The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker sustained an amputation injury to his left foot in 1997 which was accepted by the Workers Compensation Board (WCB). The worker requested that the WCB accept financial responsibility for the purchase of an ankle exercising machine. The WCB considered the request but declined to accept financial responsibility for the machine. The worker appealed the WCB decision.

A file review was held on July 24, 2006 at the worker's request.

Issue

Whether or not financial responsibility should be accepted for the purchase of an ankle exercising machine.

Decision

That no financial responsibility should be accepted for the purchase of an ankle exercising machine.

Decision: Unanimous

Background

On August 6, 1997, the worker sustained a partial amputation to his left foot during the course of his employment as a labourer. The WCB accepted the claim for compensation and various types of benefits and services were paid. The worker has permanent restrictions to avoid walking on uneven ground, frequent stair climbing and the ability to rest or elevate his leg during the day. The worker is presently involved in a job search through the WCB's vocational rehabilitation branch.

On September 25, 2001, the treating physiotherapist suggested that the worker would benefit from a leg/ankle exerciser which would allow him to strengthen his ankle and lower leg region and to assist him with proprioception.

The above request was reviewed by the WCB's physiotherapy consultant on October 3, 2001. He noted that the treating physiotherapist did not provide proper rationale as to how the machine would benefit the worker. He advised primary adjudication that he would not authorize the purchase of the leg/ankle exerciser as the worker could adequately strengthen his leg/ankle with weight bearing exercises. This decision was relayed to the worker on October 10, 2001.

On February 18, 2002, the worker appealed a number of issues concerning his claim. With respect to his ankle exerciser (DeLorme Boot), he stated,

"The reason for the deterioration of my ankle and calf is because - without a full-size foot - I am unable to do the exercises that are needed to strengthen them on my own and the Delorme Boot would do the work that I am unable to do and thus strengthen the calf muscle and the ankle. Having two legs that are not same size has greatly restricted activities - eg. Walking for any length of time."

In a memo to file dated March 13, 2002, a WCB case manager documented that she discussed "gait retraining" with the WCB physiotherapy consultant. With regard to the request for an ankle exercise machine for the worker, she stated, "An ankle exercise machine such as the one recommended by the physio is unnecessary. Clmt [claimant] could use a rubber tubing for resistance/strength training of his ankles. Clmt could also do calf raises even with the extent of the left foot amputation. His calf raises may be a bit more limited but would still have the same effect in strengthening the ankles."

In a letter to the worker dated March 13, 2002, the case manager outlined her position that the ankle exerciser would not provide any greater benefit to his strength training routine than regular home exercises (e.g. exercises with rubber tubing, calf raises, etc.) and that no change would be made to her earlier decision.

On June 14, 2002, Review Office agreed that financial responsibility should not be accepted for the purchase of an ankle exercising machine. Review Office discussed the matter with a WCB physiotherapy consultant. "He has pointed out that two areas in which the worker has lost range of motion would not particularly benefit by usage of the ankle exercising machine which in actual fact is not in usage in many physiotherapy clinics. There are alternatives that are just as effective and far less expensive and can be done as part of a home exercise program."

On April 10, 2006, the worker appealed Review Office's decision to deny financial responsibility for the costs associated with an ankle exercising machine to the Appeal Commission and a review was arranged.

Reasons

Worker's Position

In April 2006, the worker filed an application to appeal the Review Office decision of June 14, 2002 in which the WCB refused to accept financial responsibility for the purchase of an ankle exercising machine. In support of the appeal, the worker referred to an e-mail note that he sent to the WCB on December 28, 2005 in which he submitted that:

"…the ankle machine would be very beneficial for the future health of my foot, ankle, calf, knee & hip which are deteriorating over time. It would be a very small expense to ensure the strength of my lower extremities for the rest of my life. It would raise the quality of my life and my new career in the pharmacy tech field, ensuring success and to protect the investments of the WCB and myself. I will definitely need it to strengthen my lower extremities with the very physically demanding job ahead that we are pursuing…It will definitely save the WCB a great sum of money towards medications if I receive this item, meaning that I know this machine is the key to pain control and strengthening…"

Applicable Legislation

Medical aid payments for items such as exercise machines, are payable in accordance with subsection 27(1) of The Workers Compensation Act. The WCB makes these payments where it determines that the symptoms/conditions being treated are caused by the workplace injury and the equipment is necessary for the treatment of the symptoms/conditions.

Analysis

The worker has requested that the WCB accept responsibility for an ankle exercising machine. The worker first requested that the WCB consider purchase of an ankle exercising machine in 1998. Since this time the worker has repeated the request. The issue was last considered by the WCB Review Office on June 14, 2002.

The panel has reviewed the medical file and considered the worker's request. The panel notes that recent medical reports have not identified changes in the ankle or recommended the use of an ankle exercising machine. The panel notes and places significant weight on the opinion of the WCB physiotherapy consultant. The consultant considered the request for an ankle exercising machine on two occasions, October 3, 2001 and June 11, 2002. In a memo dated June 11, 2002 the consultant wrote:

"I would not authorize the ankle exercising machine. Ankle … will strengthen with walking and activities of daily living. [WCB medical advisor's] February 25, 1999 PPI exam notes 2 ankle inversions of 10 degrees and extension of 5 degrees. With this unit he would not be able to adequately strengthen in this range. I suggest using surgical tubing or single leg balancing exercises."

The panel finds that financial responsibility should not be accepted for the purchase of an ankle exercising machine. The panel finds that the purchase and use of an ankle exercising machine is not medically required and that suitable alternatives to the ankle exercising machine are available that should be as effective if the worker utilizes them.

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 6th day of September, 2006