The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that his ongoing hip condition was not related to his workplace injury and that he was not entitled to benefits after July 12, 2016. A hearing was held on October 25, 2017 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to benefits after July 12, 2016.

Decision

That the worker is entitled to benefits after July 12, 2016.

Background

On January 13, 2016, the worker reported that he injured his left hip and leg when he slipped on a piece of metal while going down steps. Immediately after the accident, the worker sought medical attention and was diagnosed with a hip strain. The claim for compensation was accepted and benefits were paid to the worker. On January 18, 2016, the worker was diagnosed with a lumbosacral sprain/strain and a left hip strain by the attending physiotherapist.

On February 19, 2016, the treating physician noted a change in diagnosis to sciatica.

On March 15, 2016, the worker underwent an MRI of the lumbosacral spine which identified a large diffuse bulging disc at L4-L5 that just contacts the L4 nerve root within the foramina. There was no nerve root compression or severe spinal stenosis present.

On May 9, 2016, the worker was seen by a sports medicine specialist who reported that the worker's low back and left leg pain was mostly due to degenerative disc disease (L4-5 level).

On June 24, 2016, the worker was seen at the WCB by a WCB orthopedic medical advisor. In a decision dated July 6, 2016, Compensation Services advised the worker that it was not able to accept ongoing responsibility for his workplace injury beyond July 12, 2016. The letter stated, in part:

Based on the examination, the Medical Advisor provided the opinion the diagnosis of the workplace injury was a back strain, which typically resolves in 6 - 8 weeks. The examination has not demonstrated any significant loss of lumbar spine range of motion, no tenderness in the midline ligaments and paravertebral musculature and no specific complaint of low back pain. In fact, the presentation is of left lower limb symptoms of a claudicating nature.

In a further letter to the worker dated July 27, 2016, the case manager stated:

I have reviewed the medical information you submitted which provided a diagnosis of lumbar spine disc disease. This diagnosis is not related to your workplace injury of January 2016. As such there is no change to my previous decision.

On September 13, 2016, the case manager advised the worker that:

I have reviewed the medical information you submitted…However the information doesn't include any objective medical evidence to support an ongoing relationship. There is no change to my previous decision. I am unable to accept ongoing responsibility as related to your injury of January 13, 2016.

On January 2, 2017, the worker submitted medical reports from a neurosurgeon dated November 10, 2016 and an occupational health physician dated December 21, 2016. On January 10, 2017, a WCB orthopedic medical advisor reviewed these reports and provided his opinion to the file.

On January 17, 2017, the worker was advised by Compensation Services that the new diagnosis provided by the occupational health physician was not accounted for in relation to the workplace injury of January 13, 2016. As such, no change will be made to the previous decision. On March 10, 2017, a worker advisor, acting on the worker's behalf, appealed the decision to Review Office.

On May 2, 2017, Review Office determined that the worker was not entitled to benefits beyond July 12, 2016.

Review Office indicated that it accepted the opinions of the other doctors involved in the worker's care who found that he suffered from a back injury over the one physician who found that the worker suffered a left hip and leg injury from which he had not recovered. Review Office accepted the WCB medical opinions on file dated June 15 and 24, 2016 and stated that these opinions on the nature of the worker's workplace injury are supported by the treating physicians who provided diagnoses indicating the worker had injured the lumbar area of his back. Review Office acknowledged the initial medical information queried a left hip strain. As the claim progressed, however, the medical information pertained to the worker's back. Review Office noted that the worker showed good progress in his recovery consistent with a strain type injury.

On May 5, 2017, the worker advisor appealed Review Office's decision to the Appeal Commission and an oral hearing 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 WCB's 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.

Subsection 27(1) provides that the WCB may provide the worker with such medical aid as the board considers necessary to cure and provide relief from a work injury.

Subsection 39(1) of the Act provides that wage loss benefits will be paid: “…where an injury to a worker results in a loss of earning capacity…” Subsection 39(2) of the Act 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.

The worker has an accepted claim for a workplace injury on January 13, 2016. He is appealing the WCB decision that he is not entitled to benefits after July 12, 2016.

Worker's Position

The worker was represented by a worker advisor. The worker answered questions posed by his representative and the panel.

The worker described the accident and provided a photo of the metal piece that he stepped on while descending the stairs on January 13, 2016.

He advised that he was walking down the stairs at a fast pace when he stepped on a small round piece of metal as he stepped onto the landing and rotated to the right. He said his right foot was on the last stair and his left leg went straight out in front of him as he held on to the railing awkwardly. He showed the panel photos of the metal piece that he stepped on. He said that he felt a sharp pain in his left hip and could not walk down any more stairs. He did not fall, but somehow was able to pull his left leg back. He had to stop work and attended a clinic. He said that he had no prior problem with his leg or hip.

The worker's representative submitted that:

In conclusion medical reports on file show [the worker] has experienced left sided difficulties since the January 13, 2016 injury for which he sought ongoing medical treatment. [Occupational health physician's] and [pain clinic physician's] clinical findings support [the worker] has been experiencing Myofascial Pain for which he has responded positively to treatment.

It is our opinion the medical information presented supports an association between [worker's] ongoing left sided difficulties and the January 13, 2016 compensation injury. Therefore [worker] should be entitled to benefits after July 12, 2016.

In the course of questioning, the worker advisor confirmed that the worker had recovered from the low back injury, and that her focus was on establishing that the original injury and the left hip/buttock was still affecting the worker at the time his benefits were terminated in July 2016.

Employer's Position

The employer did not participate in the appeal.

Analysis

The issue before the panel was whether the worker is entitled to benefits after July 12, 2016.

For the worker's appeal of this matter to be approved, the panel must find, on a balance of probabilities, that the worker continued to sustain a loss of earning capacity and required medical aid benefits after July 12, 2016, as a result of his 2016 workplace injury. The panel was able to make this finding.

The panel finds that as of July 12, 2016, the worker had not recovered from his workplace injury to the extent that he could return to his regular employment as a security officer. The panel finds, on a balance of probabilities, that the worker injured his left hip area, including the gluteus and piriformis muscles, when he slipped on a piece of metal while walking down stairs at work on January 13, 2016, and that there was continuity of symptoms and functional limitations in July 2016. 

In reaching this decision, the panel notes that throughout the claim, the worker consistently complained about pain in the left hip area. This is noted in the following correspondence and documentation:

• report of injury - the worker identified an injury to left hip and leg.

• Doctor's First report completed by his primary physician, dated January 13, 2016, indicated "tender to lateral hip and some restriction in flexion of low back and pain with trendelenberg…" and diagnosis of hip strain.

• Physiotherapist Initial Assessment, dated January 18, 2016, noted complaints of left hip/buttock and left post thigh complaints and provided a diagnosis of "L/S sprain/strain. L hip strain."

• Physiotherapy Progress Report indicated "Intermittent L buttock/hip pain which is aggravated by walking > one block" and left sided objective findings including "Palp-triggered glut and piri."

• Doctor's Progress Report dated February 8, 2016 which indicated subjective complaints of "pain to L. hip and worse with prolonged walking..."

• Pain Clinic physician report dated March 3, 2016 indicated that:

There is point tenderness to deep muscle palpation over the left quadratus lumborum muscle and the left iliotibial band. Deep palpation of these muscles does reproduce some of his pain that he experiences while walking. Dorsalis padis pulse is appreciated on the right side, but not on the left…

The differential diagnosis for this problem would include myofascial pain at the quadratus lumborum and iliotibial band at the top of the differential…

• Physiotherapist Application for Additional Treatment dated March 4, 2016 noted subjective complaints of intermittent L buttock/hip pain and provided objective findings related to the left side including "Palp. triggered glut."

• Physiotherapy Discharge Report dated March 24, 2016 noted objective findings related to the left side including painful hip and "Palp - painful L glut."

• WCB Orthopedic Consultant report dated June 24, 2016 noted: "Straight leg raising left was also permitted to 50 degree with complaint of pain in the left buttock and popliteal area." The consultant later noted on January 10, 2017 that "Examination findings did not identify any problems with the lumbar spine but significant abnormal tonicity of the left gluteal and thigh muscles with trigger points."

• Neurosurgeon's report dated November 10, 2016 noted complaints of:

"low back pain that he describes as an intense dull aching tightening sensation of the lumbosacral junction and upper gluteal region, left thigh with some occasional pain extending further distally to the left leg."

• Occupational health clinic physician's report noted:

"on my examination November 24, 2016 [worker's] main complaint was left leg pain with walking, especially upstairs in a pattern involving the posterior lateral thigh and buttock, with assosciated weakness as if it will give way…

By my review of the injury mechanics, his course post-injury, and clinical assessment, I do not think he sustained lumbar back strain or other injury related to his lumbar spine. In particular, there is no indication of radiculopathic pain."

The panel concurs with the occupational health physician's opinion that the injury was a left gluteal muscle injury. The worker's job as a security guard involved walking long distances and climbing stairs. The panel finds that the worker could not perform his employment duties when his claim was discontinued on July 12, 2016.

With respect to ongoing benefits, both wage loss and medical aid, the panel remits the claim to the WCB to adjudicate entitlement in light of this decision.

The worker's appeal is approved.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 1st day of November, 2017