Decision #130/11 - Type: Workers Compensation
Preamble
This appeal deals with a decision made by the Workers Compensation Board ("WCB") to deny responsibility for further physiotherapy treatment related to her left shoulder injury of December 9, 2010. A file review was held on September 6, 2011 to consider the matter.Issue
Whether or not further physiotherapy treatment should be authorized.Decision
That further physiotherapy treatment should not be authorized.Decision: Unanimous
Background
The worker reported to the WCB that she sustained injuries to her neck, left shoulder and both elbows on December 9, 2010, when she slipped and fell backwards at work and put her left arm out to prevent her head from hitting concrete. When seen for medical treatment following the accident, it was reported that the worker complained of neck and left shoulder pain from the slip and fall at work. The report indicated that the worker had a neck injury from a motor vehicle accident ("MVA") that happened several years ago. The diagnosis outlined by the treating physician was a sprain/strain injury to the cervical spine and left shoulder. The claim for compensation was accepted by the WCB and benefits and services were paid.
A physiotherapy report dated December 28, 2010 showed that the worker attended for treatment on December 14, 2010 related to her left shoulder, neck, elbow and knee. The diagnoses outlined were neck strain/sprain, TMJ strain/sprain and left shoulder impingement. On January 4, 2011, the WCB authorized physiotherapy treatment.
A doctor's progress report dated January 13, 2011, noted that the worker's shoulder pain was less with better range of movement and that she still had neck discomfort. It was indicated in a medical note that the worker may do six hours a day of regular duties starting January 17, 2011 and back to normal work and duties January 24, 2011.
A physiotherapy progress report dated January 14, 2011 indicated that the worker had some persistent pain but it was not as constant. Her shoulder and neck were most painful and her elbows were not too bad. An extension request was made for five additional weeks of physiotherapy treatment. On January 25, 2011, a WCB physiotherapy consultant approved five additional physiotherapy sessions.
A report was received from a pain management specialist dated January 13, 2011. The specialist reported that he assessed the worker on October 22, 2009 for neck pain related to a 2001 MVA. He said the worker pursued an interdisciplinary pain management program for her neck injury including one session of therapeutic Botox injections that were performed on November 18, 2010. Following the needling session the worker returned to his office on December 10, 2010 noting that she had fallen at work on December 9, 2010. The worker said she landed on her left shoulder region at the time. Prior to the fall, the worker stated that her neck pain had decreased to 4-5 out of 10 in intensity and that she had taken Tylenol extra strength on only three occasions for her pain since she last attended his office on November 18, 2010. Following the work related accident, the worker required more Tylenol and Arthrotec for her left shoulder pain.
The specialist stated that he advised the worker on December 10, 2010 to continue with her current medications, to rest and to apply heat to the affected region. The worker was encouraged to follow up for her physiotherapy session and with her family physician. When seen again on January 13, 2011, the worker complained of left shoulder stiffness with anterior left shoulder pain. The worker advised that she was attending physiotherapy sessions three times weekly and that she was now able to fully move her left shoulder in spite of left shoulder region pain. He noted that the worker had restricted range of movement of the cervical spine in all directions. It was the specialist's opinion that the worker had been slowly improving with conservative management and for her to continue with her gradual return to work program.
On January 27, 2011, the WCB physiotherapy consultant indicated that he reviewed the mechanism of injury and the multiple areas of injury including the neck and left shoulder. He stated: "WCB has approved a full course of physiotherapy (1 initial assessment and 14 subsequent visits). Six (6) out of the 15 visits can be billed multi-site. Physiotherapy extension request is approved for 4 additional sessions at a frequency of once per week for progression of an exercise based home program then self manage." On January 27, 2011, the worker and the physiotherapy clinic were advised of this decision in writing.
A doctor's progress report dated January 31, 2011 indicated that the worker's shoulder was good and that she still had discomfort and stiffness in her neck. It was indicated that the worker should continue with physiotherapy for her neck.
On March 8, 2011, the physiotherapist reported to the WCB that the worker had some persistent left neck pain, TMJ pain and left knee pain. An extension request was made for four weeks of additional physiotherapy treatment for manual therapy of these areas.
On March 28, 2011, the WCB advised the treating physiotherapist that the WCB was unable to approve the extension request as there was no evidence that further in clinic treatment was warranted. A home program and/or self pain management techniques should suffice. On April 19, 2011, the worker appealed the decision to Review Office, submitting that she had not fully recovered to her pre-accident condition.
On May 5, 2011, Review Office determined that further physiotherapy treatment was not authorized. Review Office indicated that the worker had a significant pre-existing condition from a non-work MVA and was still receiving treatment for that injury a few weeks before her compensable work injury. Review Office indicated that they agreed with the position taken by the adjudicator and WCB physiotherapy consultant that physiotherapy was not warranted in relation to the compensable injury of December 9, 2010 and that the home exercise program should suffice in this situation. On May 27, 2011, the worker appealed Review Office's decision to the Appeal Commission and a file review was arranged.
In a doctor's progress report dated May 30, 2011, it was indicated that the worker's left shoulder was non tender with no atrophy and range of motion was full and strength was 5/5.
On July 7, 2011 a WCB medical advisor made reference to the findings of the treating physician dated May 30, 2011. He indicated that these findings supported that the worker's left shoulder strain related to the workplace injury had likely functionally resolved.
Reasons
Applicable Legislation
In deciding appeals, the Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.
The worker is appealing ongoing medical aid benefits, specifically physiotherapy treatment. Subsection 27(1) 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's notice of appeal filed May 27, 2011 states that the worker is appealing the discontinuation of physiotherapy for her left shoulder injury from December 9, 2010.
Under "reason for appeal" the worker states:
"I still have limited range of motion and pain in my left shoulder, which was not a pre-existing injury. The previous decision not to authorize any further treatments was based on my pre-existing neck injury. My physician [doctor's name] has been only treating me for my previous neck injury from a MVA. Also Subsection 27(1) of the WCB Act states Medical Aid paid for as long as necessary to cure and provide relief from the injury. I have a follow-up appointment with my physician [doctor's name] on May 30/11 regarding my shoulder injury."
Employer's Position
The employer did not participate in this appeal.
Analysis
The panel notes from the Notice of Appeal that the worker has not appealed the denial of physiotherapy treatments for her neck injury which she describes and acknowledges as pre-existing. Accordingly the panel has not addressed the issue of ongoing medical treatment for her neck injury.
The worker is appealing the discontinuation of physiotherapy benefits for her left shoulder injury after a request for extended physiotherapy treatment was denied by the WCB on March 28, 2011. For the worker's appeal to be successful the panel must find that the worker continues to require medical aid benefits, specifically physiotherapy treatments for her left shoulder, as a result of the accident. The panel was not able to make this finding. The panel finds, on a balance of probabilities, that the worker is not entitled to physiotherapy treatments beyond March 8, 2010 for her left shoulder condition.
In reaching our decision we rely upon the following information:
- The physiotherapy discharge report dated March 8, 2011 does not identify complaints or provide clinical findings regarding the worker's left shoulder.
- The treating physician's report dated January 31, 2011 indicates "shoulder good."
- The treating physician's report dated May 30, 2011 reports left shoulder "Not tender. No atrophy. AROM [active range of motion] full. Strength 5/5."
- WCB medical advisor opinion dated July 7, 2011 that findings reported by treating physician on May 30, 2011 "…support that the left shoulder strain related to the workplace injury had likely functionally resolved."
The worker's appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 15th day of September, 2011