Decision #75/11 - Type: Workers Compensation

Preamble

This appeal deals with a decision made by Review Office of the Workers Compensation Board ("WCB") which determined that the worker had made a satisfactory recovery from her compensable injury of September 12, 2005. The worker disagreed with the decision and an appeal was filed with the Appeal Commission through the Worker Advisor Office. A hearing was held on January 26, 2011 to consider the matter.

Issue

Whether or not the worker is entitled to further medical aid benefits.

Decision

That the worker is not entitled to further medical aid benefits.

Decision: Unanimous

Background

The worker filed a claim with the WCB for injuries to her low back, head and neck that she related to the following work related accident that occurred on September 12, 2005:

"9 sheets of 8 x 4 plywood …stacked and tied inside of the truck gave way while I was standing in front of them. They came down on top of me which threw me towards a metal shelf on the other side. I hit the lower part of my head off the shelf and landed twisted on two rented patio heaters, whilst the plywood landed on my side and back, trapping me underneath."

The claim for compensation was accepted for probable contusions to the neck, face, shoulder and back and for mechanical back pain.

When speaking with a WCB case manager on November 24, 2005, the worker reported that at the time of the September accident, she was hit in the neck and was knocked over and she landed on her right shoulder and right hand. The worker noted that her low back was the main problem and that she had no problems with her neck. Her right shoulder had recovered.

Medical records showed that the worker attended physiotherapy treatment related to her low back and also underwent a CT scan on January 5, 2006. The CT results revealed a large central disc herniation just contacting the thecal sac at the L5-S1 region. No stenosis or nerve root compression was demonstrated. On February 16, 2006, a WCB medical advisor confirmed that the CT scan findings were consistent with the mechanism of injury.

On April 18, 2006, the worker was assessed by a WCB physiotherapy consultant. He noted that the worker's condition continued to improve and that the history and findings were consistent with a central disc. The worker was encouraged to continue her activities as tolerated. The consultant wrote that he contacted the treating therapist and suggested that proprioceptive and gluteus maximus exercises be added to her regime. The worker had three more therapy sessions remaining and then she should then be self-managed with a home program.

File records showed that the worker resigned from her pre-accident employment and moved out of province on April 28, 2006. The worker's wage loss benefits ended as of April 14, 2006 as she had resigned from her employment. A discharge physiotherapy report dated April 25, 2006 noted that the worker was doing better and was tolerating activities of daily living. The worker had soreness in her low back, occasionally into her buttocks.

On June 2, 2006, the worker's out of province physician referred the worker to a physiotherapy clinic for ongoing low back pain and right trapezius pain.

A physiotherapy report for an initial assessment on June 6, 2006 indicated subjective complaints of neck and back pain. The diagnosis was strained and sprained neck, back and pelvis.

On June 16, 2006, the worker called the WCB to advise that she was doing a home program but started to experience pain again. She went back for treatment and the therapist said she was all tight again. She was told that her spine was out of alignment. The worker was told by the case manager that that the WCB was not authorizing further therapy treatments based on the advice of a WCB consultant. A letter was sent to the physiotherapy clinic on June 16, 2006 advising them of the decision.

In a report dated August 2, 2006, the worker's out of province treating physician reported that the worker was seen on May 17, 2006 and "At that time she was still having, although improved, significant symptoms of lower back pain consistent with a disc herniation. Her pain was flared by increased mobility or prolonged posturing." The physician noted the WCB physiotherapy consultant's suggestion that the worker self-manage with a home program, but she felt it was imperative that the worker continue with a monitored physiotherapy/active rehabilitation for an additional 4 to 8 weeks.

In a memorandum dated September 11, 2006, the WCB physiotherapy consultant reported that he spoke to three physiotherapists who treated the worker and it was confirmed that the WCB would authorize 14 treatments for the worker's low back only. It was considered that the worker's neck problems appeared to be related to the recent move rather than to the September 5, 2005 compensable injury.

In a progress report dated November 10, 2006, the treating physician reported subjective complaints of back pain, neck pain and right shoulder pain.

The worker underwent a Functional Capacities Evaluation ("FCE") on February 15, 2007. The report indicated that the worker did not complete the FCE protocol. Her participation during the FCE was identified to be a full voluntary effort. The worker demonstrated the ability to do 'sedentary' to 'light' activities with some limitation.

The worker was assessed by a WCB medical advisor on February 15, 2007. The medical advisor stated that the compensable injury accepted by the WCB was a central disc herniation and that the current diagnosis was non-specific low back discomfort. He said there was no objective evidence of an ongoing limitation from the compensable injury. The worker continued to report symptoms although the lack of objective findings/limitations did not support the central disc herniation as the primary pain generator.

The medical advisor was of the opinion that given the lack of substantive response to physiotherapy, he would not support further physiotherapy authorization and felt that the home exercise program suggested by the WCB physiotherapy consultant would be appropriate. It was felt that current restrictions would be based on the worker's reported symptoms, not objective limitations. It was further indicated that based on the worker's young age, general good health and demonstrated abilities, she would likely be able to return to her pre-accident type employment.

A video surveillance between February 14 and February 16, 2007 was taken of the worker's activities and was reviewed by a WCB medical advisor. It was felt that the worker was performing her day to day activities without apparent limitation or discomfort.

On March 9, 2007, the worker was advised that in the opinion of the WCB case manager, she had recovered from the effects of her compensable injuries to the point that no further medical treatment was warranted. Although the worker still reported symptoms, the case manager was of the opinion that her back symptoms could be managed with a home exercise program. It was felt that the worker had already recovered from her other injuries to her face, neck and shoulder.

On September 16, 2008, a worker advisor submitted medical information dated August 12, 2008 from a rheumatology and spine medicine specialist to support that the worker's current low back condition was causally related to the September 12, 2005 compensable injury and asked that the decision made on March 9, 2007 be reconsidered.

On May 4, 2009, a WCB medical advisor reviewed the August 12, 2008 report as well as the results of a CT scan of the lumbar spine dated June 4, 2007, a bone scan dated September 12, 2007 and an MRI of the thoracic spine and sacroiliac joints dated April 28, 2008. The medical advisor stated that the August 12, 2008 report provided a diagnosis of mechanical low back pain. He said the worker had a normal examination and there was no evidence of mechanical back pathology. He indicated that the up-dated medical information did not change his opinion that was outlined on February 15, 2007 regarding the worker's recovery from her compensable injury.

On May 25, 2009, the worker was advised that the new information did not alter the WCB's previous decision dated March 9, 2007. On June 5, 2009, the worker advisor appealed this decision to Review Office.

In its decision dated July 23, 2009, Review Office determined that there was no entitlement to further WCB medical aid benefits. In making its decision, Review Office outlined the following:

  • The evidence supported that the initial reports of injuries to the head, right shoulder and neck resolved early on in the course of the worker's recovery;
  • The reported signs and symptoms were consistent with a low back injury. The January 26, 2006 CT scan showed a large disc herniation and there was no indication of radicular signs or other clinical findings to support neurological involvement;
  • The history provided by the worker to the rheumatology and spine specialist was not consistent with the file evidence;
  • The opinion of a WCB orthopaedic consultant was that the current symptoms were most likely a non-specific low back pain of undetermined cause and which are unrelated to the compensable injury. The L5-S1 disc was not the generator of current symptoms and there were no clinical findings to point specifically to the L5-S1 disc as the site of pain;
  • The symptoms associated with the compensable injury had made a satisfactory recovery such that they were not contributing in a significant manner to the worker's current symptom presentation.

On September 18, 2009, the worker advisor appealed Review Office's decision to the Appeal Commission and hearing was held on January 26, 2011 via teleconference.

Following discussion of the case after the hearing, the appeal panel requested additional information from the worker's treating physician as well as two physiotherapists. The requested information was later received and the reports were provided to the interested parties for comment. On May 18, 2011, the panel met further to discuss the case and rendered its final decision. 

Reasons

Applicable Legislation

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

This appeal by the worker concerns her entitlement to further healthcare benefits for the injury that she sustained on September 12, 2005. Subsection 27(1) of the Act provides that medical aid will be paid by the WCB for so long as is necessary to cure and provide relief from the injury.

Worker's Position

The worker participated in the hearing via teleconference and was represented at the hearing by a worker advisor.

The worker advisor noted that the issue is the relationship between the worker's ongoing difficulties and the compensable injury. She noted there is no evidence of a pre-existing condition that would have delayed recovery. She also noted that the WCB accepted the L5-S1 central disc herniation and contusions to the face, neck and shoulder. Although the disc herniation has reduced in size, as shown on the MRI, it is still present. She stated the orthopaedic specialist who examined the worker in 2008 supports that the L5-S1 disc herniation is still the pain generator and that the worker is suffering from the residual effects of this disc herniation.

In answer to questions, the worker described the treatment she is currently receiving from her physiotherapist. She confirmed that he has given her exercises similar to the ones that the physiotherapist gave her in Winnipeg. However, she stated that he also does more body manipulation. She said "he massages my muscles and gives me stretching exercises." She described the massage as foot to head. She indicated that he concentrates on her hip area, buttock area, and all the muscles going up her back to her shoulders and neck and that this entire condition is related to her work injury, in the view of her physiotherapist. She advised that she has also participated in back healing yoga.

The worker advised that she continues to see a massage therapist. She receives a two hour full body deep muscle massage which extends from foot to head.

Regarding muscle spasms, she indicated that she experiences muscle spasms in both left and right buttock, up her back and through her shoulder region and neck. She said these are predominantly on her right side. She described her shoulder pain as radiating from her spine across her shoulder blade.

The worker explained that after the accident the pain from her lower back actually got worse and started to dominate, masking the pain from her neck and shoulder region. As her back improved she started to feel the neck and shoulder pain return.

She said that when she was examined by the physiotherapist in Winnipeg in April 2006, the neck and shoulder pain was not as strong as her back pain. She said when she was examined by the WCB medical advisor in February 2007 her back pain and neck and shoulder were equal.

The worker advisor confirmed that the worker is seeking medical coverage for the worker's neck, shoulder and back.

Employer's Position

The employer attended the hearing. She described the project the worker was working on when the accident occurred. Regarding the worker's appeal she noted that the worker has received a "…good range and full range of and a fair and well considered range of treatment and that she has improved according to the reports that I have received." She advised that she agrees with the WCB's evaluation that her medical benefits not be continued.

Analysis

For the worker's appeal to be successful we must find that the worker required additional healthcare treatments as a result of the workplace injury. We found that the worker is not entitled to additional healthcare treatment.

To assist in adjudicating this issue we sought medical information from the worker's treating physician and two physiotherapists. Upon reviewing the information we note that:

  • the worker's symptoms did not appear to be consistent, with different symptoms identified for different parts of her body.
  • range of motion findings for the worker's neck, shoulders and lumbar spine were generally normal. For example, the treating physician reports that on October 25, 2006 range of motion for the neck, shoulders, and lumbar spine were normal.
  • the treating physician noted in her April 7, 2011 reported that she had referred the worker to a rheumatologist whose impression was that the worker suffered from axial/mechanical back pain likely related to degenerative disc disease.
  • there were many complaints of chronic back pain.
  • many of the visits to the physiotherapist included massage treatments.

We note the opinion of the WCB medical advisor who examined the worker on February 15, 2007. He found evidence of a functional range of motion, normal strength, normal reflexes and normal sensations and concluded there was no objective evidence of an ongoing limitation from the compensable injury. The panel agrees with these findings, finds that the worker had recovered from her September 12, 2005 injury, and accordingly finds there is no basis to provide additional medical treatments to the worker.

The worker's appeal is dismissed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 14th day of June, 2011

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