The Appeal CommissionThe Workers Compensation Act of Manitoba

The worker was assisted by a worker advisor at the hearing. It was submitted that the worker was entitled to medical and wage loss benefits beyond June 2, 2014.

The worker provided a detailed narrative of the accident which occurred when the gate at which he was working came down suddenly and unexpectedly and struck him in the head. Although he was not knocked unconscious, he did sustain a laceration to his head. He was taken to a hospital Emergency Department where he received 20 stitches.

Over the following weeks, the worker stated that he continued to experience ongoing symptoms of headaches and dizzinesss. He attempted a return to work in January 2014, but this greatly exacerbated his symptoms. He was therefore sent for further evaluation and a recommendation was made that he undergo a neurological assessment. The worker states that he continued to experience symptoms of headache, dizziness, eye strain and nausea with movement into February 2014. In March 2014, the worker was evaluated by a physiotherapist who commented that the worker’s symptoms were suggestive of post concussion syndrome with a vestibular dysfunction component. That same month, he was assessed by a neurologist who concluded that some of his dizziness and lightheadedness was post-traumatic in origin.

Over the next several months, the worker reported that he continued to experience symptoms of severe headaches, dizziness, photosensitivity, and nausea.

In July 2014, the worker was referred to a neurologist who concluded that his symptoms were possibly a peripheral vestibular lesion and referred the worker to an otolaryngology specialist who, in September 2014, diagnosed bilateral hypofunction and recommended continued vestibular physiotherapy and ongoing rehabilitation.

Although it was acknowledged that the causes of vestibular dysfunction can include aging and viral infection in addition to head injury, it was submitted that the weight of the evidence supports an association between the diagnosis of bilateral vestibular hypofunction and the compensable injury. The worker should, therefore, be entitled to benefits beyond June 2, 2014.

Employer’s Position

The employer was represented by a supervisor who was present at the time of the workplace accident. She corroborated the circumstances surrounding the accident and the nature and the extent of the initial injuries. She also testified as to the worker’s excellent character, ethics and workplace performance. She did not provide any comment with respect to the issue raised on appeal.

Analysis

The issue before the panel is whether or not the worker is entitled to benefits after June 2, 2014. For the worker’s appeal to be successful, the panel must find, on a balance of probabilities, that his ongoing medical issues are causally related to his compensable injuries and that he has not recovered from the effects of the December 7, 2013 workplace accident. We are not able to make that finding.

This was a very difficult case to decide. The panel does not question that the worker currently suffers from a number of symptoms which may be concussive in nature or that he is suffering from symptoms of bilateral vestibular hypofunction. The issue for the panel, however, is whether a causal relationship can be established between the symptoms currently experienced by the worker and the workplace accident.

With respect to post-concussion syndrome, the panel notes that in the initial period immediately following the workplace accident, the worker did not exhibit the usual range of symptoms associated with a concussion and he was not diagnosed with a concussion either by the Emergency Room physician or in the subsequent days and weeks by his treating physician. Although he was admitted to the hospital overnight on the day of the workplace accident, the admission was to monitor his blood pressure which was noted to be particularly high. His diagnosis at the time was “an uncomplicated 5 inch open wound” on the forehead and neck strain. The panel carefully reviewed the initial reports from the treating medical practitioners which noted no symptoms of immediate post-accident altered consciousness. Neurological exams, which would have included mental status examinations, were also normal.

Although in the days and weeks following the workplace accident the worker complained of light headedness and dizziness, such symptoms are not unique to a concussion. The symptoms could also have been related to hypertension, a condition with which the worker was diagnosed at about the same time as the workplace accident, from the treatment for hypertension, or alternately, from the neck strain which the worker experienced as a result of the workplace accident.

According to the January 17, 2014 memo from the WCB medical advisor, in order for there to be post-concussion syndrome, there must first be a diagnosis of concussion. In this case, it was her opinion that the evidence on the file did not support a concussion diagnosis in relation to the workplace accident. A subsequent review of the file by a WCB sports medicine consultant came to a similar conclusion. In his May 8, 2014 memo, he concludes that a concussion did not occur as a result of the workplace accident, and that the current presentation was unlikely a post-concussion syndrome.

While the neurologist’s report of July 10, 2014, did provide a diagnosis of concussion and supports a causal relationship between the workplace accident and post-concussion syndrome, the panel notes that the neurologist is basing his opinion on the assumption that the worker had exhibited symptoms of a concussion immediately following the accident. Based on all of the medical evidence before us, we do not find this to be, in fact, the case. In the circumstances, we accept the opinions of the WCB medical advisor and the WCB sports medicine consultant that a concussion did not occur as a result of the workplace accident.

With respect to bilateral vestibular hypofunction, once again, we do not question that the worker suffers or has been suffering from symptoms associated with the condition. The issue is whether it is causally related to the workplace accident. According to the November 19, 2014 examination notes of the WCB medical advisor, a blow to the head can cause vestibular symptoms in the absence of a concussion. For that to be the case, however, the vestibular symptoms and findings would have had to have been present immediately or shortly after the workplace trauma. In this case, the presence of such symptoms and findings were not documented. On the contrary, medical reports on file do not document vestibular symptoms or findings until months afterwards. The WCB medical advisor notes that the worker’s presentation and symptoms appear to have increased or grown worse with time which, in her opinion, would not be consistent with the development of bilateral vestibular hypofunction as a result of the blunt head trauma involved in the workplace accident. Based on our review of the evidence, we accept her conclusion.

Overall, while the panel has considerable sympathy for the worker’s situation, we are unable to find that there is sufficient evidence to support a conclusion, on a balance of probabilities, that the worker exhibited symptoms or signs of a concussion or bilateral vestibular hypofunction in the initial period following the workplace accident. Similarly, when considering the evidence as a whole, the panel is not satisfied on a balance of probabilities that post concussion syndrome is a compensable diagnosis resulting from the workplace accident of December 7, 2013. We are unable to find a causal relationship between the worker’s current diagnosis of vestibular hypofunction, or alternately post concussion syndrome, and the workplace accident. We therefore conclude that the worker is not entitled to wage loss and medical aid benefits beyond June 2, 2014 and the worker’s appeal is dismissed.