Decision #140/06 - Type: Workers Compensation
Preamble
This appeal deals with the relationship between the worker's ongoing symptomotolgy and her compensable injury.On December 10, 2003, the worker filed a claim with the Workers Compensation Board (the "WCB") for a lower back injury. Her claim was accepted and she received benefits until February 5, 2005, when the WCB determined that the worker had recovered from the effects of her compensable injury and that her ongoing symptomotology was related to pre-existing degenerative changes. Review Office upheld this position in a decision dated November 25, 2005. It is this decision that the worker appealed to the Appeal Commission.
An appeal panel hearing was held on June 29, 2006. The worker appeared and provided evidence. She was represented by a worker advisor. No one attended the hearing on the employer's behalf.
After the hearing, the appeal panel requested and received medical information from two of the worker's treating physicians. The interested parties were copied and on July 27, 2006 the worker advisor provided his comments. On August 10, 2006, the appeal panel met to render its final decision.
Issue
Whether or not the worker is entitled to further benefits and services beyond February 5, 2005.Decision
That the worker is entitled to benefits and services from February 5, 2005 to March 23, 2005.Decision: Unanimous
Background
Reasons
BackgroundThough this appeal deals with a workplace injury that occurred on December 5, 2003, it is important to review a prior compensable injury of February 4, 2003 as it places the worker's ongoing symptomotology into context.
The February 4, 2003 Accident
On February 4, 2003 the worker was hip-checked at work and suffered injury to her back which was diagnosed by her chiropractor as sub-acute bilateral sciatic neuralgia.
An x-ray taken of her lumbosacral spine on March 31, 2003 revealed minor scoliosis convex to the left and degenerative changes with considerable narrowing of the intervertebral disc space at L5-S1.
She was seen on this same day by a sports medicine specialist who diagnosed her with myofascial irritation and chronic de-conditioning. He reassured the worker that an aggressive program of re-conditioning should improve her function and diminish her symptom complaints.
The worker received physiotherapy and acupuncture treatments and gradually returned to work in June, 2003.
A CT scan was taken on October 14, 2003 which revealed an L4-5 minimal central disc prominence in association with early facet arthropathy with the spinal canal diameter being reasonably maintained. At L5-S1, there was a vacuum disc phenomenon noted and a minor central disc prominence without evidence of nerve root compression. Facet arthropathy was also noted.
On October 14, 2003 the WCB took the position that the worker had recovered from the effects of her compensable injury and her benefits ended.
The December 5, 2003 Accident
On December 5, 2003, the worker suffered a compensable injury to her back which occurred after moving a vacuum cleaner. The worker explained that she went to the stockroom to get a vacuum cleaner for a customer. The stockroom was filled with merchandise and she was unable to simply walk out with the box. Rather, she lifted the vacuum cleaner box which weighed approximately 20 pounds over her head onto other boxes. Then with her right hand extended over and back behind her head, she pushed the vacuum cleaner box across the other boxes until she came to the end. She dropped the box onto the ground and put it on a wheeler that she rolled out of the stockroom. Shortly thereafter she felt low back pain which radiated into her left leg.
The worker saw her chiropractor who, on clinical examination found muscle spasm, and left sacroiliac joint and L5-S1 rotation/flexion hypomobility. He diagnosed her with acute left sciatic neuritis with lumbosacral apophysitis. He advised her to remain off work until December 21, 2003 at which time she could return to full time duties with restrictions.
The worker underwent chiropractic and physiotherapy treatments and returned to her job duties on December 29, 2003. After her return to work, she suffered two exacerbations (lifting a sewing machine and wrapping a bed) and she ultimately went off work on March 16, 2004.
On April 1, 2004, the worker was examined by a WCB chiropractic advisor to review her ongoing back discomfort. It was his opinion that the worker suffered an irritation involving the left sacroiliac joint. There were no nerve root signs and/or nerve root impingement issues involved with her injury. The chiropractic advisor indicated that there was a myofascial component to the injury involving the left gluteal musculature which he thought was responsible for her left leg discomfort. He thought that after utilizing a sacroiliac support for one to two weeks and increasing her physical activity, the worker should be able to return to employment.
On July 13, 2004, a WCB medical advisor reviewed the file information. He thought that the worker's ongoing symptoms were chronologically related to the compensable injury but would have expected her symptoms to have resolved.
The worker continued with chiropractic and physiotherapy treatments with some noted improvement until she plateaued in August 2004.
The worker was then seen by the sports medicine specialist in August 2004 who diagnosed the worker's condition as lumbar and left sacro-gluteal myofascial pain underlying lumbar facet arthropathy, left SI joint dysfunction, decreased trochanteric pain/diffuse ITB irritation. He recommended that the worker continue with physiotherapy, acupuncture and medication, ordered an MRI and referred her to a physiatrist.
The medical information on file was reviewed by a WCB physiatrist on October 1, 2004. It was his opinion that the mechanism of injury would not have been expected to cause a significant back injury. He thought that the lumbar facet and SI joint conditions were more likely related to pre-existing conditions and not related to the compensable injury.
An MRI was done on November 22, 2004. It revealed degenerative disc disease with associated narrowing involving the L3-4, L4-5 and L5-S1 discs as well as disc bulging at L4-5 and L5-S1.
On January 6, 2005, a WCB medical advisor reviewed that file and opined that the worker's ongoing symptomotology was not related to her compensable injury.
On January 28, 2005 primary adjudication determined that the worker's ongoing symptoms were not related to her December 2003 compensable injury. Wage loss benefits were paid to February 5, 2005 inclusive and final. The worker appealed this decision to Review Office which ultimately upheld this decision.
In the review process a WCB medical advisor reviewed both the February 4 and December 5, 2003 accidents and provided his opinion on the worker's symptoms and their relationship to the compensable injuries.
An October 11, 2005 memorandum to file outlines the WCB medical advisor's opinion:
- The February 4, 2003 mechanism of injury was most consistent with a soft tissue injury. There were minimal findings to suggest a radicular component to the worker's pain. This was supported by the lack of evidence of nerve root involvement on the CT scan.
- The December 5, 2003 mechanism of injury would not have resulted in a nerve root irritation and the worker's symptoms appeared to be mechanical in nature.
- He did not think that the February 4, 2003 injury played a role in the December 5, 2003 accident.
- The worker's current symptoms appeared related to her pre-existing degenerative changes and not her compensable injuries of either February 4 or December 5, 2003.
The additional information from the worker's treating physiatrist revealed that the physiatrist had treated the worker with an epidural injection on March 8, 2005. She was seen for follow-up on March 22, 2005 at which time the worker reported that her symptoms had partially improved. The physiatrist recommended that she gradually increase her activity as tolerated with no specific restrictions. He added that her physical examination was normal and her symptoms were the only parameter used to gauge her progress. She was seen again on May 10, 2005 at which time the worker reported continued improvement. In a May 11, 2005 report to the sports medicine specialist he stated:
"I saw this patient for review of her left L4 radiculopathy on May 10, 2005. She continues to improve symptomatically. She has been very slow to increase her activity and is just starting to go back to exercises. She is planning on restarting work in June. She still has some symptoms that are in the L5 distribution for which an epidural can be repeated in the future. However, she is inclined to increase her activity on her own and I think this is reasonable…"On July 21, 2006, the chiropractor provided the appeal panel with a narrative report outlining his examination findings from February 8, 2005 to November 22, 2005. He stated:
"I considered [the worker] able to assume a return to work program on June 1, 2005 on a modified schedule (as detailed May 18, 2006) (sic). Work restrictions were supplied on this date of May 18, 2006 (sic) in the areas of days worked, hours of shift work, weight restrictions and stair climbing. The [worker] required these restrictions to enable her body to accommodate to the various stress loads, endurance levels and physical demands of her employment."A review of his chart notes indicates the following pertinent information:
- On March 9, 2005 she reported reduced pain in her low back and pelvis after the epidural injection;
- On March 23, 2005 she reported she had only mild pain in her low back/pelvis and left leg radiation until she chopped ice on the walkway which increased her pain to a moderate level with left low back muscle spasm;
- On April 20, 2005 she reported moderate pain aggravated by raking leaves - twisting activity;
- On May 4, 2005 she reported an aggravation of low back pain upon moving furniture at home;
- On May 18, 2005 she reported decreased pain upon commencing an exercise program. At that time a gradual return to work program was devised.
Worker's Position
The worker says that she should be entitled to further benefits beyond February 5, 2005 as her symptoms had not yet resolved by that date. She says that from February to June, 2005, when she began a gradual return to work, she was hardly able to function and only returned to work for financial reasons. She relies on the medical reports revealing ongoing symptomotology in support of her position.
Analysis
To accept the worker's appeal we must find that her ongoing symptomotology beyond February 5, 2005 is causally related to her compensable injury. We are able to make that finding up until March 23, 2005. After that date, we find that the worker's ongoing symptomotology is not related to the December 5, 2003 compensable injury.
The evidence is that the worker suffered an injury to her pre-existing degenerative back on December 5, 2003. The exact diagnosis of the worker's back injury is not clear though it appears to be a sprain/strain type of injury given the clinical findings of muscle spasm at the time of the injury.
Though the worker's muscle spasm appears to have resolved relatively quickly, she was left with mechanical and myofascial pain. Despite medical treatment, the worker continued symptomatic until she received an epidural injection on March 8, 2005. At the hearing, the worker denied much relief from the epidural injection. The reports received from the physiatrist and the chiropractor indicate otherwise. In fact, we place great weight on the physiatrist's March 23, 2005 report and the chiropractor's March 9 and 23, 2005 entries which record reduced back pain after the injection.
Subsequent to this date, the worker was able to increase her activity and join a fitness program as had been suggested by many of her treating physicians. Though the worker continued to have flare-ups of her back pain we do not find that the December 5, 2003 accident played any significant role in their onset.
Based on the foregoing we find, on a balance of probabilities that the worker's compensable symptoms had resolved by March 23, 2005. What transpired after this date, as suggested by the additional information, are additional non compensable accidents that aggravated her pre-existing degenerative back condition.
For these reasons we find that the worker is entitled to benefits from February 5, 2005 to March 23, 2005 inclusive.
Accordingly, the worker's appeal is successful in part.
Panel Members
L. Martin, Presiding OfficerR. Koslowsky, Commissioner
M. Day, Commissioner
Recording Secretary, B. Kosc
L. Martin - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 19th day of September, 2006