The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by Review Office of the Workers Compensation Board ("WCB") which determined that she was not entitled to acupuncture treatment beyond April 19, 2012 as the treatment did not provide her with any long term benefit. A file review was held on February 4, 2013 to consider the matter.

Issue

Whether or not the worker is entitled to chiropractic treatment (acupuncture) beyond April 19, 2012.

Decision

That the worker is not entitled to chiropractic treatment (acupuncture) beyond April 19, 2012.

Decision: Unanimous

Background

On January 19, 2011, the worker sustained injures to her knee, back and arm from a fall at work. The diagnosis accepted as compensable was a right S1 lumbar radiculopathy of the low back. In late March 2011, the worker began to receive acupuncture treatment from a chiropractor for her low back starting twice per week for six weeks.

In a follow-up report dated April 28, 2011, the treating chiropractor noted that acupuncture treatment had provided the worker with mild pain relief and slightly improved her range of motion. A request was made for the continuance of acupuncture treatment for another eight weeks, twice per week. After a file review on May 17, 2011, a WCB chiropractic consultant authorized further chiropractic treatment to July 28, 2011 inclusive.

On August 2, 2011, the treating chiropractor reported that the worker would like to continue with acupuncture treatments once per week. She noted that the worker "was completely off pain medication and they were well into a rehabilitation program including protocols for disc bulges which has been working." After a file review on August 3, 2011, the WCB authorized an additional eight weeks of treatment to include acupuncture component to September 23, 2011.

In a follow-up report dated September 20, 2011, the treating chiropractor noted that the treatments were lasting for one week but by the time the worker was due to come in for the next visit, she could start feeling leg discomfort. A further treatment extension was requested. On September 30, 2011, the WCB chiropractor consultant noted that acupuncture treatment appeared to be of benefit to the worker and that it should be continued. He noted that the worker was working full duties and that she was performing a home exercise program in conjunction with her in-clinic treatment.

At the request of primary adjudication, a WCB medical advisor reviewed the worker's file on October 11, 2011. She noted that the prognosis for lumbar radiculopathy was variable and could range from six to 18 months with a good prognosis for full functional recovery. She opined that the current treatment plan involving end-range loading and acupuncture treatment for pain would be considered medically reasonable.

On November 29, 2011, the treating chiropractor requested an extension for chiropractic treatment. She noted: "Progress is continual and centralization is occurring so we would like to continue the trend for another 8 weeks at 1x per week." On December 7, 2011, a WCB chiropractic consultant noted that the worker was working and was off medication. An eight week extension of chiropractic treatment was authorized to January 25, 2012.

In February 2012, the treating chiropractor requested a treatment extension for eight more weeks noting that the worker had a flare-up of low back pain from moving a box of files at work which aggravated her condition. She noted that travelling had not helped the situation. On April 16, 2012, a WCB chiropractic consultant reviewed the file and stated that the effects of the worker's move should now have resolved. The consultant indicated that he was extending chiropractic treatment up to the end of the present week and following this, the worker should be able to self-manage without additional in-clinic treatment. On April 16, 2012, the treating chiropractor was advised by the WCB that treatment would be authorized up until April 20, 2012.

In a chiropractor progress report dated April 18, 2012, the treating chiropractor requested authorization for eight further weeks of chiropractic treatment on the following basis: "This patient has an extensive disc bulge and we have been able to keep her at work full duties and without any pain meds at all. Continue until we can get 10+ days relief and then we will decrease frequency of visits…" On May 16, 2012, the WCB chiropractor consultant stated:

"It is over a year from the date of the compensable injury. The claimant seen (sic) [chiropractor] for over a year, and has received acupuncture treatment weekly for most of that time. This is far in excess of the expected duration of acupuncture treatment. There is no evidence of sustained or progressive benefit to the claimant as a consequence of her treatment. For that reason, in my opinion, acupuncture treatment would not be considered a medical requirement at this time."

On May 16, 2012, the WCB advised the treating chiropractor that the WCB had not been able to identify exceptional circumstances that would warrant additional treatment beyond April 20, 2012.

On May 18, 2012, the worker's treating physician noted that the worker had been receiving acupuncture weekly which kept her from being in any pain. The worker found that when she does not have acupuncture, the symptoms of low back pain and numbness in her right foot return. The physician outlined concerns that without this treatment, the worker would suffer and be unable to work.

On June 20, 2012, a WCB chiropractic consultant stated: "There are no robust studies, to the best of my knowledge, that support a significant benefit of acupuncture in the treatment of radiculopathy. The mechanism by which acupuncture would provide benefit in the treatment of radiculopathy is speculative, recognizing that the mechanism of acupuncture in pain control is largely unknown. A proposed mechanism is the facilitation of endorphin release accompanying acupuncture."

On June 25, 2012, the treating chiropractor stated: "This progress report is submitted in part for her appeal. I recommend she continue acupuncture on a supportive basis to ensure [the worker] is able to continue working and functioning on a full time basis. Acupuncture provides her with relief and improvement in her quality of life and activities of daily living. She's never had back pain before this injury and she's still having a lot of discomfort."

In a decision dated June 29, 2012, a WCB case manager advised the worker that further funding for acupuncture care was not warranted as acupuncture care did not directly cure or fix the underlying physiological problem, nor had it proven to significantly increase her level of function. The case manager indicted that he was authorizing a four to six week global reconditioning program for the worker.

On July 11, 2012, Review Office confirmed that the worker was not entitled to acupuncture care beyond April 19, 2012. Review Office stated in its decision that the WCB authorized 130 acupuncture treatments in a span of just over one year and that the treatment did not provide any long term benefit. Review Office accepted the WCB chiropractic's consultant's opinion of June 20, 2012. Review Office noted the opinion expressed by the treating chiropractor that the worker should continue acupuncture treatments on a supportive basis. Review Office referred to the WCB chiropractic management guidelines and found that the worker's case did not meet the criteria to qualify for supportive care. On November 5, 2012, a worker advisor appealed Review Office's decision to the Appeal Commission and a file review was arranged.

Reasons

The panel notes that the WCB has established its own WCB Chiropractic Management Guidelines and that Review Office applied these guidelines in its decision. The guidelines provide that continuous treatments are not considered supportive care and are not usually authorized by the WCB. Continuous treatments are considered supportive care where they are provided in order to either prevent or ameliorate the effects of an established pattern of recurrences.

While the Appeal Commission is not bound by the guidelines, the panel considers the guidelines to be useful in addressing the issue of further acupuncture treatments. The panel finds that the worker's ongoing acupuncture treatments, beyond the 130 treatments received, cannot be considered as supportive care in accordance with the guidelines.

Given the above information, the panel concludes that the provision of further acupuncture treatment beyond April 19, 2012 was not necessary for the treatment of the worker's back and that further acupuncture treatments are not authorized. 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 12th day of March, 2013