The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") to deny his request for the costs associated with a mattress warmer. A file review was held on September 24, 2014 to consider the matter.

Issue

Whether or not the worker should be reimbursed for the cost of a mattress warmer.

Decision

That the worker should be reimbursed for the cost of a mattress warmer.

Decision: Unanimous

Background

On April 28, 1980, the worker slipped on steps when exiting a grader, injuring his lumbar spine and right hip. His claim for compensation was accepted and on September 21, 1981, the worker underwent decompression laminectomy at the L4-5 interspace.

On December 14, 2004, the worker was advised that his request for the WCB to cover the costs of a mattress warmer would not be accepted in relation to his 1980 compensable back injury. The decision was based on the opinion expressed by a WCB medical advisor on November 9, 2004 who stated that there was no indication on file that a mattress warmer had been prescribed to the worker by a healthcare provider.

On January 9, 2005, the worker appealed the above decision to Review Office. The worker stated that a mattress warmer on the lower half of his bed helped him to sleep.

On February 10, 2005, Review Office determined that the worker should not be reimbursed for the costs of a mattress warmer. Review Office indicated that the worker felt the use of a mattress heater on the lower half of his bed increased the quality of his sleep as he "is unable to warm the lower part of [his] body in bed." While Review Office accepted that this was the case, it did not feel there was any relationship between the worker's cold lower extremities and his compensable injury.

At a Permanent Partial Impairment ("PPI") exam on March 17, 2005, the WCB Impairment Awards Medical Advisor noted that the worker had made good recovery from the 1981 surgery but a return to work was unsuccessful due to the worker's ongoing pain, cold sensitivity in his right buttock and a right-sided foot drop. The examination also revealed evidence of a partial cauda equina lesion and the worker was provided with a 5.0% PPI rating for this particular condition.

In May 2014, the worker asked Review Office to reconsider its decision dated February 10, 2005. On May 21, 2014, Review Office advised the worker that his submission provided no new evidence and therefore no change could be made to its previous decision to deny responsibility for a mattress warmer. On June 17, 2014, the worker appealed Review Office's decision to the Appeal Commission and a file review 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.

The worker has an accepted claim for a workplace injury. He is asking that the WCB reimburse him for the costs of a mattress warmer for his bed.

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.

The WCB Board of Directors established WCB Policy 44.120.10 (Medical Aid) which notes that provision of medical aid attempts to minimize the impact of the worker's injury and to enhance an injured worker's recovery to the greatest extent possible.

Worker's Position

The worker filed an Appeal of Claims Decision Form on June 17, 2014 , appealing the Review Office decision that he is not to be reimbursed the cost of a mattress heater. He advises that his compensable back surgery left him with a cold sensation below his belt line from his hip all the way down to his great toe. He advised that the mattress warmer is a great help.

Employer's Position

The employer was represented by a staff member who submitted a written submission to the Appeal Commission dated September 18, 2014.

The employer representative noted that the WCB policy allows for expenditures on treatments and devices which are required by reason of a compensable injury and the treatment or device is likely to improve function or minimize the chance of aggravating the existing injury. He noted that the key point is that the need for the device must arise from and be directly related to the compensable injury. He noted that a WCB medical advisor reviewed the worker's request and commented that the mattress warmer was not prescribed by a healthcare provider and was not necessary or related to the worker's compensable injury.

The employer representative agreed with the February 10, 2005 and May 21, 2014 WCB Review Office decisions that there is no relationship between the worker's cold lower extremities and his injury. He submitted that the worker has not provided any medical support that the need for a mattress heater is directly relate to his 1980 injury. He submitted that the worker's request does not meet the test under WCB Policy 44.120.10.

Analysis

For the worker's appeal to be successful, the panel must find that a mattress warmer is required as a result of the worker's compensable injury. The panel was able to make this finding.

The panel has reviewed the file in detail and finds there has been a lengthy and well documented history of cold sensitivity resulting from the workplace injury and subsequent treatment. The details of the relationship include the following:

• September 23, 1982 call-in exam. It was noted that the worker reported intermittent numbness and soreness posterior right hip, right knee, sole right foot lateral 4 toes on right foot, considerable cold intolerance right foot.
  
• March 23, 1984 WCB call-in exam. It was noted that the worker complained of persistently cold right foot and experienced coldness from buttock down the entire leg.
  
• November 13, 1984. A physician noted pain down both legs, right to heel and left to back of knee. It also noted sensation of cold at buttocks.
  
• September 1985. A physician notes ENG report indicates clinical and electrophysiologic evidence of S1 lesion. Report notes a coolness in his right leg, probably related to autonomic dysfunction included in the right side nerve lesion at S1.
• December 16, 1985 WCB call-in exam. Medical advisor notes some evidence of S1 root irritation.
• April 17, 1990 WCB call-in exam. Medical advisor notes the worker experiences cold sensation in right buttock and right foot and has purchased a heating pad to use at all times on his lower back and buttock whilst in bed at night. Medical advisor finds absence of peripheral vascular disease as contributing to muscle weakness or complaint of cold sensation.
  
• March 26, 1990 referral to physician for acupuncture. Physician notes worker's main problem is cold feeling in right leg and buttock.
  
• July 17, 1997. A WCB medical advisor accepts acupuncture treatment for cold sensation.
  
• October 16, 2001. Expense claim for car seat and seat back warmer prescribed by treating physician approved and paid by WCB on November 26, 2001.
  
• January 6, 2004 call-in exam. Worker's symptom diagram notes worker's chief complaint is cold all around belt line including groin area, hips and feet.
  
• March 17, 2005 call-in exam. Medical advisor examines worker and notes changes in loss of range of motion including evidence of partial cauda equina lesion and rated PPI at 5% for a final rating of 28%.
  
• April 18, 2005. Medical advisor notes worker's cauda equina syndrome could be major contributor to worker's symptoms and is related to the compensable condition and its complications.

The panel finds the worker's history of cold sensitivity commenced after the injury and the related surgery. It notes that the WCB has accepted cauda equina syndrome as being related to the compensable injury. The panel notes that symptoms related to this condition include:

• severe low back pain
• loss of or altered sensation in legs, buttocks, inner thigh, back of legs, and feet
• sexual dysfunction

The panel further notes that in 1997 the WCB authorized acupuncture treatment for the worker's cold sensation issues and in 2001, the WCB paid for a car seat and seat back warmer that had been prescribed by the worker's attending physician. In the panel's view, these are indicators that the worker's cold sensation symptoms are considered related to his compensable injury.

The panel finds that the worker's cold sensitivity in the area below his belt line on the right hip and down to his heel and foot, including his groin area are, on a balance of probabilities, related to his later diagnosed cauda equina syndrome which is related to his compensable injury. Accordingly, the panel finds that the request for a mattress warmer is related to his compensable injury and is approved, as it provides relief from his injury.

The worker's appeal is accepted.

Panel Members

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

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 1st day of October, 2014