Decision #139/14 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his current difficulties were more related to his pre-existing left knee condition(s) as opposed to his June 12, 2002 compensable injury. A hearing was held on October 20, 2014 to consider the matter.Issue
Whether or not the worker's current left knee difficulties are related to the June 12, 2002 compensable injury.Decision
That the worker's current left knee difficulties are not related to the June 12, 2002 compensable injury.Decision: Unanimous
Background
The worker filed a claim with the WCB for a left leg injury that occurred at work on June 12, 2002 when he fell to the ground while exiting a hydraulic excavator. Prior to the June 12, 2002 accident, the worker reported that he was already seeing a physician for a left knee injury that occurred on June 1, 2002 when he twisted his knee when he jumped off his deck at home.
Medical information showed that the worker was diagnosed with a left knee strain on June 4, 2002. On June 7, 2002, x-rays taken of the left knee showed a small marginal osteophyte on the medial tibial plateau which was consistent with very slight osteoarthritis.
On June 14, 2002, a doctor's progress report indicated that the worker had "reinjured his knee while it was not fully healed."
On June 19, 2002, the worker underwent left knee surgery and the operative report stated:
Patient had marked retropatellar arthritis on the femoral condyle as well as on the patella itself. The medial femoral condyle on the tibial articulation surface was also showing mild osteoarthritic change on the tibia, as well as femur. Medial and lateral menisci were normal...Suprapatellar tendon showed complete disruption, therefore further surgery was continued.
The worker's claim was accepted based the diagnosis of a rupture of the supraptellar tendon and benefits were paid while he underwent post-operative treatment related to his knee.
On January 16, 2003, the worker was seen at the WCB's office by an orthopedic specialist who made the following comments:
"The claimant had a rupture of the quadriceps tendon from the superior pole of the patella. Quite possibly this was a partial tear on June 1 and a more complete tear occurred on June 14. X-ray examination showed a pre-existing traction spur or osteophyte at the site of the rupture. I think it is speculative to say whether or not this was related to the rupture...Osteoarthritis also was demonstrated on the x-rays and reported at the time of arthroscopy. This would not be due to his injury of June 2002. I think the claimant is likely to have ongoing symptoms from this. This is more likely because of the claimant's weight."
On January 31, 2003, an ultrasound report indicated that there was no evidence to suggest disruption of the quadriceps tendon. X-rays of the left knee taken the same date were read as showing mild osteoarthritis and evidence of an old quadriceps tendon injury.
On July 3, 2003, MRI results of the left knee read as follows:
Scarring distal extensor mechanism. Palpable gap likely represents the proximal end of the scar tissue. No evidence for re-tear.
On July 23, 2003, a WCB medical advisor outlined restrictions for the worker for a one year period to avoid heavy lifting over 50 lbs., no squatting or crouching or kneeling. In July 2003, the worker returned to his pre-accident work duties.
The next medical report on file dated April 6, 2004 indicated that the worker was seen for treatment on November 10, 2003 and February 13, 2004 and was prescribed medication for knee pain which the physician indicated was secondary to osteoarthritis, likely aggravated by the previous injury to his left leg.
In a medical report dated August 30, 2005, the treating physician noted that the worker was seen for left knee pain on July 29 and on several occasions over six months.
On September 22, 2005, a WCB orthopedic consultant reviewed the worker's file and stated:
- the diagnosis for the worker's ongoing left knee symptoms is osteoarthritis of the knee.
- there was no evidence that the osteoarthritis of the knee was enhanced by the rupture of the left quadriceps tendon.
On September 26, 2005, a WCB medical advisor made the following comments:
"[The worker's] ongoing symptoms are felt to be due to his pre-existing osteo-arthritis and not due to the diagnosis of compensable injuries i.e. ruptured supra-patellar tendon. [The worker] therefore has no restrictions with regard to his compensable injury and also does not require medications..."
In a decision dated February 7, 2006, the worker was advised that the WCB considered him to have recovered from the effects of the tendon rupture sustained at work on June 12, 2002. It was felt that his current left knee symptoms were related to osteoarthritis and that this degenerative condition was not enhanced or accelerated by the accident at work. Responsibility for medical treatment and prescription medication would not be paid beyond February 14, 2006.
In a September 5, 2006 report, an orthopedic specialist reported that the worker was seen for his left knee complaints. The specialist concluded that the worker suffered from osteoarthritis from his left knee and that this was mostly patellofemoral. He further stated: The patient strongly believes that this is due to the quadriceps rupture. It is quite possible that with the altered loading pattern that a bit of arthritis could have developed. However, this patient is grossly overweight and should endeavor to lose at least 100 pounds. This will certainly improve the knee function. Long term prognosis is guarded but I do believe that arthroscopy and patellofemoral debridement should give short term benefit in terms of pain relief.
On September 18, 2006, the WCB advised the worker that no change would be made to the February 7, 2006 decision after its review of the September 5, 2006 medical information.
On July 17, 2013, the treating physician diagnosed the worker with left knee arthralgia.
In a memo to file dated September 13, 2013, the WCB case manager noted that she spoke with the worker regarding another WCB claim when he reported difficulties with his left knee which he related to this claim. The worker advised that he had no new accidents or incidents and that the onset occurred during the summer of 2013. He saw a physician and was scheduled for an MRI.
On October 7, 2013 the worker underwent a left knee MRI and the results were read as showing:
- Multidirectional tearing body and posterior horn medial meniscus.
- Chondromalacia at the patellofemoral and medial femorotibial compartments.
- Discoid lateral meniscus.
- Evidence of previous quadriceps tendon repair.
On October 16, 2013, the worker was advised that the WCB was unable to accept responsibility for his left knee difficulties as a relationship between his current difficulties and his June 12, 2002 left leg injury had not been established.
On October 29, 2013, the worker filed an appeal with Review Office stating that he disagreed with his orthopedic surgeon. He noted that his left knee has been hurting since the June 19, 2002 left knee surgery.
In a decision dated December 19, 2013, Review Office stated that it was unable to find a causal relationship between the worker's current left knee difficulties and the compensable injury of June 12, 2002. Review Office noted that the compensable injury resulted in a rupture of the quadriceps tendon. There was also evidence of arthritis and osteoarthritis in the left knee as documented in the June 19, 2002 operative report and Review Office considered these conditions to be pre-existing and not related to the work accident. Review Office accepted the WCB medical opinion outlined on September 22, 2005 that the worker's ongoing left knee symptoms were osteoarthritis and that this was not enhanced by the rupture of the left quadriceps tendon. Review Office also stated that it was unable to account for the x-ray and MRI findings in relation to the compensable injury. It found that the medical evidence supported the worker's difficulties were more in keeping with the natural history of his pre-existing left knee condition. On July 31, 2014, the worker appealed Review Office's decision to the Appeal Commission and a hearing was arranged.
Reasons
Applicable Legislation
The worker has an accepted claim arising from an injury that occurred on June 12, 2002. He is appealing the WCB decisions that his current left knee condition is not related to his June 12, 2002 claim.
In dealing with this appeal, the appeal panel is bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.
Relevant provisions of the Act include:
- ss. 4(1) provides that 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.
- ss. 39(1) provides that wage loss benefits will be paid: “…where an injury to a worker results in a loss of earning capacity…”
- ss. 39(2) 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.
- ss. 27(1) empowers the WCB to provide such medical aid as the WCB considers necessary to cure and provide relief from an injury.
Worker's Submission
The worker attended the hearing and explained his reasons for appealing the Review Office decision. He answered questions from the panel.
The worker said that he first injured his left leg in 2002 when he ruptured his left quadriceps. Since his original accident he has had problems with his left knee and has contacted the WCB several times but the WCB had not provided assistance for his knee. He has, for the most part, been able to continue working. He advised that he was able to work because he used a high dosage of medication.
The worker said that in September 2013 his left knee began to bother him more. He said that he was off work on a different claim at the time, was walking regularly and his knee condition worsened. He said that he did not have an accident, only that his knee became worse. He attributed his problems to his 2002 workplace accident. He advised that he has been listed for a left knee replacement. He said that he has no problem with his right knee.
Employer's Position
The employer did not participate in the appeal.
Analysis
The issue before the panel is whether the worker's current left knee difficulties are related to his June 12, 2002 compensable injury. For the worker's claim to be accepted the panel must find, on a balance of probabilities, that the worker's current left knee problems are causally related to the 2002 injury. The panel was not able to make this finding.
The panel notes that the worker's 2002 injury was accepted with a diagnosis of rupture of the suprapatellar tendon. This injury was surgically repaired. X-rays from March 1989, before the accident, and June 2002, before the surgery, show evidence of pre-existing osteoarthritis in the knee. This pre-existing condition is noted in diagnostic and other reports after the surgery. The panel finds that the worker has osteoarthritis in his knee which existed before and after the workplace injury.
The panel finds that the worker's current difficulties with his left knee are not related to his 2002 claim. The panel relies upon the September 22, 2005, opinion of the WCB orthopedic consultant. He commented that "I do not feel there is any objective evidence that the osteoarthritis of the knee was enhanced by the rupture of the left quadriceps tendon."
The panel notes that the worker's current complaints of pain relate to a different area of the knee than that injured in the 2002 accident
The panel also notes the August 30, 2005 comments of his then physician. The physician noted that the worker had osteoarthritis of his knee and commented that "as his osteoarthritis is a progressive disease and specifically big frame in mind I don't think that his OA will improve significantly over the next foreseeable future."
Finally, the panel notes there is no medical information relating to his knee between 2006 and 2013. The evidence does not demonstrate an ongoing knee injury arising from the 2002 workplace accident.
The worker's appeal is dismissed.
Panel Members
A. Scramstad, Presiding OfficerR. Koslowsky, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
A. Scramstad - Presiding Officer
Signed at Winnipeg this 12th day of November, 2014