Decision #201/06 - Type: Workers Compensation

Preamble

This appeal deals with whether the worker’s cellulitis condition is related to his workplace injury. The Workers Compensation Board (WCB) accepted the worker’s claim and paid wage loss to the worker. The employer submits that the wage loss was paid for a pre-existing condition unrelated to the worker’s accident. The employer appealed the payment of wage loss and the WCB denied the appeal. The employer asked for a review by the Appeal Commission.

A file review was held on November 1, 2006, at the employer’s request.

Issue

Whether or not the worker is entitled to wage loss benefits in relation to the cellulitis condition.

Decision

That the worker is entitled to wage loss benefits in relation to the cellulitis condition.

Decision: Unanimous

Background

On May 19, 2006, the worker reported injuries to his left lower leg, neck and back of his head when he slipped and fell off a 1.5 foot high pile cap.

On the day of accident, the worker attended a hospital emergency facility for treatment. The physical examination of the knee, leg and ankle was considered to be normal. The dorsal surface of the foot was non-tender and the toes were normal. There was pain over the plantar aspect of the foot at the insertion point of the plantar fascia. The attending physician reported that x-rays revealed a calcaneal bone spur but no acute injuries. The worker was instructed to be off work for a few days and to use crutches. The worker returned to light duty work the following day.

Then on May 25, 2006, the worker was admitted to a hospital emergency facility because of left leg cellulitis. The attending physician noted that the worker had a past history of recurrent severe cellulitis of the left lower leg.

On May 26, 2006, a hospital internal medicine specialist noted that the worker had a past history of severe cellulitis and had exploratory surgery in 2001 to rule out necrotizing fasciitis. The current physical examination of the worker’s left lower leg revealed “…a couple of minor scrapes on the anterior area that seem to have been recently healing…” His impression of the worker’s condition was a severe case of cellulitis with some systemic manifestations.

In a letter dated May 26, 2006, an advocate for the employer disagreed with the WCB’s decision to accept the cellulitis condition as part of the claim as he was not convinced that the worker’s new diagnosis of cellulitis was causally related to his original injury. He asked the WCB to investigate and to look into any pre-existing related conditions or other non-compensable causes for the cellulitus diagnosis.

The worker subsequently advised his WCB adjudicator that he had an abrasion to his left leg as a result of striking his left leg on the pile cap. He said he focused originally on the state of his left foot condition as there was concern of a potential fracture due to immediate swelling in the area.

On June 7, 2006, a WCB medical advisor noted that the worker reportedly scratched/abraded his lower leg in the initial accident. It was likely that this break in the skin was the portal of entry that led to the development of his cellulitis condition.

In a decision to the employer dated June 11, 2006, the adjudicator outlined her position that the scratches to the worker’s left leg at the time of his original injury was the cause of his cellulitis condition and was a direct result of his work related injury of May 19, 2006. On August 8, 2006, the employer’s advocate appealed this decision. He submitted that on a balance of probabilities, the worker’s cellulitis was a non-compensable condition and was not caused by the workplace accident. He noted that the worker had previous non-occupational occurrences of cellulitis in the same anatomical area.

On August 31, 2006, Review Office outlined its opinion that the worker’s cellulitis condition was a sequela of his compensable accident based on the internal medicine specialist’s findings of May 26, 2006. Review Office also acknowledged that the worker seemed to be prone to the development of cellulitis but this did not disentitle him to workers’ compensation. On September 19, 2006, the employer’s advocate appealed Review Office’s decision and a file review was arranged.

Reasons

Employer’s Position

The employer was represented by an advocate who provided a written submission. The advocate submitted that the worker’s condition, cellulitis, resulted in his hospitalization and rendered him disabled from performing even modified/light duties. He submitted that this condition was a wholly pre-existing condition. He noted that Review Office acknowledged that the worker was prone to the development of cellulitis. He submitted that the evidence does not establish that the relatively minor workplace accident was the proximate cause of the cellulitis.

In reviewing the evidence the advocate noted that the worker did not initially have red spots at the site of the workplace injury, rather the spots came on after several days. He also noted that the condition affected more than one part of the body. He referred to the medical reports on the file indicating that the worker had severe recurrent cellulitis.

The advocate submitted that the medical evidence on file does not support that the worker’s condition of severe cellulitis was caused by his workplace accident/injury. He submitted further that the evidence supports that the condition was non-compensable.

Worker’s Position

The worker did not participate in the appeal.

Analysis

The issue before the panel is whether the worker is entitled to wage loss benefits in relation to his cellulitis condition. For the appeal to succeed, the panel must find there is no relationship between the cellulitis condition and the workplace accident. The panel was not able to make this finding. The panel finds that there is a relationship between the worker’s cellulitis and his workplace injury and that the worker is entitled to wage loss benefits in relation to this condition.

As noted in the background, the worker fell at work on May 19, 2006. He sought medical treatment immediately for his left foot and was advised to remain off work for a few days. On May 25, 2006 the worker again attended a hospital and was admitted due to left leg cellulitis. The worker has previously suffered from celluitis.

In reviewing all the facts, including those noted by the employer’s advocate, the panel finds, on a balance of probabilities, that the worker’s cellulitis is related to the workplace accident for the following reasons:

-the worker injured his left leg at work on May 19, 2006.

-a specialist in internal medicine who saw the worker on May 26, 2006 noted a “couple of minor scrapes on the anterior area (of the lower left leg) that seem to have been recently healing.

- the worker advised the WCB on June 7, 2006 that he had scraped his leg when he sustained the injury but did not notice this right away due to the pain in the foot.

- a WCB medical advisor reviewed the file on June 7, 2006 and noted that documentation on the file notes that the worker reportedly scratched/abraded his lower leg in the initial workplace injury. The physician concluded that this skin break was the portal of entry that led to the development of cellulitis. He commented that this may not have been apparent at the initial emergency room assessment, but the worker subsequently became symptomatic.

The panel finds that the worker is entitled to wage loss benefits in relation to his cellulitis condition.

The employer’s appeal is therefore dismissed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
B. Malazdrewich, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 15th day of December, 2006

Back