Decision #100/12 - Type: Workers Compensation

Preamble

The worker is appealing the decision made by Review Office of the Workers Compensation Board ("WCB") which determined that he was not entitled to benefits beyond December 2, 2010 in relation to his compensable left knee injury that occurred in June 2010. A hearing was held on August 30, 2012 to consider the matter.

Issue

Whether or not the worker is entitled to benefits beyond December 2, 2010.

Decision

That the worker is entitled to benefits beyond December 2, 2010.

Decision: Unanimous

Background

On June 2, 2010, the worker suffered an injury to his left knee when a speaker fell on it during the course of his employment as a caretaker. The claim for compensation was accepted by the WCB and no time loss was experienced by the worker.

On July 15, 2011, the worker informed the WCB that he was scheduled to undergo left knee surgery on September 6, 2011 which he related to the effects of the June 2, 2010 compensable injury.

On September 8, 2011, the worker described the accident that occurred on June 2, 2010. To the best of his recollection, his knee was bent when the sound system fell and he was struck just above and in the centre of his left knee cap.

Medical information on file consisted of reports from the family physician, orthopaedic surgeon and laboratory test results.

A report from the family physician dated June 30, 2010 noted that the worker injured the lateral aspect of his left knee 3 to 4 weeks ago when a sound system fell on his knee. He stated that the knee started to swell last week and the worker felt pain in the medial aspect of the left knee. Objective findings were as follows: range of motion was okay, strength was 5/5, edema to superior medial aspect, muscular bulge in that area, ligaments intact, negative McMurray test. The worker was assessed with a muscle tear.

An x-ray taken of the worker's left knee on July 5, 2010 was read as showing early degenerative changes of the medial and lateral compartments of the knee as well as the patellofemoral joint. A small joint effusion was present. There was no acute bony process. The impression was read as follows: "Mild knee osteoarthritis."

A report from the family physician dated July 15, 2010 reported that the worker still complained of tenderness of the left knee especially at night with loud clicking. Objective findings were a lump on the lateral distal quad of the left knee, tenderness, patella was lax with crepitus and range of motion was normal.

An MRI of the worker's left knee taken November 22, 2010 was reported to reveal a horizontal tear involving the body and posterior horn of the medial meniscus, free edge fraying at the lateral meniscus with no discrete cleavage tear and chondromalacia involving the patellofemoral and medial femoral tibial compartments.

A soft tissue sonogram was performed on December 2, 2010 and was compared to the MRI findings of November 22, 2010. The results were read as follows: "A targeted soft tissue sonogram was performed. The patient indicates that the lump is no longer palpable and has resolved. No focal sonographic abnormalities are visualized in the area of concern. Clinical follow-up is recommended with re-imaging if the abnormality returns."

In a progress report dated December 17, 2010, the family physician stated: "No obvious pain on direct palpation of knee but he had issues with his knee for a long time, ROM [range of motion] is well maintained." The physician assessed the worker with a left knee meniscus tear based on the MRI results.

In a report dated March 17, 2011, an orthopaedic surgeon noted that the worker had a piece of equipment fall on his knee while at work in June 2010. The knee swelled at the time and swells on and off since then. He reported that the worker currently has locking and grinding of the knee and that squatting or going up and down stairs causes pain. Based on his examination findings and MRI scan results, a left knee arthroscopy and intra-articular surgery for a meniscal tear was recommended.

The surgical report of September 6, 2011 revealed the following post-operative diagnoses:

  • Medial meniscal tear horizontal cleavage type 3 x 1 cm
  • Lateral meniscal tear 0.5 cm to 1 cm radial tear
  • Chondromalacia of femur medial compartment 2 x 2 cm, grade 2
  • Chondromalacia of the patella which was grade 2, diffuse.

At the request of primary adjudication, a WCB medical advisor was asked to review the worker's file and answer the following question: "Based on the mechanism of injury, that being that a sound system fell on [the worker's] knee, what would be the likely DX [diagnosis] to follow? Medial? Lateral? Both? If lateral, would it be expected that a lateral tear could result in medial problems?" On September 6, 2011, the WCB medical advisor documented that she reviewed the file along with the September 6, 2011 surgical report and discussed it with a WCB orthopaedic consultant. She stated:

  • based on the reported mechanism of injury on June 2, 2010, the probable diagnosis was left distal quadriceps contusion. This was supported by the documented painful lump on the distal lateral quadriceps. The direct trauma likely caused quadriceps contusion and local hematoma, for which medical tests were ordered, i.e. the November 22, 2010 MRI and December 2, 2010 left knee sonogram.

  • the November 22, 2010 MRI findings were reflective of pre-existing degenerative changes that would not likely have been materially influenced by the June 2, 2010 mechanism of injury.

In a decision dated September 21, 2011, the worker was advised that the WCB was unable to accept responsibility for his claim beyond July 15, 2010. The adjudicator referred to the medical opinion outlined on September 6, 2011. She stated that in the opinion of the WCB, the worker sustained a left lateral distal quadriceps contusion as a result of the June 2, 2010 workplace accident and that based on the weight of evidence including the history of injury, diagnosis, expected symptom duration, subsequent investigations, current clinical findings and the time that had passed, supported that the worker had recovered from his left knee injury by July 15, 2010.

On November 17, 2011, the case was considered by Review Office based on an appeal submitted by the worker. Review Office found that the worker was entitled to benefits up to December 2, 2010. Review Office referred to file evidence to support that the probable diagnosis in relation to the compensable injury of June 2, 2010 was a left lateral disc quadriceps contusion/hematoma or "lump" and that the condition had resolved by December 2, 2010 based on the sonogram findings of that date. Review Office found that there was no causal relationship between the compensable injury of June 2, 2010 and the MRI findings of November 22, 2010 or the post-operative diagnoses of September 6, 2011.

In a follow-up report dated December 22, 2011, the treating orthopaedic surgeon reported that the worker was seen post knee scope. He noted that a 20 pound object fell on the superior aspect of the worker's flexed knee and that he had no symptoms prior. The surgeon stated: "This probably caused a burst injury to his meniscus, horizontal cleavage tear."

On January 6, 2012, the worker asked Review Office to reconsider its decision of November 17, 2011. The worker indicated in his submission that his current knee problems were due to the June 2, 2010 accident and that he had no pre-existing problems with his knee.

In a decision letter dated March 14, 2012, Review Office advised the worker that it considered his appeal of January 6, 2012 along with the report from the treating surgeon dated December 22, 2011. Review Office found that the new evidence did not support a change in its previous decision of November 17, 2011. Review Office stated that it was unable to establish that there was a causal relationship between the September 6, 2011 operative findings and the accident of June 2, 2010. On May 24, 2012, the Worker Advisor Office appealed Review Office's decision to the Appeal Commission on the worker's behalf and a hearing was held on August 30, 2012.

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.

Subsection 4(2) of the Act provides that a worker who is injured in an accident, as defined under subsection 1(1) the Act, is entitled to wage loss benefits for the loss of earning capacity resulting from the accident. 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.

Worker's Position

The worker was represented by a worker advisor who made a presentation on the worker's behalf. The worker answered questions posed by the worker advisor and the panel.

The worker advisor submitted that the workplace accident either caused the worker's medial meniscus tear or aggravated a pre-existing medial meniscus tear.

The worker advised that he has worked in his position for four and a half years. He said that before the accident, he had no difficulty performing his duties. He also said that he had no prior problems with his left knee.

The worker described the accident. He said that he was reaching above shoulder height to a speaker and the speaker began to fall. He said the speaker was in freefall and that he could not control it. He instinctively put out his left knee to break the speaker's fall and was hit by the corner of the speaker just above his knee cap. He said the speaker was approximately 2 to 2 ½ feet high and 1 foot wide.

The worker advised that he left work early on the day of the injury and applied ice to the knee. He applied ice to the full knee not just the area above his knee. He said the swelling started on the day after the accident, and it came and went. He found it difficult to kneel, bend or climb ladders and stairs, and noticed that his knee would lock-up and crack. The worker developed a limp immediately after the injury which continued until he had surgery. The worker bought a brace at a local pharmacy which he used until he had surgery.

The worker advisor noted the WCB medical advisor's comments regarding normal range of motion findings. He said that the range of motion findings were the same after the meniscus tear was confirmed. He suggested that expected findings are not always present.

Employer's Position

The employer did not participate in the appeal.

Analysis

This appeal deals with an accepted claim for a workplace injury that occurred on June 2, 2010. The issue under appeal is whether the worker is entitled to benefits beyond December 2, 2010.

The panel notes that after December 2, 2010, the worker missed work and received medical treatments for the surgical repair of a medial meniscus tear. To find that the worker is entitled to benefits after December 2, 2010, the panel must find that the worker's medial meniscus tear was caused by or enhanced by the workplace accident. The panel finds, on a balance of probabilities, that the worker had an asymptomatic pre-existing condition which was enhanced by the workplace accident. Accordingly, the worker is entitled to benefits attributable to the treatment of this pre-existing condition.

The panel believes there may have been some misunderstanding of the injury and symptoms due to the worker's general reference to his "knee" without distinguishing the specific parts of the knee. In answer to questions the worker was more specific about where the knee was injured and when symptoms, such as swelling, occurred.

At the hearing, the worker provided a more detailed account of the accident. He said the speaker was approximately 2 to 2 ½ feel by 1 foot. He advised that the speaker fell from shoulder height with the corner of the speaker hitting his knee just above his knee cap. The panel finds this blow to the knee was very focused and jarred the worker's knee with significant force. The panel finds the mechanism of injury is consistent with the description of a "burst injury" provided by the orthopaedic specialist.

The panel finds that this accident caused the worker's previously asymptomatic medial meniscus tear to become symptomatic. In other words, the worker's pre-existing condition was enhanced by the accident.

In reaching this decision the panel relies upon the following information:

  • the worker's description of the accident.
  • the worker's evidence that he had no problem with his knee prior to the accident.
  • the worker's evidence that he developed a limp immediately after the accident and that the limp worsened as he continued to work after the accident.
  • the worker's evidence that his knee developed a clicking sound. He reported the clicking at his July 15, 2010 examination. The panel notes that clicking is consistent with a meniscus tear.
  • the worker's evidence that shortly after the incident he developed generalized swelling. The swelling was not limited to the lateral quadriceps, although the worker did develop a lump at that site. The worker's work journal notes swelling on June 4, 2010.
  • within 3 weeks of the injury, the examining physician noted edema to the superior medial aspect of the knee. In his July 30, 2010 report, the examining physician noted "last week started swelling and feeling pain in the medial aspect of knee, worse when getting up from a squat, no weakness, has been applying ice and using advil…"
  • the December 22, 2011 opinion of the orthopaedic specialist that the accident probably caused "a burst injury to his meniscus, horizontal cleavage tear", which is consistent with the mechanism of injury described to the panel.

The panel notes that the WCB medical advisor commented that "decreased knee range of motion is typical with traumatic meniscal injuries" and that the left knee range of motion was reported as normal on June 30, 2010 and July 15, 2010. The panel also notes that the worker had normal range of motion in December 2010 and March 2011, after the meniscus tear was confirmed on the MRI, and as a result, the panel attaches no weight to the findings of normal range of motion.

The worker's appeal is allowed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Lafond, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 25th day of September, 2012

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