to work at this time due to his back problem. He advised that standing bothers his back and that he is only able to walk about two blocks. He described the pain as "grinding in my lower back" and that he also has a warm sensation down the backs of both legs. He described recent treatments and advised that surgery is not being considered.

Employer's Position

The employer's representative participated in the hearing by teleconference. She advised that the employer supports the WCB's decision that the worker's back problem is not related to the worker's knee injury and that benefits were terminated.

Analysis

Whether or not the worker has recovered from the compensable left knee injury:

The panel finds, on a balance of probabilities, that the worker has recovered from the left knee injury and is not sustaining a loss in earning capacity due to this injury. In reaching this conclusion the panel's relies on the following:

-the report of an orthopedic specialist dated June 21, 2005 which notes a normal MRI and minimal positive findings. The report suggests difficulty in defining the etiology behind the worker's pain.

-the report of a WCB medical advisor dated August 29, 2005. The medical advisor noted that the clinical examination did not demonstrate any objective evidence of a structural problem in the left knee and there was no objective loss of muscle power in the left lower extremity. The medical advisor also noted that an x-ray of the left knee demonstrated no joint effusions and no significant bone or joint abnormalities and that an MRI of the left knee demonstrated no significant abnormalities. The medical advisor concluded that further workplace restrictions are not recommended and that the worker can return to his regular duties.

- file information suggests the worker stopped work in August 2005 due to his back complaints, not his left knee injury. The worker's treating physician reported on August 18, 2005 that the worker's back pain had increased and that he was "tolerating less work."

- in a narrative report dated May 4, 2006 the treating physician noted that the worker was seen on August 31, 2005. His findings at that time with respect to the knee included: left knee did not reveal any articular effusion and he had full range of motion. The balance of the narrative report focuses on the worker's low back complaints.

Whether there is a relationship between the compensable left knee injury and the worker's back complaints

The worker has been diagnosed by his treating physician with discogenic low back pain with right radiculopathy. A physical medicine and rehabilitation specialist notes evidence of a right-sided L5-S1 disc herniation. The worker's representative argued that the limp resulting from the knee injury caused the worker's back complaints. The panel disagrees and finds, on a balance of probabilities, that the worker's back complaints are not related to the worker's left knee injury. The panel finds that the evidence does not support a causal relationship between the worker's limp and his back injury.

The panel notes that in the narrative report dated May 4, 2006, the treating physician states that "This became increasingly suspicious that his lumbar spine may be contributing to his left leg symptom." This contradicts the worker's position which is the limp caused the back complaints.

The worker's representative referred to discussion papers prepared for the WSIAT dealing with the impact of limps on various areas of the body. The panel noted the conclusion in the paper entitled "Limping and Back Pain". While the paper concluded that "Limping can, in some specific instances, cause back pain and aggravate pre-existing back pain", it goes on to comment:

"Can knee/leg injury cause back problems? It is also unlikely that injuries such as a meniscal tear involving either the medial or lateral meniscus or any condition, e.g. chondromalacia of the patella etc, that caused a mild or moderate degree of limping over a relatively short period of time would have any major detrimental effect on the lumbar spine …"

The panel also notes that the WCB medical advisor opined in an August 29, 2005 report that there does not appear to be any connection between the worker's left knee injury and his low back pain.

Whether the worker is entitled to full wage loss benefits between August 14, 2005 and September 17, 2005

The panel finds, on a balance of probabilities, that the worker is not entitled to full wage loss benefits during this period. In addition to the evidence relied upon in deciding the above issues, the panel also finds that the worker was provided with suitable duties at reduced hours during this period. The panel also finds that the likely cause of any loss of earning capacity during this period was the worker's non-compensable back condition.

The worker's appeal is denied.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
W. Leake, Commissioner

Recording Secretary, B. Miller

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

Signed at Winnipeg this 18th day of July, 2006