The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that he is not entitled to further benefits in relation to the July 18, 2019 accident. A teleconference hearing was held on June 4, 2020 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to further benefits in relation to the July 18, 2019 accident.

Decision

The worker is not entitled to further benefits in relation to the July 18, 2019 accident.

Background

The worker filed a Worker Incident Report with the WCB on August 14, 2019 reporting that he injured his left knee in an incident at work on July 18, 2019. He described working underneath a boat when he became stuck and had to “…spin to get out. I twisted my leg and caused something to happen to [my] knee.” The worker reported the incident to his employer and an Employer’s Incident Report was provided to the WCB, also on August 14, 2019, confirming the mechanism of injury.

On August 19, 2019, the worker discussed his claim with a WCB adjudicator. He advised the adjudicator that he did not feel an immediate snap or pain when the workplace accident occurred. Further, the worker advised that he went on holidays shortly after the workplace accident, resting and elevating his leg while on holidays. Upon his return to work and resumption of his regular duties, his knee began to ache. The worker advised that he sought medical treatment on July 19, 2019. The physician thought the worker had arthritis in his knee and referred him for x-rays. He further advised that he would be following up with his family physician.

The WCB received the Doctor’s First Report for the worker’s July 19, 2019 assessment on August 26, 2019. The worker was diagnosed with a left knee strain after a normal examination by the physician who recorded the worker’s complaints of pain and stiffness in his left knee. The physician also made note that the worker did not disclose a workplace injury during the appointment. The x-ray report of the worker’s left knee from July 19, 2019 indicated possible trace joint effusion with no fracture identified. The worker attended for an appointment with his family physician on August 19, 2019. The treating physician noted the worker’s complaints of pain in his left knee, that was worse when hyperflexed and found the worker’s knee was not swollen, no bony abnormalities and the worker had full range of motion. He was diagnosed with a left knee strain and referred for chiropractic treatment. The worker’s claim was accepted by the WCB on October 3, 2019.

At the request of the worker’s treating chiropractor, the worker was referred for an MRI study of his left knee, which took place on November 2, 2019. The MRI indicated an oblique radial tear of the posterior horn of the medial meniscus and minimal degenerative chondromalacia. The worker attended for a follow-up appointment with his treating chiropractor on November 20, 2019 who reviewed the November 2, 2019 MRI and updated the diagnosis for a medial meniscus tear. The chiropractor noted on the report that the worker’s family physician had referred him to an orthopedic surgeon for a surgical consultation.

On December 4, 2019, a WCB medical advisor reviewed the worker’s file. The WCB medical advisor noted the worker’s current diagnosis of an oblique radial tear of the posterior horn of the left medial meniscus and chondromalacia of the patella and medial femoral condyle. It was opined that “A twisting injury of the bent and loaded knee would be expected to cause the medial meniscus tear. Alternatively, the meniscus tear may have been caused by repeated minor twisting injuries”. Further, the chondromalacia was noted to likely be degenerative in nature. The WCB medical advisor further provided that had the worker acutely injured his meniscus from the workplace accident on July 18, 2019, there would have been acute pain and immediate loss of function of his knee. As such, the WCB medical advisor opined that the worker’s current difficulties were not related to the workplace accident but instead were caused by the degenerative chondromalacia in his left knee. On December 5, 2019, the worker was advised that he was not entitled to further benefits as the WCB had determined his compensable injury to be a left knee sprain/strain that based on the natural history of, he was recovered from.

The WCB received a copy of the orthopedic surgeon’s report dated December 3, 2019. The orthopedic surgeon examined the worker and reviewed the MRI and recommended the worker undergo a arthroscopy surgery to repair the medial meniscus tear.

On December 27, 2019, the worker requested reconsideration of the WCB’s decision to Review Office. The worker noted in his request that his knee was fine before the incident on July 18, 2019, that he could barely walk after the workplace accident and now he is experiencing symptoms that his healthcare providers have determined to be related to the workplace accident.

Review Office determined on January 28, 2020 that the worker was not entitled to additional benefits. Review Office noted the medical evidence did not support the worker’s reporting that he could barely walk after the workplace accident. Review Office found that the worker attended for medical treatment the day following the workplace accident and the doctor reported that the worker had a normal examination, with no mention of a workplace accident. Further, a history of knee pain was noted which pre-dated the workplace accident. Review Office placed weight and relied on the WCB medical advisor’s opinion that had the worker sustained a meniscus tear at the time of the workplace accident, he would have been in acute pain, with swelling and inability to use his knee. Also, Review Office further found that if there was a relationship between the workplace accident and the worker’s knee difficulties, the worker would have reported a mechanism of injury involving a twisting motion. Review Office determined the worker’s difficulties relate to his pre-existing condition with no medical evidence to support he aggravated or enhanced that condition.

The worker filed an appeal with the Appeal Commission on February 10, 2020. A teleconference hearing was arranged for June 4, 2020.

Reasons

Applicable Legislation and Policy

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.

Subsection 4(1) of the Act provides that where a worker suffers personal injury by accident arising out of and in the course of employment, compensation shall be paid.

Subsection 4(2) provides that a worker who is injured in an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident, but no wage loss benefits are payable where the injury does not result in a loss of earning capacity during any period after the day on which the accident happens.

Subsection 27(1) of the Act provides that the WCB "…may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury resulting from an accident."

Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such time as the worker's loss of earning capacity ends, or the worker attains the age of 65 years.

The WCB's Board of Directors has established WCB Policy 44.10.20.10, Pre-existing Conditions (the "Policy"), which deals with issues involving pre-existing conditions. The Policy provides that:

The Workers Compensation Board (WCB) will not provide benefits for disablement resulting solely from the effects of worker's pre-existing condition as a pre-existing condition is not "personal injury by accident arising out of and in the course of employment." The WCB is only responsible for personal injury as a result of accidents that are determined to be arising out of and in the course of employment.

The following definitions are set out in the Policy:

Pre-existing condition: A pre-existing condition is a medical condition that existed prior to the compensable injury.

Aggravation: The temporary clinical effect of a compensable injury on a pre-existing condition such that the pre-existing condition will eventually return to its pre-accident state unaffected by the compensable injury.

Worker's Position

The worker was self-represented on the appeal held by teleconference. The worker made an oral presentation during the scheduled hearing and responded to questions from the panel members.

The worker’s position was that he is entitled to further benefits in relation to the July 18, 2019 accident.

The worker noted that his doctor made him aware of his MRI report that indicated a partial thickness degenerative chondral loss. The worker does not agree that this pre-existing condition has bearing on the decision to deny his claim.

The worker reports that his injury on July 18, 2019 was diagnosed as a sprain or strain by the doctor he saw on July 19, 2019. He accepted that diagnosis, went on vacation, and advised that he did not exert himself during that time. Upon return to work, the worker advised that his knee became aggravated as a result of working on concrete floors.

Prior to the July 18, 2019 injury, the worker submitted that he was able to walk on cement floors and climb stairs without pain.

The worker states that the opinion of two medical doctors supports his claim for benefits for the injury he sustained on July 18, 2019.

Employer's Position

The employer did not participate in the appeal.

Analysis

The issue before the panel is whether or not the worker is entitled to further benefits in relation to the July 18, 2019 accident. For the worker's appeal to be successful, the panel must find, on a balance of probabilities, that the worker suffered a loss of earning capacity and/or required further medical aid benefits as a result of his July 18, 2019 workplace accident. The panel is unable to make that finding, for the reasons that follow.

The worker has an accepted claim for a knee sprain/strain arising out of his July 18, 2019 workplace accident. This diagnosis was indicated by a medical professional on July 19, 2019. The first report indicates objective findings were normal. An x-ray image report from that day indicated “There is early tricompartmental joint spurring. The medial and lateral joint space compartments are fairly well maintained. There may be joint effusion. No fracture indicated.”

On a follow up visit on August 19, 2019 the findings indicated in part that the knee was not swollen, no bony abnormalities, full range of motion.

The September 12, 2019 progress report indicates that the knee was much better, and pain was intermittent, range of motion almost full.

The first indication of a change in diagnosis came as a result of the October 4, 2019 examination. A referral to the worker’s family physician and subsequent requisition for an MRI was made.

The MRI report indicated an oblique radial tear of the posterior horn of the medial meniscus near the posterior root. It also indicates the presence of a small amount of degenerative chondral loss at the weightbearing surface of the medial femoral condyle.

The panel questioned the worker in detail with respect to the workplace accident to better understand the mechanism of injury. The worker did not provide an indication of typical responses to a torn meniscus. While performing a repair on equipment in the workplace, the worker described a twisting motion he reported as the cause of injury. His initial reaction was that nothing felt out of the ordinary and he encountered no immediate snap or pain.

In addition, medical reports dated August 19th, August 23th and Sept 12th that indicate full or almost full range of motion, no swelling and reports of a normal exam provides the panel with medical evidence that does not support a meniscal tear caused by the workplace accident.

The panel places weight on the findings of the WCB medical advisor's review that took place on December 4, 2019. “If an acute meniscal injury had occurred on July 18, 2019, one would expect acute pain and loss of function of the knee.”

In conclusion, the panel finds, on a balance of probabilities, that the medical evidence supports that the worker suffered a sprain/strain from the workplace accident. The worker is not entitled to additional benefits in relation to the July 18, 2019 workplace accident.

The worker’s appeal is dismissed.

Panel Members

B. Hartley, Presiding Officer
P. Challoner, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

B. Hartley - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 7th day of July, 2020