The Appeal CommissionThe Workers Compensation Act of Manitoba

Introduction

This appeal deals with the relationship between the worker’s ongoing neck and back symptoms after December 13, 2001 and his August 20, 1999 workplace accident within the context of pre-existing arthritis.

Background

On May 2, 1999 the worker began roofing work with the employer. On August 23, 1999 he filed a WCB claim for acute low back pain that he said he suffered on August 20, 1999 because of the daily work load. He saw his family physician who diagnosed him with “lumbago most likely muscle sprain”. He returned to his regular work duties a few days later and then began complaining of upper back and neck pain. His treating physician clarified on November 14, 1999, that the worker’s initial workplace injury was for the upper dorsal muscles on the right side including muscles of the right shoulder and not the lower back.

In a signed statement dated October 14, 1999, the worker indicated that he had been experiencing back, shoulder blades and neck symptoms on and off since 1987. During the week of August 16, 1999 the pain started between and across his shoulder blades and neck. It was never to his low back. He said his symptoms came on gradually and he could not recall a specific accident.

Several medical reports from the family physician from that time forward note the worker’s continued complaints of neck and back pain which increased with activity.

On February 3, 2000, the worker was called in to be examined by a WCB medical advisor to establish a diagnosis for his condition. The medical advisor commented that the worker had a generally stiff neck. He had some shoulder girdle irritability but not specifically the rotator cuff. The worker had chronic problems with his right elbow. The medical advisor’s view was that the worker’s condition was an aggravation involving his neck and shoulders and that with four to six weeks of physiotherapy treatment, the aggravation would settle down and he would return to his usual status. He commented that the worker would likely require preventive restrictions.

In a February 29, 2000 report, the treating physiotherapist noted that the worker reported little change in his pain levels but his neck movements had increased. Acupuncture of his left trapezius muscle indicated objective trigger points but the worker did not report any pain reduction post-acupuncture. A referral to a physical medicine specialist was suggested.

In a progress report dated March 11, 2000, the treating physician said the worker was de-conditioned and would need a longer recovery period than was thought. In a progress report dated April 12, 2000, the treating physician identified a new diagnosis “myofascitis”.

On July 6, 2000, it was determined by the WCB case manager that the worker had recovered from the effects of his aggravation and no longer was suffering from the effects of his workplace injury. This decision was overturned by Review Office on February 23, 2001 and the worker was placed back on compensation benefits. He was then referred to a physical medicine specialist for needling treatment to his symptomatic soft tissues.

The worker was assessed at the Pain and Injury Clinic on June 4, 2001 with sleep disturbance, depressive features and soft tissue pain of four quadrants. The worker was referred back to his family physician for anti-depressants.

On October 20, 2001, the family physician reported that the worker suffered from soft tissue pain to his upper and low back as a result of the 1999 workplace accident. The worker further developed signs and symptoms of a major depression.

A follow up report from the Pain and Injury Clinic dated November 20, 2001 indicated the worker had been seen for the fifth time for acupuncture type trigger point needling of the paraspinal musculature. There was no change in the worker’s symptoms and he continued to have sleep disturbance despite medication and depression. It was felt the worker would not benefit from any further physical therapies.

On December 4, 2001, a WCB physical medicine and rehabilitation consultant reviewed the file. As the worker did not benefit from the acupuncture treatment, he felt the worker’s symptoms were not muscular in nature or myofascial in origin.

In a decision dated December 6, 2001, the case manager determined that the worker had recovered from his compensable injuries. No further WCB benefits were payable beyond December 13, 2001. This decision was confirmed by Review Office on January 18, 2002.

Analysis

To accept the worker’s appeal we must find on a balance of probabilities that his ongoing pain complaints after December 13, 2001 are related to his August 20, 1999 workplace accident. We are unable to make that finding.

The evidence before us is that on August 20, 1999, the worker suffered a non-specific muscular strain injury to his upper back and neck on top of his pre-existing arthritis. The medical evidence before us indicates that the worker underwent various treatments for this condition and that by December 2001 there were no longer any clinical signs of muscular involvement; the worker’s main complaint remained one of pain with depressive symptoms. We find that the medical evidence before us does not support a finding that these conditions are related to his compensable injury.

As the worker does not have a compensable medical condition as of December 13, 2001, we are unable to find, on a balance of probabilities, that the worker is entitled to benefits beyond December 13, 2001.