Decision #68/15 - Type: Workers Compensation
Preamble
The worker is appealing the decision made by the Workers Compensation Board ("WCB")that his current right foot difficulties were not a consequence of the February16, 1996 compensable injury. A hearingwas held on March 5, 2015 to consider the matter.
Issue
Whether or not the worker's current right foot difficultiesare a consequence of the February 16, 1996 compensable injury.
Decision
That the worker's current right ankle osteoarthritis issuesare a consequence of the February 16, 1996 compensable injury, but that theworker's right calcaneal condition is not a consequence of the February 16,1996 compensable injury.
Decision: Unanimous
Background
On February 14, 1996, the worker reported that he was installing electrical wiring on a house and he lost his balance while on the third rung of a six foot stepladder. He landed onto his right foot and broke the bone below his ankle.
Medical information showed that the worker sustained a right ankle fracture/dislocation of the right talus neck also known as a Hawkins III fracture of the talus. By November 1996, x-rays showed solid union of the fractures with no significant complications. In May 1997, the worker returned to his regular job duties and was later awarded a 7.5% permanent partial impairment award for the restriction of movements in his right foot.
In late December 2013, the worker advised the WCB that he was having ongoing problems with his compensable right foot injury.
Up-dated medical information was obtained. April 8, 2009 x-ray results showed early right knee osteoarthritis (OA) and post-traumatic alterations in the right ankle with no obvious complication.
On December 10, 2013, the treating physician noted that the worker was experiencing increased pain in his right ankle and he was not able to climb ladders. This caused issues with his ability to perform work-related duties. The diagnosis was "traumatic arthritis right ankle secondary to injury in 1996". An x-ray dated December 11, 2013 showed "little change" since April 2009.
The worker saw his orthopedic surgeon January 17, 2014 who reviewed the recent x-rays, noting that the talus fracture had healed and there was no evidence of an avascular necrosis (“AVN”) with collapse. He went on to note that the worker had “…a little bit of ankle arthritis but this present pain is not over the ankle. Therefore, this was likely an asymptomatic ankle arthritis. The subtalar joint was not arthritic.” In this examination, the pain specifically noted by the orthopedic consultant was in the retrocalcaneal bursa area.
On March 18, 2014, the worker underwent MRI testing which revealed “…the artifact related to the patient's talar screw, with a small focus of subchondral sclerosis involving the central aspect of the talar dome however, no significant tibiotalar osteoarthritis has been demonstrated. There is evidence of remote ligamentous avulsion of the anterior talofibular ligament.”
The MRI results were reviewed on April 9, 2014 by the treating orthopedic consultant, who reported there is some subchondral sclerosis, probably secondary to healing and maybe a bit of old AVN that healed. There is no tibiotalar osteoarthritis and there is an avulsion of the anterior talofibular ligament which probably occurred at the time of his original injury.
Based upon the new information obtained on May 22, 2014, a WCB orthopedic consultant reviewed the file and concluded:
- the present posterior right foot pain was caused by retro-calcaneal bursitis and it was not possible to relate this diagnosis to the 1996 workplace injury of the talus fracture;
- there was very minor asymptomatic osteoarthritis of the ankle joint and the clinical examination findings do not point to this as the cause of his difficulties; and
- the minor degree of ankle osteoarthritis was probably the result of the workplace injury and was commonly seen as a long term sequelae to such a fracture.
By letter dated May 23, 2014, the worker was advised that based on WCB medical opinion, his current foot difficulties were not related to his 1996 workplace injury and restrictions were not required. On July 27, 2014, the worker appealed the decision and the case was forwarded to Review Office for consideration.
The treating physician submitted progress reports to the WCB in September, October and November 2014 stating "this is likely a traumatic OA secondary injury in 1996 - AVN of talus."
On November 4, 2014, Review Office determined it could not find the worker's current difficulties were a recurrence of his compensable injury or that the diagnosis of retrocalcaneal bursitis was related to the 1996 fracture, based on the medical opinion of the WCB orthopedic consultant.
On January 13, 2015, the worker appealed Review Office's decision to the Appeal Commission and a hearing was arranged.
Reasons
Applicable Legislation and Policy
In considering this appeal, the panel is bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.
Under subsection 4(1) of the Act, 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.
WCB Policy 44.10.20.50.10, Recurring Effects of Injuries and Illness applies where a worker has returned to work following a compensable injury and subsequently suffers a further loss of earning capacity as a result of the same injury. The WCB must determine whether the current loss of earning capacity is a consequence of the original compensable injury or illness or an intervening incident event, or exposure that contributed to the injury. In making this determination, the WCB must consider whether the loss of earning has any relationship to a previous injury or illness.
Worker’s Position
The worker, representing himself in the appeal, advanced the position that his ongoing right foot difficulties relate directly to the compensable injury incurred on February 16, 1996. He noted that he continues to experience symptoms including generalized ache, cold and stiffness and reduced mobility in his right ankle by late in his workday. He stated that there is no other possible cause for the ongoing difficulties with his right ankle which he relates directly to the injury that occurred in 1996.
Employer’s Position
The employer did not participate in the appeal.
Reasons and Analysis
The worker seeks a determination that his current right foot difficulties are a consequence of the February 16, 1996 compensable injury to his right ankle.
In order to find that the worker’s current right foot difficulties are a consequence of the original compensable injury, we must determine that there is a relationship between the current complaints and the previous injury. We are able to make this finding, in part.
To assist the panel in making a determination of this issue, a further medical report was obtained from the treating orthopedic consultant. That report, dated January 13, 2015, was received on March 25, 2015.
The worker, in his submission, confirmed that his current complaints are with respect to pain and lack of mobility and stiffness of his right ankle, which was the site of the original compensable injury.
The treating orthopedic consultant describes the current issues in his report of January 13, 2015:
He continues to have pain in his ankle….He complains of both pain and of stiffness in the foot and ankle while working...Currently he is working three days a week at eight hours. He has significant pain as he uses two Tylenol #3 per day to get through a day. His pain is located medial and lateral.
Physical examination revealed reduced range of motion in the right ankle as compared to the left ankle and tenderness “…about the subtalar joint, ankle joint, medial, and lateral.
The orthopedic consultant concludes that the worker’s limitations in range of motion and pain are related to the work he does and to the osteoarthritis in his right ankle, secondary to his trauma. He clearly states “This is all related to the injury that he sustained after falling off a ladder and having a comminuted talus fracture.”
This view is supported by the WCB medical advisor in a report dated May 22, 2014. That report confirms that the worker’s osteoarthritis in his right ankle is likely the result of the workplace injury and notes that it is commonly seen as a long-term sequela to such a fracture. The panel accepts the analysis of the treating orthopedic specialist in respect of the current symptomatic status of the osteoarthritic condition.
We note, however, that in the same report, the WCB medical advisor indicates that the worker’s posterior right foot pain is the result of retrocalcaneal bursitis. The medical advisor’s opinion is that this diagnosis cannot be related to the 1996 fracture of the talus. The panel concurs with this opinion.
The findings related to retrocalcaneal bursa are first noted in the orthopedic consultant’s report dated January 17, 2014, 18 years after the workplace accident. He noted that on palpation, most of the worker’s pain is in the retrocalcaneal bursa area. We note, that this was not at the anatomical site of the original injury and the orthopedic consultant, in his reports, does not make any express link between this finding and the original injury of 1996.
Based on the medical findings and reports, as well as the evidence and submissions of the worker, we have determined on a balance of probabilities that the worker’s osteoarthritis in his right ankle is a consequence of and related to the 1996 compensable injury, but the right retrocalcaneal bursa condition is not related to or a consequence of the original compensable injury.
Panel Members
K. Dyck, Presiding OfficerA. Finkel, Commissioner
P. Walker, Commissioner
Recording Secretary, B. Kosc
K. Dyck - Presiding Officer
Signed at Winnipeg this 1st day of June, 2015