Decision #204/06 - Type: Workers Compensation
Preamble
This appeal deals with the causal relationship between the worker’s compensable right knee injury and his ongoing symptoms after January 13, 2004 and to a subsequent surgery.
On June 24, 2003, the worker suffered a compensable injury to his right knee. His claim for compensation was accepted by the Workers Compensation Board (the “WCB”) for an aggravation to a pre-existing chondromalacia condition to his knee. Benefits were paid until January 13, 2004, at which point the WCB considered that the worker’s aggravation had resolved. WCB responsibility for a subsequent surgery to the right knee was denied on the basis that it was not related to his compensable injury. Review Office upheld these findings in a decision dated December 13, 2005. It is this decision that the worker appealed to the Appeal Commission.
A hearing was held on October 26, 2006. The worker appeared and provided evidence. He was represented by a worker advisor. A witness also appeared and provided evidence on behalf of the worker. No one appeared on the employer’s behalf.
Issue
Whether or not responsibility should be accepted for the worker’s right knee problem beyond January 13, 2004; and
Whether or not responsibility should be accepted for the September 1, 2005 right knee surgery.
Decision
That responsibility should be accepted for the worker’s right knee problem beyond January 13, 2004; and
That responsibility should be accepted for the September 1, 2005 right knee surgery.
Decision: Unanimous
Background
Reasons
Background
The worker is in his early 20s. On June 24, 2003, he had a workplace injury to his right knee. As indicated in the preamble, this injury was accepted as an aggravation to his pre-existing chondromalacia. It is on this basis that further responsibility for the worker’s ongoing knee complaints and subsequent surgery were denied. The worker disputes the nature of the injury sustained as well as the WCB’s denial of further benefits and responsibility.
Given this context, it is important to examine the mechanism of injury and the medical evidence on the worker’s knee condition.
The Mechanism of Injury
The worker’s claim with the WCB states that he first noticed symptoms of mild pain in his right knee which kept getting worse. It also adds that “there was a really sharp pain at the knee cap, and continued to hurt since”. He thought the accident occurred because he was pivoting all the time in his job duties and might have turned a bit too hard.
This description of the mechanism of injury was explored further by the case manager on July 16, 2003. The worker explained that he did not recall anything specific happening when using a file. However, when he was turning, he noticed that if he turned to the right and stepped out on his right foot, his right knee was quite sore.
The worker was questioned further about the mechanism of injury at the hearing. He explained that he was pivoting back and forth when he felt a sharp pain in his knee. From that point forward the pain slowly became worse; he noticed it when crouching and then all of the time.
Medical Evidence
The worker went to see a physician on July 7, 2003. On examination, he noted swelling. It was the physician’s opinion that the worker might have suffered cartilage damage from a twisting injury, though this diagnosis was later changed to a contusion.
The worker was referred for physiotherapy. The physiotherapist noted that the worker’s knee was still swollen. A July 22, 2003 WCB memorandum adds:
“She indicated that the [worker’s] clinical findings totally fit with the job duties he described to her. She stated that there is pain and popping that would fit with medial damage to right knee. The [worker] is turning with force and mentioned one time making a sharp turn with force, while at work, when he felt the pain.”
The physiotherapist thought that the worker had a right meniscal tear.
As the worker continued to be symptomatic, he was referred to an orthopaedic surgeon who thought that the worker suffered medial collateral and cruciate damage. A WCB medical advisor concurred that the mechanism of injury could have caused a meniscal strain or tear.
An MRI of the right knee performed on October 10, 2003 ruled out a meniscal tear; in fact, it only revealed very mild chondromalacia.
On the basis of this medical evidence, the WCB medical advisor thought that the worker had only aggravated his pre-existing chondromalacia, which could have a similar presentation to a meniscal injury. She thought that this aggravation should resolve after a six week course of quadriceps strengthening exercises. Though this was done, the worker continued to be symptomatic.
The family physician thought that the worker might have enhanced his pre-existing chondromalacia though he did note that the worker’s symptoms and signs did not correlate well with the MRI findings.
The WCB medical advisor did concur that an MRI could miss a meniscal tear. As the worker’s symptoms and signs were consistent with a meniscal tear, she thought that a diagnostic scope would be warranted, and related to the compensable injury.
The worker was then referred to a second orthopaedic surgeon who confirmed chondromalacia and also suspected a meniscal tear. Given these findings, a right knee arthroscopy was done on September 1, 2005 that revealed a possible healed medial meniscal tear. A partial medial meniscectomy was done following which the worker felt better. The orthopaedic surgeon thought that this improvement in symptoms might be due from some “contractures” or scarring that would have been stretched out by scoping the knee and manipulating it. At the hearing, the worker added that the orthopaedic surgeon told him that during the surgery he had found some scar tissue from a healed small tear. He cleaned out this scar tissue and probed the tendons and ligaments to loosen them up. Though he was not sure when the tear occurred, he thought that the tear was at least a year old given the appearance of the scar tissue.
A WCB senior medical advisor disputed that the arthroscopy revealed any pathology. This was also the opinion of the orthopaedic consultant to Review Office.
Worker’s Position
The worker says that the mechanism of injury is consistent with a medical meniscal tear. His signs and symptoms were also consistent with this diagnosis. Over time, his meniscal tear healed on its own, as evidenced during the arthroscopy. It was also after this procedure that his right knee symptoms improved and he was able to return to work. He adds that had his symptoms been due to chondromalacia, he would not have been able to return to work.
Analysis
To accept the worker’s appeal we must find on a balance of probabilities that his ongoing right knee complaints after January 13, 2004 and his right knee surgery are related to his compensable injury. We are able to make these findings.
Indeed, we find that the worker suffered a meniscal tear on June 24, 2003 and not a simple aggravation of pre-existing chondromalacia. We make this finding based on the mechanism of injury and the worker’s signs and symptoms that were consistent as of the date of his injury until the date of his September 1, 2005 surgery. Though the MRI taken in October 2003 did not reveal a tear, it was accepted by the medical practitioners that MRIs are not always accurate in respect of this particular medical condition. This was the case here as the orthopaedic surgeon in fact found evidence of a healed torn meniscus that dated back to at least one year.
We also note that after the surgery, the worker’s right knee complaints resolved and that he was able to return to work after that date.
Based on the foregoing, we find on a balance of probabilities that responsibility should be accepted for the worker’s right knee problem beyond January 13, 2004 as well as for the September 1, 2005 right knee surgery.
Accordingly, the worker’s appeal is granted.
Panel Members
L. Martin, Presiding OfficerA. Finkel, Commissioner
M. Day, Commissioner
Recording Secretary, B. Kosc
L. Martin - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 18th day of December, 2006