Decision #199/06 - Type: Workers Compensation
Preamble
This appeal dealt with the relationship between the worker’s bilateral shoulder injury and his current low back and neck difficulties. The worker injured his shoulders in 1988. His claim was accepted by the Workers Compensation Board (WCB) and he subsequently developed difficulties with his low back and neck. The WCB denied responsibility for the worker’s back and neck difficulties. The worker appealed this determination.
An appeal panel hearing was held on October 25, 2006, at the request of a worker advisor, acting on behalf of the worker. The panel discussed this appeal following the hearing on October 25, 2006.
Issue
Whether or not the worker’s current low back and neck difficulties are causally related to the bilateral shoulder injury of November 28, 1988.Decision
That the worker’s current low back and neck difficulties are not causally related to the bilateral shoulder injury of November 28, 1988.Decision: Unanimous
Background
In 1988, the worker filed a claim with the WCB for bilateral shoulder difficulties that he related to the repetitive nature of his employment activities as a meat handler. His claim for compensation was accepted and the worker was awarded various types of benefits and services from the WCB.
A review of medical information revealed that the worker underwent surgery to repair his distal right clavicle in 1991 and 1993 and his left lateral clavicle in 1994. He was also diagnosed with major depression which was accepted as a WCB responsibility. In 1999, it was determined that the worker had permanent restrictions related to his bilateral shoulder condition.
On February 1, 2003, x-rays were taken of the cervical spine. The radiological report revealed “moderately severe degenerative narrowing of the C4-5 and C5-6 and C6-7 disc spaces”.
In September 2004, the worker discussed the discomfort in his neck and low back areas with his case manager. In a memo dated September 23, 2004 the case manager noted “We discussed medical opinion obtained & I explained that back & neck related however not entitled to PPI [permanent partial impairment] at this time as these sx [symptoms] might improve.” The case manager advised the worker that she would obtain medical opinion with respect to restrictions for his neck and back condition.
In a memo dated May 6, 2005, the case manager noted that a letter had not been sent to the worker outlining the WCB’s responsibility for his back and neck pain. In a further memo dated June 1, 2005, the case manager noted that she advised the worker that the WCB had not determined if his neck and back complaints are related to his claim for bilateral shoulders and that testing is required prior to authorization of treatment.
Subsequently, a WCB call-in examination took place on June 30, 2005. At this examination, the worker indicated that he began to experience discomfort in his neck and back region in the mid to late 90’s while working with the accident employer. He attributed these symptoms to his shoulder difficulties and stated that no specific investigations or treatments were initiated. The medical advisor concluded that he could not substantiate a probable patho-anatomic mechanism to account for the worker’s neck and back symptoms in relation to his shoulder overuse injuries.
In a telephone conversation on September 30, 2005, the worker told his case manager that his neck and back problems relate to his many years of heavy lifting while performing his job duties, and because he had to stand differently due to his shoulder difficulties. The case manager explained that based on her review of the medical evidence, the worker’s neck and back complaints began in approximately 2000 and there was no specific diagnosis for the two regions or a causal relationship to the worker’s job duties.
In a decision dated September 30, 2005, the worker was advised that the WCB was unable to accept responsibility for medical treatment or time loss as a result of his low back and neck difficulties. It was the case manager’s opinion, based on the findings of the WCB medical advisor on June 30, 2005 and her review of the file information, there was no cause and effect relationship between his 1988 compensable bilateral shoulder injury and his low back/neck difficulties.
On February 16, 2006, the worker disagreed with the above decision and appealed to Review Office. The worker relied on a report from his treating physician dated October 18, 2005, to support his position that he began to experience excessive back and neck pain as far back as 1997.
In a decision letter dated March 29, 2006, Review Office agreed that there was no cause and effect relationship between the worker’s bilateral shoulder condition from November 1988 and his neck and low back complaints which became evident in either 1997 or 2000. Review Office based its decision on the fact that the worker’s neck and back complaints commenced nine years post-trauma and on the opinion expressed by the examining medical advisor on June 30, 2005. On April 13, 2006, the worker appealed Review Office’s decision and requested an oral hearing.
Reasons
Worker’s Position
The worker was represented by a worker advisor who made a submission on his behalf. The worker answered question posed by the panel.
The worker advisor reviewed the file information regarding the worker’s back and neck condition. He noted that file information indicates that medical treatment for the worker’s neck commenced in July 2000 and for the back in November 2000.
The worker advisor advised that the worker was left with the impression that the WCB had accepted responsibility for his low back and neck complaints. The worker advisor noted that in April 2004 a WCB medical advisor had authorized payment for treatment for the worker’s condition. He noted a file memo from the WCB medical advisor dated April 20, 2004 authorizing the treatments. He also noted a memo by the WCB medical advisor dated July 12, 2004 which opined that the arthropathy and myofascial pain (diagnosed by the treating physician) are, on balance of probability, causally related.
The representative noted that it was not until September 2005 that the WCB denied responsibility for the back and neck.
The worker advisor advised that the worker’s current treating general practitioner supported a relationship between the worker’s shoulders and his back and neck. The physician noted the worker’s medical chart refers to neck and back problems in 1997. He commented that it is “…quite entirely possible that due to the chronic problems he has had in his shoulders that it wouldn’t be unreasonable to think that he could experience neck and back pain secondary to this.
The worker described his symptoms and treatments which included a rhizotomy and injections. He advised that he feels a “little bit better” after the injections.
When asked about an x-ray which referred to degeneration in his neck, the worker responded that his physician told him he had just worn out. The worker explained that after his shoulder injury he continued to work. He said that he could not specify an event that caused his neck and back condition. He believes he first reported these problems to his former general practitioner in the 1990’s. He stated that the neck and back condition are a secondary injury to his shoulder injury.
The worker advisor suggested that when the WCB medical consultants arrive at two different opinions, as they have in this case, there should be some consultation between the consultants to determine why they’ve come to different opinions.
Employer’s Position
The employer was represented by an advocate who made a submission to the panel. The representative acknowledged that the worker definitely has back and neck problems but submitted that the problems are not related to the worker’s shoulder injury. She noted that the worker has pre-existing degenerative problems. She stated it would have been in the worker’s interest to have filed a new claim as there is no causal relationship to the shoulder injury.
Analysis
The issue before the panel was whether the worker’s current low back and neck difficulties are causally related to the bilateral shoulder injury of November 28, 1988. For this appeal to succeed, the panel must find a causal relationship exists between the neck and low back complaints and the shoulder injuries. The panel was not able to make this determination.
The panel has reviewed the claim file and taken into consideration the evidence and argument presented at the hearing and finds, on a balance of probabilities, that the worker’s neck and low back difficulties are not causally related to the worker’s bilateral shoulder condition.
In reaching this decision, the panel notes the long period of time that passed between the worker’s original shoulder injury and the apparent development of his neck and low back conditions. The panel accepts the evidence from the worker’s current general practitioner that the worker’s medical charts confirm that the worker complained of mid and low back problems as early as 1997. These complaints were not brought to the WCB’s attention until approximately 2000. In any case, the panel is unable to find a link between the shoulder condition and neck and low back given the significant time period that passed after the shoulder injury.
With respect to medical opinion, the panel places significant weight upon the opinion of the WCB medical advisor who examined the worker on June 30, 2005. This physician concluded that information on file as well as the history obtained from the worker and the physical exam do not substantiate a probable patho-anatomic mechanism to account for the worker’s neck and back symptoms in relation to the shoulder overuse injuries. The panel also notes that this conclusion was reviewed with the WCB’s physical medicine specialist who agreed with this opinion.
The panel gives greater weight to this opinion which was provided by the WCB medical advisor after examining the worker, than the opinion of the WCB medical advisor provided in 2004 which was based upon a file review.
The panel notes that the diagnosis provided by a pain clinic physician in a letter to the WCB dated March 27, 2004 is consistent with a degenerative condition unrelated to a workplace injury. The diagnosis provided was myofascial musculoskeletal pain related to facet joint arthropathy of the lumbar spine and degenerative changes of the cervical spine. The degenerative changes are noted in both an x-ray and a CT scan. The panel also notes that the worker’s neck and low back conditions appear to have worsened since first reported to the WCB. This is despite the fact that the worker ceased work in 1999. The panel considers this to be consistent with a progressive degenerative condition.
The worker’s appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 14th day of December, 2006