The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The employer is appealing the decision made by the Workers Compensation Board ("WCB") that the worker's left knee injury occurring on June 19, 2014 was work-related. A hearing was held on February 4, 2015 to consider the matter.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable.

Decision: Unanimous

Background

On June 19, 2014, the worker indicated that he was walking at work when his left knee gave out. He did not step on anything and there were no obstructions.

The employer's accident report stated that they were protesting the acceptance of the claim as there was no causal relationship between the worker's employment and his knee symptoms. The employer asserted that the worker's knee symptoms occurred during an off duty incident and there was nothing work-related that contributed to his alleged symptoms.

On June 24, 2014, the worker advised a WCB adjudicator that his knee was fine at the start of his shift on June 19. The accident occurred while walking on uneven ground that was covered with ballast or crushed stone. There was no twisting motion and his knee just gave out. The worker indicated that he previously injured his left knee at home about one year ago when he was coming down some stairs. He did not fall down the stairs but caught himself. The next day his knee was swollen and he attended physiotherapy treatment. He was off work for maybe two months.

By letter dated July 8, 2014, the worker was advised that his claim for compensation was not accepted as the WCB was unable to establish that his left knee injury that occurred during work hours was directly attributable to a workplace accident, given that he had previously injured his left knee at home. On July 14, 2014, the worker appealed the decision to Review Office.

On September 22, 2014, Review Office overturned the adjudicator's decision and found that the worker's claim for compensation was acceptable. Review Office noted that the worker provided a consistent accident history to the WCB, his employer and his doctor that he injured his left knee while walking or taking a step. The left knee injury occurred on the employer's premises and it arose out of his employment. On November 6, 2014, the employer appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

Following the hearing, the appeal panel met to discuss the case and requested additional medical information prior to rendering a decision. On March 23, 2015, the interested parties were provided with a copy of the medical information that the panel had received and were asked to provide comment. On April 7, 2015, the panel met further to discuss the case and to render its decision.

Reasons

Applicable Legislation:

The Appeal Commission and its panels are bound by the Act, regulations and policies of the Board of Directors. Subsection 4(1) of the Act provides:

4(1) Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment is caused to a worker, compensation as provided by this Part shall be paid by the board out of the accident fund, subject to the following subsections. (emphasis added)

The employer’s position:

The employer was represented by a claims specialist who participated via teleconference. The employer's position was that the worker's claim was not acceptable. In support of this position, the employer submitted that the reported mechanism of injury did not give rise to a claim. While the injury was sustained during work hours, it was not directly attributable to a workplace accident. The worker described the knee pain as coming on while walking, and was not due to a specific work incident. There was ballast on the ground, but this was not a hazard of employment. There were no holes or obstructions and the ballast was virtually flat where the worker was walking. The worker did not twist, slip or trip on the ballast. He was simply walking when his knee gave out on him.

The employer made the distinction between injuries which resulted from employment, which are compensable, and injuries related purely to natural causes, which are not compensable. An injury will not be compensable simply because it happened at work. It must be one which arises out of and in the course of employment. There must have been something in the employment relationship or situation that had a causative significance in producing the injury. It was submitted that the worker's knee injury resulted from his natural condition, together with general activities of life. The simple act of walking fell into the realm of natural or normal body functions. The only connection between them and the employment was the coincidental fact that the worker was on the job at the time.

The employer also submitted that the objective medical evidence did not support the worker's claim. The MRI of October 9, 2014 showed a small insufficiency fracture in the medial femoral condyle. The orthopedic specialist stated that it was difficult to know what to make of the fracture and that it was quite unusual given the worker's age and the mechanism of injury. The WCB medical advisor also confirmed that the described workplace injury would be an improbable mechanism to result in a medial femoral condyle fracture. It was therefore submitted that the worker's left knee diagnosis did not match the original mechanism of injury.

Overall, the employer stated that although motion may be required as part of the worker's work duties, it was a normal body motion that he would do regularly outside of work as well as at work. As a result, the injury should not be compensable. The injury came on without an intervening work event and the diagnosis did not match the mechanism of injury. The panel was therefore asked to overturn the WCB's decision to accept the claim.

The worker’s position:

The worker was assisted by a union representative at the hearing. The worker acknowledged that he had a pre-existing injury, but stated that he had been cleared by his doctor to return to work "one hundred percent." The worker stated that he had no pain up until the injury happened on June 19, 2014 and that things had been fine. With respect to the mechanism of injury, the worker clarified that he did not feel pain before his knee gave out. Rather, his knee gave out and then he felt pain in his knee. With respect to the location, the worker submitted that the ground he was walking on was uneven and was not like walking on a sidewalk or at home.

When describing the injury, the worker indicated that both his doctor and his surgeon identified that there was something wrong with his posterior cruciate ligament ("PCL"). The worker indicated that his surgeon told him that an MRI is not always an exact science and does not always show what is going on. The worker acknowledged that his surgeon stated that the insufficiency fracture which showed up on the MRI did not correlate with what occurred at work. The worker submitted, however, that he was not treated for a fracture. He went to physiotherapy and was treated for a PCL injury. The worker's position was that he should have an acceptable claim for this injury.

Analysis:

The issue before the panel is claim acceptability. In order for the employer's appeal to be successful, the panel must find that the worker did not injure his left knee as a result of performing his work duties on June 19, 2014. We are not able to make that finding.

The panel agrees with the employer's submission that the medial femoral condyle insufficiency fracture identified in the October 9, 2014 MRI is inconsistent with the mechanism of injury and we do not accept that there is a claim with respect to this medical condition. The worker also acknowledged this at the hearing. The panel does, however, find that the worker has an acceptable claim with respect to the PCL injury which was diagnosed by the surgeon based on clinical presentation and which was the medical condition for which the worker received physiotherapy treatment.

With respect to mechanism of injury, the panel finds that the work environment where the worker sustained the injury to his knee contributed to the accident. The worker was walking in an area between two sets of railway tracks. On the ground there was ballast of varying size, ranging from approximately one to three inches in diameter and an incline in the railbed. The worker stated that the ballast was loose and when walking on it, it was possible to slide or move a little bit. The panel notes that the worker had a pre-existing vulnerability in his knee due to previous injury to his left knee. The panel accepts the worker's evidence that: "when you're walking in the yard, if it's a little, you know, slanted or whatever, I think I just, the way I planted my foot, maybe because it wasn't on total solid ground, it just kind of swayed my knee like, and then it gave out, as well as maybe some sort of weakness in the knee."

On a balance of probabilities, the panel accepts that the worker suffered a PCL injury to his left knee while walking on the ballast on June 19, 2014. We accept that the uneven ground was a work-related factor which contributed to the worker's left knee injury. Following the incident, there was a distinct change in the worker's functional abilities and he was then required to seek medical attention. Although a specific diagnosis for the worker's injury was not initially apparent, the panel accepts the diagnosis subsequently identified by the surgeon of a significant PCL laxity.

The panel therefore finds that the worker's claim is acceptable. The employer's appeal is dismissed.

Panel Members

L. Choy, Presiding Officer
A. Finkel, Commissioner
M. Lafond, Commissioner

Recording Secretary, B. Kosc

L. Choy - Presiding Officer

Signed at Winnipeg this 10th day of April, 2015