Decision #164/11 - Type: Workers Compensation

Preamble

The worker is appealing a decision made by the Workers Compensation Board ("WCB") which determined that he had recovered from the effects of his compensable injury by March 31, 2011 based on the diagnosis of a medial collateral ligament injury. It was also determined that the worker's compensable injury was no longer contributing to any of his ongoing back difficulties. A hearing was held on October 27, 2011 to consider the matter.

Issue

Whether or not the worker is entitled to benefits beyond March 31, 2011.

Decision

That the worker is not entitled to benefits beyond March 31, 2011.

Decision: Unanimous

Background

On November 19, 2010, the worker twisted his right knee when he slipped on snow during the course of his employment as a support worker. The worker advised the WCB that he did not fall to the ground when the accident occurred. The worker also stated that he had a previous right knee injury from the 1990s. His claim for compensation was accepted by the WCB based on the diagnosis of a right knee strain/possible meniscus tear.

The worker underwent several investigations after the November 2010 accident. The test results showed the following findings:

  • November 22, 2010 - x-rays of the right knee revealed a previous cruciate ligament repair and mild osteoarthritic changes with minimal marginal osteophytes.

  • January 7, 2011 - MRI of the right knee:

1) ACL reconstruction. Graft intact.

2) Possible localized arthrofibrosis (cyclops lesion)

3) Suspect healed or healing medial collateral ligament injury.

4) Possible oblique tear of the posterior horn of the lateral meniscus. Acuity uncertain.

A report from an orthopaedic specialist dated February 11, 2011 reported:

[the worker] slipped and twisted his knee while delivering flyers. He did not strike the ground, but experienced pain in the anterolateral and peripatellar region which has been more or less ongoing from that time… There is a history of previous problems referable to the knee, in that some 20 years ago he underwent anterior cruciate ligament reconstruction…This knee has been serviceable over the years, although he has had some minimal aches and complaints… At the present time, he denied locking or catching, but has had some episodes of giving way and, on fairly ongoing fashion, experiences pain climbing stairs. There is very often a throbbing sensation arising from the periopatellar and lateral joint region. At this point, he has not had any therapy for his knee, nor has he used a brace…It is conceivable that the MCL injury was sustained at the time of the injury in November, but it has gone on to heal satisfactorily and really would not be a source of ongoing discomfort. The more likely culprit, in terms of his present symptoms, appears to be the lateral meniscus which is fairly consistently tender. It does not fit completely with the peripatellar complaints but there does not appear to be on examination to be (sic) any substantial crepitation or any other features of patellar femoral malacia….I felt that it would not be inappropriate to consider him for an arthroscopic assessment and perhaps deal with the lateral meniscal lesion in particular.

On March 7, 2011, a WCB medical advisor reviewed the file and responded as follows to questions posed by the WCB case manager:

  • the initial diagnosis of the November 19, 2010 injury was likely an MCL ("medial collateral ligament" tear). The treating orthopaedic specialist did not feel there was any current discomfort originating from the medial compartment.

  • the treating orthopaedic surgeon indicated that the current condition involved the lateral compartment of the knee. The current diagnosis was a lateral meniscal tear and the WCB medical advisor indicated that it was unlikely that the lateral meniscal tear was related to the workplace injury. He noted that there were no findings involving the lateral aspect of the knee until the February 2011 report from the orthopaedic surgeon.

  • the proposed surgery was not a WCB responsibility as a causal relationship between the LMT (lateral meniscal tear) and the workplace injury had not been established.

  • the prior anterior cruciate ligament repair and the resultant numerous abnormalities reported on the MRI were pre-existing and were likely major contributors to the current symptoms/findings.

  • the evidence did not support that the compensable injury aggravated or enhanced the pre-existing condition.

On March 18, 2011, the worker was advised that in the opinion of his case manager, he had recovered from the effects of his injury and therefore wage loss benefits were not payable beyond March 25, 2011. It was felt that the worker's ongoing right knee difficulties related to the lateral meniscus and were not related to his November 19, 2010 injury.

Medical reports were obtained with respect to the worker's 1991 right knee surgery and the reports were considered by a WCB medical advisor on March 30, 2011. On March 31, 2011, the worker was advised by his case manager that the new information was reviewed and no change would be made to the decision of March 18, 2011.

On April 5, 2011, Review Office confirmed that the worker was not entitled to benefits beyond March 31, 2011. Review Office accepted that the worker suffered a back strain in relation to the difficulties he had as a result of his compensable right knee injury. The file information, however, supported that the medial collateral ligament injury had healed as evidenced by the MRI findings in January 2011 and the orthopaedic consultant's opinion in February 2011. Based on these findings, Review Office was of the opinion that the compensable injury was no longer contributing to any ongoing back difficulties reported by the worker. Review Office concluded that the worker recovered from the effects of his compensable right knee and back injuries. On May 31, 2011, the worker appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

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.

Under subsection 4(1) of the Act, where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid to the worker by the WCB.

Subsection 39(1) of the Act provides that wage loss benefits will be paid “where an injury to a worker results in a loss of earning capacity.” Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such a time as the worker’s loss of earning capacity ends, or the worker attains the age of 65 years.

The worker’s position:

The worker was self represented at the hearing and participated with the assistance of interpretation services. The worker indicated that he was disappointed that responsibility for his right knee surgery was simply declined by the WCB and no other options were discussed. He described the day of the accident, which was the first snowy day of the year and there was a lot of snow on the street. He was walking with a client when his leg slipped out from under him very quickly. He did not fall but he did twist his right knee in the process. He tried to continue assisting his client, but his leg would not allow him to continue walking. Prior to the accident, he had no problems with his knee, despite the fact that he had surgery on that knee 20 years prior. He knew that he may develop arthritis in his right knee as he got older, but at the time of the accident, he was not experiencing any such symptoms. Since the accident, he has not been able to return to his job as his work required him to be very mobile.

Analysis:

The issue before the panel is whether the worker is entitled to wage loss benefits beyond March 31, 2011. In order for the appeal to be successful, the panel must find that the worker's right knee and back difficulties beyond that date are related to the injury he suffered from his slip while working on November 19, 2010. After reviewing the evidence as a whole, we find on a balance of probabilities that the worker's ongoing difficulties are not a result of the injury sustained in the workplace accident and accordingly, the worker is not entitled to wage loss benefits beyond March 31, 2011.

In the panel's opinion, the injury suffered by the worker on November 19, 2010 was limited to a right medial collateral ligament strain and any ongoing knee or back issues beyond March 31, 2011 were not caused by the work accident. In coming to this conclusion, the panel relied on the following:

  • The worker's knee difficulties beyond March 31, 2011 concern the lateral compartment of his right knee. The proposed surgery (which the worker has chosen to defer) is the repair of a lateral meniscal lesion.
  • At the time of the injury, the worker's complaints centered on the medial (inner) aspect of his right knee. The physician reports from attendances on November 20, 2010 and December 20, 2010 both reference medial side symptoms. There is no mention of lateral side symptoms.
  • The worker's evidence at the hearing was that his current pain is along the bottom of his kneecap and more so up towards the outside part of his knee. The panel notes that this confirms that the worker's current difficulties involve the lateral aspect of his right knee.
  • When the worker saw the orthopaedic surgeon on February 11, 2011, his problems were with the lateral meniscus. The orthopaedic surgeon surmised that the worker may have sustained a medial collateral ligament injury in November, but that had gone on to heal satisfactorily and that the cause of ongoing discomfort was the lateral meniscus.
  • There is no medical opinion or other evidence which would link the lateral meniscal tear to the workplace accident. In particular, the absence of lateral symptoms at the time of the injury would tend to negate any causal relationship.

The panel therefore finds that the worker’s compensable right knee injury was limited to a medial collateral ligament strain which healed and that his ongoing lateral difficulties are not related to the workplace accident of November 19, 2010. It follows that the worker is not entitled to benefits beyond March 31, 2011. The worker's appeal is dismissed.

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 7th day of December, 2011

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