The Appeal CommissionThe Workers Compensation Act of Manitoba

The treating physician, in his report dated January 9, 2006, indicated that the worker’s knee symptoms and function began to worsen in early 2005. The worker underwent physiotherapy treatments and was controlling his pain with codeine and topical pennsaid drops. He was also referred to a knee specialist for his knee symptomotology.

An MRI taken February 12, 2006 revealed the following:

“There is diffuse bulkiness and signal hyperintensity within the ACL compatible with a moderate to high grade tear. The PCL, MCL, LCL, and extensor complex are intact. There is no joint effusion seen. There is moderate osteoarthritic change in the medial tibiofemoral compartment and mild degenerative change in the lateral compartment. There is signal hyperintensity in the body and posterior horn of the medial meniscus compatible with internal degeneration. There is no discrete surfacing tear identified. A moderate to large sized Baker’s cyst is noted which extends superiorly behind the femoral metaphysic.”

In a consultation report dated February 22, 2005, the specialist reported that the worker has had difficulties with his knee on and off since 1999 when he twisted his knee while walking down a grade. He noted that the worker had another recent injury to his knee when his knee ‘gave out’ while descending stairs and he fell directly on the anterior aspect of both knees. The worker continued to walk with a cane and was complaining of pain over the lateral aspect of his right hip. Examination revealed a basically normal knee although there was a very small effusion and considerable patellar femoral crepitus. His standing x-rays showed medial cartilage space narrowing. The specialist saw no difficulties with the hip. A recent MRI was not available. There was no evidence of fracture or ligamentous damage to the knee. The specialist opined that the worker likely had a degenerative tear of the medial meniscus, in association with early median compartment degenerative arthritis. “Although this is obviously of a long-standing nature, the degenerative tear of the meniscus, certainly could have occurred at the time of his original injury in 1999, and was exacerbated when he fell more recently. His symptoms are on going, and arrangements have been made for an arthroscopic examination of the knee.”

On March 2, 2006, the file was referred to a WCB medical advisor to review the medical information and to comment on the worker’s current knee difficulties and its possible relationship to his 1999 compensable injury. On March 2, 2006, the medical advisor opined that the worker’s current knee difficulties were not related to his 1999 accident. The medical advisor stated,

“Claimant injured knee October 25, 1999 with a twisting mechanism. Initial assessment showed no effusion, no laxity, & medial tenderness. X-ray was reported as showing no fractures. An MCL and medial meniscus tear were queried. When reassessed November 15 (21 days later) the knee exam was said to be normal and the claimant was said to be capable of normal duties. The effects of the CI [compensable injury] appeared to have completely resolved. We then have no medical until 6 years later, when he is thought to have a degenerative meniscal tear.

I cannot relate this dx [diagnosis] to the CI. If he had had a significant meniscal tear in 1999, he would not have recovered in 3 weeks nor would it have taken 6 yrs. to become symptomatic enough to require surgery. An acute meniscal tear generally does not heal on its own and surgery would be considered much closer to the time of injury.

The surgery may be recommended for the claimant’s knee but it is not related to the CI.”

On March 21, 2006, the worker was informed of the WCB’s position that his 1999 compensable injuries were not contributing to the difficulties that he was currently experiencing. The adjudicator referred to the opinion expressed by the WCB medical advisor on March 2, 2006 in support of his decision. On April 3, 2006, the worker appealed this decision to Review Office.

Prior to rendering the worker’s appeal, Review Office sought the medical advice of a WCB orthopaedic consultant as to whether the recent MRI findings had a relationship to the original 1999 accident. In response, the orthopaedic consultant stated:

“The MRI of February 12, 2006 reports a tear of the ACL right knee, which was reported normal at the time of examination October 25, 1999. Findings at that time not consistent with ACL and as the WCB Medical Advisor has noted with file records, recovery was too quick (three weeks). The MRI also reports degenerative traumatic tear in the injury occurring December 9, 2005 and I would think this is a new injury. The MRI also reports a large Baker’s cyst, which is consistent with long standing osteoarthritis and/or a long standing tear of the posterior horn of the medial meniscus. The degenerative changes are playing a significant role. The reported ACL tear not likely to have occurred with either injury.”

On April 11, 2006, Review Office confirmed that the worker’s knee complaints, as evidenced through medical evidence commencing on March 30, 2005 and leading up to the giving out of the knee on December 9, 2005, were not related to the worker’s right knee injury of October 25, 1999. Review Office was of the opinion that the ACL tear that was found through the MRI study did not occur during the 1999 accident as three weeks post-trauma the worker would have far more significant complaints than were shown in the November 15, 1999 medical report. Review Office suggested to the worker that he could proceed with a new claim for the December 9, 2005 injury if he so wished. On May 15, 2006, the worker appealed Review Office’s decision and a file review was arranged.