The Appeal CommissionThe Workers Compensation Act of Manitoba

Reasons:

Background

The worker suffers from a pre-existing degenerative back condition that was managed by regular chiropractic care.

On September 30, 2004, the worker was involved in two incidents at work involving bending and weight bearing which caused her lower back pain with numbness and weakness of the left leg. She was diagnosed with L5 discopathy and underwent a course of chiropractic treatment. An x-ray taken October 12, 2004 confirmed the L5 discopathy as well as osteoarthritic changes, facet asymmetry and arthrosis.

The worker continued at work with lifting restrictions until she aggravated her back at work in November 2004. She saw her family physician who referred her to physiotherapy. The physiotherapist found the worker to be extremely de-conditioned. She also noted numbness in the worker’s left inner leg to her knee.

The worker remained off work until mid February 2005 when she worked for 2 days then went off work again.

As she continued to be symptomatic she was examined by a WCB chiropractic consultant on February 3, 2005. The WCB chiropractic consultant thought that the workplace injury caused a soft tissue injury to the worker’s left lumbosacral/gluteal musculature with no distinct nerve root signs. He recommended aggressive exercise and a gradual return to work with restrictions until she was able to work at her regular duties.

The worker did return to work at modified duties in April 2005 but only lasted 2 hours due to increasing back pain. Her ongoing symptoms were investigated through an MRI which revealed multi-level degeneration with small midline disc protrusions at the T11-12 and L5-S1.

A WCB medical advisor reviewed the file information on March 3, 2005. He thought that the worker had simply aggravated her pre-existing degenerative disc disease. However, he felt the worker had not yet recovered from her compensable injury and should be seen by a specialist.

This was done on March 18, 2005. The sports medicine specialist noted a long history of back problems that adversely affected her ability to perform her occupation at times. Following the examination, the specialist concluded that the worker’s pain complaints arose from “underlying lumbar spondylosis and facet joint osteoarthritis”. There were no clinical findings of radiculopathy. He encouraged the worker to increase her activities and recommended an exercise program to increase mobility, strength and overall endurance. He also thought that the worker was capable of returning to work in a modified capacity and on a graduated basis. Restrictions were outlined to avoid moderate to heavy lifting or activities that required repetitive stooping and/or forward bending.

Once again the worker returned to work with these restrictions only to stop due to increased back pain. Her chiropractor thought that the worker had aggravated her compensable back injury though he did not provide any findings or rationale for this opinion. She returned to the specialist who continued to recommend that the worker remain active and return to her modified duties. She never did. Instead, she saw a physiatrist who noted an array of other unrelated symptoms in addition to her low back complaints. He confirmed the degenerative changes and the absence of any radiculopathy. He did opine however that given the worker’s overall restricted level of movement and the frequent “events” at work that she should not return to her regular duties. He recommended exercise and trigger point injections. The worker never followed through with these recommendations.

A WCB medical advisor reviewed the file on November 9, 2005 at the request of the case manager. He was of the opinion that the worker only suffered a sprain/strain but had since recovered. Her ongoing complaints were due to her pre-existing degenerative disc disease with muscular involvement.

In December 2005 the worker had physiotherapy and acupuncture treatment which the worker says resolved her symptoms.

Worker’s Position

The worker says that she is entitled to wage loss benefits after May 15, 2005 as she had not yet recovered from her compensable injury. She says that the return to work programs did not respect her physical restrictions; on the contrary they added to her injury and prolonged her recovery.

Employer’s Position

The employer says that the worker is not entitled to wage loss benefits after May 15, 2005. It says that the worker’s ongoing symptomatology is due to her pre-existing degenerative disc disease and not her compensable injury. It also says that the modified duties offered to the worker respected her physical restrictions.

Analysis

To accept the worker’s appeal we must find it more likely than not that her ongoing symptomatology beyond May 15, 2005 is causally related to her September 30, 2004 workplace accident. We are unable to make that finding.

In reviewing and weighing the evidence, we find that the worker suffered a sprain/strain type injury (referred to in the medical reports as a soft tissue injury or discopathy) to her pre-existing degenerative lower back as a result of her September 30, 2004 workplace accident. While the worker complained of left leg symptoms of pain and a restricted range of motion, the medical and diagnostic reports do not convincingly confirm any radiculopathy.