The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An Appeal Panel hearing was held on October 5, 2000, at the request of the claimant. The Panel discussed this appeal on October 5, 2000.

Issue

Whether or not the claimant is entitled to wage loss benefits beyond January 7, 2000.

Decision

That the claimant is not entitled to wage loss benefits beyond January 7, 2000.

Background

On January 21, 1999, the claimant submitted an application for compensation benefits indicating that he had slipped and fallen down two steps from his truck and landed on his left knee. The accident occurred on April 8, 1998, however, the claimant continued working until January 4, 1999 despite ongoing knee problems. Following a thorough investigation into the case, the claim was accepted by the Workers Compensation Board (WCB) in March 1999 and the claimant received benefits commencing January 11, 1999.

The following is a brief description of medical information noted on file:

• a Doctor’s First Report dated January 12, 1999, indicated that the claimant was treated for left knee pain on several occasions commencing June 17, 1998 and was referred to an orthopaedic specialist in December 1998.
•  on December 16, 1998, an orthopaedic specialist noted that the claimant had no real history of a major injury to his knee except for the onset of anterior knee pain which became worse with stair climbing and using the clutch in his truck. X-rays of the left knee were normal. The specialist indicated that the claimant had patellofemoral joint symptoms and the cornerstone of treatment was quadriceps muscle strengthening which was done while avoiding knee flexion to prevent further irritation of the joint.
• a Chiropractor’s First Report dated January 14, 1999, indicated that the claimant was first treated on December 21, 1998. The diagnosis was patellofemoral syndrome with possible meniscal tear.
• in a January 11, 1999 report, a sports medicine specialist indicated that in his opinion, the history and physical findings suggested a patellofemoral traumatic synovitis. The knee was otherwise quite normal with no meniscal pathology.
• on April 29, 1999, a WCB medical advisor determined that the claimant was capable of modified work with restrictions to avoid stair climbing, squatting and heavy lifting over 75 pounds for 4 weeks.
• in a May 4, 1999 letter, an orthopaedic specialist reported the claimant was overweight and walked with a balanced gait. The left knee had no effusion or discoloration. There was tenderness at the patellofemoral joint. The rest of the examination was unremarkable. The specialist concurred with the sports medicine specialist that the claimant most likely had post-traumatic chondromalacia patella.
• on July 5, 1999, the claimant underwent a left knee arthroscopy, synovectomy, excision of the medial plica and debridement of the medial meniscus. The post-operative diagnosis was “Synovitis in the left knee with medial plica, as well as a partial thickness medial meniscal tear.”
• in a follow-up report dated July 19, 1999, the orthopaedic surgeon noted that the medial meniscus partial tear was very stable and probably did not fit in with the mechanism of injury.
• on September 30, 1999, the family physician stated that the claimant was capable of light to medium work and outlined various restrictions dealing with standing, lifting, and knee flexion. The physician considered that the claimant was unable to return to work at his pre-accident position as a long distance truck driver.
• the claimant was assessed by a WCB orthopaedic consultant on November 4, 1999. The diagnoses were medial meniscus tear, parapatellar synovitis and chondromalacia. The consultant was of the view that the claimant’s symptoms were suggestive of chondromalacia patellae but this was not mentioned in the arthroscopy report. He doubted that the synovial plica was of any significance and that it was unrelated to the compensable injury. He believed the claimant was not severely disabled and thought the claimant could increase his activity. The claimant should probably avoid excessive use of stairs and ladders and should try to avoid lifting with his knees. Increased walking at work would cause a problem.
• in December 1999, the orthopaedic consultant was asked to review the case at the request of primary adjudication. The consultant indicated that the current diagnosis was chondromalacia and that the claimant was capable of performing his pre-accident duties. He felt that the chondromalacia was likely to cause some recurrent or chronic mild aching in the knee but that it would not prevent the claimant from driving a truck full time.

In a decision dated January 11, 2000, the claimant was advised that in the opinion of the WCB he was considered fit to perform his pre-accident duties as a truck driver and that wage loss benefits would be paid up to and including January 7, 2000. On January 19, 2000, the claimant appealed this decision stating that he still had a great deal of pain in his knee and that he could not use his left leg to push the clutch down on his truck or climb a ladder without his leg failing. The case was referred to Review Office for consideration.

At the request of Review Office, the treating orthopaedic specialist provided up-dated information dated February 17, 2000, regarding the claimant’s medical condition. The surgeon felt that the claimant’s current residual disability was still secondary to his left knee patellofemoral syndrome. The surgeon stated, “ Based on his status symptomatology, I would suggest to avoid placing him back in his pre-accident occupation as a semi-truck driver. He could perform modified duty at this time. He must avoid using his left leg to push the clutch on a semi-truck or to climb the ladders repetitively until his investigation is completed.”

Review Office referred the case to a WCB orthopaedic consultant on March 16, 2000, for additional input with respect to the claimant’s medical condition. Briefly, the orthopaedic consultant responded as follows:

• an MRI scan would likely not provide any useful information regarding the claimant’s ongoing left knee symptoms. The consultant indicated that MRI are difficult to interpret when previous surgery has been performed and that pathology in the patellofemoral joint was not necessarily well identified by MRI.
• the consultant confirmed the diagnoses of a medial meniscus tear, post-traumatic synovitis and medial plica. There was conflicting evidence as to whether or not the claimant had chondromalacia patella as the July 5, 1999 operative report did not make mention of such a diagnosis or note changes on the articulating surface of the patella. If the claimant had post-traumatic patella, it would not prevent work activity or a total impairment. When the claimant was examined by a WCB orthopaedic surgeon in November 1999, there was no effusion within the knee joint, which normally occurred with an ongoing reactive synovitis. The medial plica in the claimant’s left knee was the only pre-existing condition and the claimant was no longer suffering from the effects of this condition.
• the claimant did not require work restrictions and his symptoms of knee pain did not constitute sufficient impairment to prevent his working as a long-distance truck driver.

On March 24, 2000, Review Office determined that the claimant was not entitled to wage loss benefits beyond January 7, 2000. Review Office reached this decision based on the evidence provided by the WCB orthopaedic consultant to Review Office together with the information provided by the claimant’s orthopaedic surgeon, family doctor, the WCB orthopaedic consultant who examined the claimant and the accident employer.

Review Office also felt that the recent recommendation by the orthopaedic specialist to avoid using a clutch was not supported objectively and appeared to be based on the worker's complaints of discomfort. Review Office indicated that the majority medical opinion suggested that the claimant should increase his activities and that he could use a clutch. The Review Office said that while the orthopaedic specialist restricted the claimant from climbing ladders repetitively, it did not believe that climbing three steps to enter and exit his truck, once every three hours, to be repetitive and that this function was within his work capabilities.

Additional medical reports were received following Review Office’s decision. These included an MRI report of the left knee dated March 3, 2000, and reports from the treating orthopaedic surgeon dated May 18^th and June 8, 2000.

On October 5, 2000, an oral hearing was held at the Appeal Commission at the request of the claimant’s advocate. Following the hearing and discussion of the case, the Appeal Panel requested additional medical opinion be obtained from the treating orthopaedic specialist. A report from the treating orthopaedic specialist dated October 31, 2000 was forwarded to the interested parties for comment. On December 4, 2000, the Panel met to render its final decision.

Reasons

We also attached considerable weight to the opinion expressed by a second WCB orthopaedic consultant, which opinion is contained in a memorandum to file dated March 16^th, 2000. The memorandum states in part:

“There is conflicting evidence as to whether or not the claimant actually has chondromalacia patella occurring again on a post-traumatic basis as the original operative report of July 5, 1999 makes no mention of chondromalacia patella or changes on the articulating surface of the patella. The operating surgeon, at a subsequent review of interoperative Polaroid pictures, now reports that there was some degree of chondromalacia patella.

Even if the claimant has some residual post-traumatic chondromalacia patella involving the patellofemoral joint, this does not comprise a total impairment preventing work activity. If the symptoms continue to be focused in the patellofemoral joint, he might benefit from wearing a knee orthosis with a patellar cut out.

Furthermore, it is noted when he was examined at the WCB by the consultant orthopaedic surgeon advisor November 4, 1999 there was no noted effusion within the knee joint which occurs with an ongoing reactive synovitis either due to trauma or prior surgery.

In my opinion, it is not necessary to impose any work restrictions. The claimant should avoid activities that aggravate the knee. He might well benefit from wearing a knee orthosis with a patellar cut out if he has ongoing symptoms that appear to be related to the patellofemoral joint. He should also continue with quadricep drill strengthening exercises and avoidance of prolonged periods of acute flexion and knee bending. Any residual symptoms of pain in the knee do not constitute sufficient impairment to prevent work activity as a long distance truck driver based on the medical reports and findings of November 1999 and the more current report from his attending orthopaedic surgeon of February 17, 2000.” (Emphasis ours)

On March 28^th, 2000 the claimant underwent a magnetic resonance imaging (MRI) of his left knee. This procedure revealed: “No abnormalities of the extensor mechanism, patella or patellar tendon are seen. The cruciate and collateral ligaments are unremarkable. No significant joint effusion is seen.” (Emphasis ours)

After having considered all of the evidence as a whole and in particular the foregoing medical evidence, we were able conclude that the claimant was not entitled to wage loss benefits beyond January 7^th, 2000. Accordingly, the claimant’s appeal is hereby dismissed.

Panel Members

R. W. MacNeil, Presiding Officer
A. Finkel, Commissioner
B. Malazdrewich, Commissioner

Recording Secretary, B. Miller

R. W. MacNeil - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 8th day of January, 2001