Decision #126/00 - Type: Workers Compensation
Preamble
A non-oral file review was held on December 4, 2000, at the request of a chiropractor, acting on behalf of the claimant.
Issue
Whether or not the WCB should authorize payment of chiropractic treatment beyond June 29, 2000.
Decision
That the WCB should not authorize payment of chiropractic treatment beyond June 29, 2000.
Background
On December 19, 1999, the claimant was carrying a box of welding rods in his right hand while climbing down a ladder into a potato bin, holding the top of the bin with his left hand, when he missed a rung on the ladder and slipped, catching himself with his left arm. The claimant indicated that he did not get stiff until the following day and reported injuries to his neck, left shoulder and arm. Subsequent information from the claimant’s treating chiropractor, attending physician and orthopaedic specialist revealed the following:
- when seen on December 21, 1999, the treating chiropractor noted that the claimant had extreme left arm pain, left neck pain, left hand weakness, and the inability to move the left shoulder. Spinal subluxations were noted in the C3/C4, C4/C5, C5/C6, and C6/C7 articulations. The treatment plan suggested was chiropractic adjustments, daily exercises to help re-establish reduced range of motion in the lower back. The chiropractic further indicated that the claimant should avoid any long periods of standing, bending or heavy lifting.
- on December 23, 1999, the attending physician diagnosed the claimant with “acute neck (?)” and noted that the claimant had been seeing a chiropractor.
- x-rays of the cervical spine dated December 23, 1999, revealed an element of spinal stenosis. No disc space narrowing was identified. The apophyseal joints appeared unremarkable.
- in a letter dated January 24, 2000, an orthopaedic surgeon reported his examination findings in relation to the claimant’s left shoulder and neck region. The surgeon indicated that the claimant had signs and symptoms which were consistent with a left C6 nerve root involvement and that the claimant most likely had a disc protrusion at the left C5-6 level. A CT scan of the cervical spine was arranged.
- a CT scan report dated February 29, 2000, revealed no abnormality at C3-C4 or C4-C5 regions. At C5-C6 there was posterior end plate spurring in association with left posterior disc herniation and compression of the left C6 root as it entered its exit foramen. No central canal stenosis was identified. The C6-C7 and C7-T1 levels were unremarkable.
- in a letter dated March 30, 2000, the orthopaedic surgeon advised the Workers Compensation Board (WCB) that the CT scan results verified his clinical impression that the claimant had a disc protrusion at C5-6 with compression of the left C6 nerve root.
- a progress report from the chiropractor dated March 31, 2000, noted that the claimant was still experiencing a moderate degree of symptomatology in the left upper extremity and that he had been undergoing continuous treatment. He stated that it was quite conceivable that the disc damage to the low cervical spine may cause permanent weakness in the left upper extremity and weakness in the low part of the cervical spine on the left hand side. Chiropractic adjustments were performed to the mid-lower cervical spine as well as the upper thoracic spine. The chiropractor also indicated that the claimant was currently undergoing chiropractic adjustments along with interferential current and massage therapy on a 3 times per week basis as the symptoms still require this level of care at the present time. The neurological deficits were still present. The chiropractor stated his opinion that the claimant still required on-going chiropractic care for the short term foreseeable future.
- in a letter dated April 18, 2000, the orthopaedic surgeon noted that the claimant had been back to work but was not performing his full duties. Examination showed an absence of the left biceps reflexes with good right biceps reflexes. The surgeon noted that the claimant was showing impairment and would best be treated non-operatively. The surgeon noted that chiropractic manipulations would not necessarily be of any benefit. His impression was that the claimant was not fit to return to his heavy duties but could perform light duties.
- on June 13, 2000, a WCB chiropractic consultant reviewed the case which included a progress report from the treating chiropractor dated May 10, 2000 and a report from the orthopaedic surgeon dated May 18, 2000. The chiropractic consultant commented that ongoing chiropractic treatment at a rate of 3 times per week was excessive and felt that treatments should be reduced. He stated that in his opinion, maximum therapeutic benefit had been obtained from chiropractic treatment.
In a decision dated June 22, 2000, the WCB adjudicator wrote to the claimant advising him that the WCB had developed guidelines with respect to the duration of frequency of chiropractic treatments. The adjudicator indicated that in this case, it was determined that the claimant had a spinal injury with complicating factors and active rehabilitation. The claimant was informed of the comments expressed by the WCB chiropractic consultant on June 13, 2000 and was advised that the WCB would not accept responsibility for chiropractic treatments past June 29, 2000. On August 9, 2000, the claimant appealed this decision stating, “I am still attending chiropractic treatment and feel I am responding to the treatments greatly.” The case was then forwarded to Review Office for consideration.
On September 8, 2000, Review Office confirmed the decision that the WCB should not authorize payment of chiropractic treatment beyond June 29, 2000.
Review Office noted that after reviewing WCB Chiropractic Guidelines, it was noted that this scenario fell under the category of spinal injury with complicating factors and active rehabilitation. The complicating factor was the disc protrusion at C5-C6 and according to the guidelines, the maximum coverage the WCB allowed for such a scenario was 14 weeks. Review Office noted that chiropractic treatment had gone beyond 14 weeks and that the orthopedic surgeon did not feel that chiropractic treatment would assist in the physical rehabilitation of the claimant’s cervical spine. In addition, Review Office stated that the WCB chiropractic consultant felt that maximum therapeutic benefit would have been obtained in this situation prior to June 29, 2000. On July 10, 2000, the claimant appealed Review Office’s decision to the Appeal Commission and a report was submitted from the treating chiropractor dated October 5, 2000.
Reasons
The panel met on December 4, 2000 to conduct a non-oral file review of this case. The claimant had appealed a decision of the Review Office which had upheld the decision to terminate payment for chiropractic treatment as of June 29, 2000.
The panel came to the unanimous decision that the Review Office decision was correct and that the WCB should not authorize payment beyond that date.
In cases such as this one, chiropractic treatment is governed by the Chiropractic Management Guidelines.
For a claimant with a spinal injury, with complicating factors and active rehabilitation, the guidelines allow a maximum of 14 weeks treatment. The guidelines do allow for an extension of this period in certain cases, upon application. No application was made in this case. However, the claimant did receive treatment well beyond the 14-week period.
In coming to our decision, we placed considerable weight on the opinion of the chiropractic consultant, who was of the opinion that continued chiropractic treatment would not be of any benefit, that the claimant had obtained the maximum therapeutic benefit from such treatment.
As we were presented with a very narrow issue - whether or not to extend chiropractic treatment, we had no choice but to come to the decision we did. Accordingly, we find that the appeal cannot be allowed.
In our consideration of this claim, we noted - based on the evidence in the file - that the claimant may not have been well served medically. We are of the view that it is unfortunate that he received only chiropractic treatment; that other medical treatment may well have been of some benefit in the latter stages of his claim.
While he did see an orthopaedic surgeon on more than one occasion, his only treatment was chiropractic. It is clear that there was no evidence that chiropractic treatment would help him to recover. However, it is also clear from the file that he had not fully recovered, at the time benefits were terminated.
Panel Members
T. Sargeant, Presiding Officer
A. Finkel, Commissioner
B. Leake, Commissioner
Recording Secretary, B. Miller
T. Sargeant - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 13th day of December, 2000