The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that they are not entitled to further benefits in relation to their ongoing eye issues. A hearing was held on May 17, 2023 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to further benefits in relation to their ongoing eye issues.

Decision

The worker is entitled to further benefits in relation to their ongoing eye issues.

Background

The employer submitted an Employer Incident Report with the WCB on June 7, 2019 reporting the worker injured the back of their head, torso and arms in an incident at work on June 5, 2019 when the worker was assaulted by an unknown person. After the incident, the worker went to the site office, where a coworker called emergency services. The worker was taken by ambulance to a local emergency department, where the treating physician noted the worker was assaulted with blunt trauma and had swelling, bruising and tenderness over the left trapezius region with normal range of motion, lower back tenderness over the S1-S2 region bilaterally, more on the left than the right, a 2 cm laceration on the scalp above the left ear, scratch marks on the right forearm, bruising over medial surface of the right elbow, with tenderness, scratch marks on the left shoulder, left knee bruising and tenderness over lower femoral area, bruising over the right upper chest with mild tenderness and superficial abrasion over the left lumbar region and medial part of the abdomen on the left. X-rays taken that day did not identify any fractures, and a CT scan of the worker's brain indicated normal findings.

When the WCB contacted the worker on June 11, 2019, the worker confirmed the assault and advised they sought further medical treatment from their family physician on June 6, 2019 as they were unable to move. The worker advised the WCB they felt afraid to return to work and were waiting to speak to their family physician on June 17, 2019. The family physician's report relating to the June 6, 2019 appointment, noted the worker reported pain in their jaw, neck, head, right shoulder, right elbow, left knee, back and chest and indicated findings of lacerations and bruising.

At an initial physiotherapy assessment on June 21, 2019, the worker reported difficulty focusing, headaches, feeling tired all the time, pain when going from sitting to standing, and reduced mobility when bending, lifting, pushing, pulling, sitting and walking. The physiotherapist noted decreased mobility in the worker's right shoulder, left knee, ankle and lumbar spine and in addition, noted "concussion-like symptoms, antalgic gait" with the worker appearing to be "…in distress, voice and hands trembling". The physiotherapist queried a referral to a psychologist and diagnosed concussion-like symptoms, bilateral elbow contusion, right ankle contusion/sprain, left rib contusion, left knee medial meniscus tear vs. irritation, right shoulder strain and lumbar spine strain. On June 21, 2019, the worker was also assessed by an orthopedic specialist for back pain. The specialist noted the worker had multiple injuries, mostly contusions, a minor head injury, a right shoulder rotator cuff injury and muscular back pain in the lumbar spine.

The worker elected to claim WCB benefits and the WCB accepted the worker's claim, providing benefits as of July 29, 2019.

An MRI study of the worker’s right shoulder on September 24, 2019 indicated a minimal partial articular insertional tear in the infraspinatus and mild glenohumeral osteoarthritis. The orthopedic specialist reviewed the MRI results with the worker on September 27, 2019 and recommended the worker continue with conservative treatment such as physiotherapy after the worker advised they did not want an injection. The worker attended an appointment with a neurologist on October 3, 2019, who noted the worker's neurological findings were normal but referred the worker for a sleep study due to the sleep difficulties the worker was experiencing.

The worker attended a call-in examination with a WCB medical advisor on October 9, 2019. The medical advisor noted the worker sustained multiple lacerations and soft tissue injuries in the June 5, 2019 accident, which were resolved and did not require further treatment. The medical advisor further noted that the worker likely suffered a concussion and was experiencing persistent symptoms of same. They recommended treatment including counselling to prevent a second impact to their head and a graduated increase in activity with pain relief medication. The WCB medical advisor further recommended a graduated return to work program for the worker with restrictions noted.

When the WCB contacted the worker on October 30, 2019, the worker described neck pain, headaches, knee, and shoulder pain with improving arm pain and occasional back pain. The worker stated they felt they were getting better but that the headaches and "wooziness" were their biggest concern. The worker further noted the assault was recently reported in the local newspaper which had an impact on them and reported ongoing psychological difficulties. The WCB referred the worker for counselling. After the WCB provided the worker's restrictions to the employer on November 6, 2019, the employer advised they could accommodate the worker.

A physiotherapy discharge report received by the WCB on November 7, 2019 indicated the worker's recovery was not satisfactory due to ongoing concussion symptoms that limited the worker's ability to exercise and participate in rehabilitation. The physiotherapist noted the worker’s sensitivity to light and headaches and dizziness easily triggered by visual and auditory stimulation.

The worker attended an appointment with a psychologist on November 26, 2019. On assessment, the psychologist diagnosed post-traumatic stress disorder, noting "Hypervigilance and avoidance are prominent features of [the worker’s] presentation and are limiting [their] ability to fully participate in [their] usual activities, or approach the building where [the worker] works." The psychologist also noted physical limitations including "wooziness" and headaches, which they believed were, in part, a manifestation of the worker's psychological distress. A WCB psychological consultant reviewed the worker's file on December 21, 2019 and authorized additional sessions with the treating psychologist. The consultant noted the diagnosis of post-traumatic stress disorder was related to the workplace accident, and that the worker was not immediately ready to return to work, but that when the worker was ready, recommended restrictions of working in an alternative location with modified duties.

An MRI study of the worker’s cervical spine on December 20, 2019 indicated degenerative changes primarily on the right side.

On February 24, 2020, the worker requested the WCB cover physiotherapy for difficulties they were experiencing with their neck. A WCB medical advisor reviewed the worker's file, including the December 20, 2019 MRI, on February 25, 2020, noting the MRI indicated degenerative changes and as such, concluded there would be no change to the previous opinion that the worker did not require further treatment for their now-resolved soft tissue injuries resulting from the workplace accident. On March 19, 2020, the WCB provided a decision letter advising the worker was not entitled to coverage for physiotherapy or chiropractic treatment as it had determined no specific treatment was required for the lacerations, soft tissue injuries and contusions, which resolved without treatment.

The worker continued with treatment from the treating family physician and psychologist. A WCB psychological consultant reviewed the worker's file on May 8, 2020 and concluded the worker was not ready to return to work based on the diagnosis of post-traumatic stress disorder and the treating psychologist's reporting of the worker's depressed mood symptoms. The psychological consultant recommended use of a community facilitator to help the worker with community exposure and desensitization. On May 20, 2020, the WCB referred the worker for assessment at a rehabilitation clinic, with initial assessment taking place on June 11, 2020. The WCB psychological consultant reviewed reports from the rehabilitation clinic and the treating family physician and recommended extensions to the rehabilitation treatment, which the WCB granted.

On August 20, 2020, the worker advised the WCB that when they feel anxious, they experience a tightening in their neck and get a headache and they requested further physiotherapy treatment for those difficulties. On August 28, 2020, the worker attended a different physiotherapy clinic for initial assessment, reporting ongoing headaches and dizziness, with a low grade "hum" in their head and numbness in both arms. The physiotherapist noted decreased mobility in the worker's upper and lower cervical spine area and provided a diagnosis of mechanical cervical spine restrictions. A WCB medical advisor reviewed the worker's file and physiotherapy initial assessment on September 1, 2020 and concluded that the worker's neck pain was associated with anxiety and physiotherapy treatment would not help or treat that issue. The medical advisor did not recommend funding physiotherapy, and the WCB advised the worker they were not entitled to coverage for physiotherapy.

On August 28, 2020, a neurologist at the concussion clinic examined the worker and opined that the worker's headaches and ongoing symptoms were likely due to post-concussion syndrome. The neurologist recommended the worker start low impact aerobic exercise and vestibular physiotherapy for the intermittent vertigo and balance issues. The worker attended an initial assessment with the vestibular physiotherapist on December 18, 2020, reporting headaches, dizziness, blurred vision, and balance issues. On testing, the physiotherapist diagnosed "…post-concussion syndrome with a visual-vestibular mismatch."

The worker's file was again reviewed by a WCB medical advisor on January 5, 2021, who opined based on the medical information on file, that the worker recovered from the concussion sustained in the June 5, 2019 workplace accident and did not require further treatment or work restrictions. On January 6, 2021, the WCB provided the worker with a letter confirming it had determined the worker was recovered from the physical injuries, including the vestibular issues, resulting from the workplace accident and therefore the worker was not entitled to further benefits related to those injuries. The WCB noted the worker's continuing diagnosis of post-traumatic stress disorder.

On February 12, 2021, the WCB received the January 14, 2021 report from the treating neuro-ophthalmologist indicating diagnoses of dysfunctional tear (dry eye) syndrome and “left hypertropia indicating left 4th nerve palsy likely traumatic and from [the worker’s] concussion”.

On February 18, 2021, the WCB received a copy of the December 8, 2020 report from the worker's treating psychiatrist. The psychiatrist provided a detailed background of the worker's difficulties resulting from the June 5, 2019 workplace accident and added a diagnosis of Major Depressive Disorder, in addition to post-traumatic stress disorder and post-concussion syndrome, based on the worker's history of …"self-isolation, loss of enjoyment, decreased energy, excess fatigue, severe hypersomnia, decreased appetite and weight loss and suicidal ideation…". The worker's file was reviewed by a WCB psychological consultant on February 21, 2022, who agreed with the additional diagnosis of Major Depressive Disorder. In a further report received on February 22, 2021, the treating psychologist outlined the worker's treatment to date, and found no "…anticipated improvement in symptoms or function with treatment…" and further noted, "…we do not anticipate further significant improvement in symptoms or gain in function with current treatment." On reviewing the worker's file on February 25, 2021, a WCB psychiatric consultant noted the worker had over 40 sessions with their treating psychologist, along with occupational therapy for activation and exposure, and that the treating psychologist "…clearly indicated that no further improvement in [the worker's] mental health symptoms or function is expected as a result of continued treatment." As such, the WCB consultant opined that "Given the extensive psychotherapy and pharmacotherapy and lack of improvement in [the worker's] mental health symptom or function, [their] prognosis of recovery is poor. [The worker] is likely at maximum medical improvement."

The WCB advised the worker on April 6, 2021 that ongoing treatments with the occupational therapist and cognitive behavioural therapy arranged by their treating psychiatrist would be covered to May 14, 2021 after which time, their entitlement to ongoing benefits would end.

On April 16, 2021, the January 14, 2021 report from the worker's treating neuro-ophthalmologist was reviewed by a WCB neuro-ophthalmology consultant, who provided that neither of the two new diagnoses provided by the neuro-ophthalmologist were medically accounted for in relation to the June 5, 2019 workplace accident.

The WCB provided a letter to the worker on April 23, 2021, advising that there would be no change to the January 6, 2021 WCB decision there was no entitlement to further benefits as the worker's physical injuries had resolved. The worker requested reconsideration of the WCB's decisions to Review Office on June 6, 2022. In their submission, the worker noted they continued to suffer from the physical effects of the workplace accident including concussion, headaches, vision problems, hand tremors, sleep disorder and neck pain. In addition, the worker noted their post-traumatic stress disorder and depression were still affecting them. The worker advised their treating healthcare providers were of the view that the worker required further benefits in relation to both their physical and psychological difficulties arising out of the workplace accident. On July 20, 2022, the employer provided a submission in support of the WCB's decisions to Review Office, a copy of which was provided to the worker on July 21, 2022. A response was provided by the worker to Review Office on September 2, 2022.

On October 26, 2022, Review Office determined the worker was not entitled to further benefits in relation to their physical and/or psychological injuries. Review Office concluded, based on the medical evidence and opinions, that further psychological treatment was unlikely to provide any longstanding benefit to the worker's mental health and function. Furthermore, Review Office found that the worker was recovered from the physical injuries they sustained at the time of the June 5, 2019 workplace accident.

The worker's representative filed an appeal with the Appeal Commission on January 26, 2023 and a hearing was arranged.

Reasons

Applicable Legislation

The Appeal Commission and its panels are bound by the provisions of The Workers Compensation Act, regulations under the Act and the policies established by the WCB's Board of Directors. The provisions of the Act and WCB policies in effect as of the date of the worker’s accident are applicable.

A worker is entitled to benefits under s 4(1) of the Act when it is established that a worker has been injured as a result of an accident at work. Under s 4(2), a worker 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.

When the WCB determines that a worker has sustained a loss of earning capacity, an impairment or requires medical aid because of an accident, compensation is payable under s 37 of the Act. Section 39(2) of the Act sets out that wage loss benefits are payable until the worker's loss of earning capacity ends or the worker attains the age of 65 years. Section 27 of the Act allows the WCB to provide medical aid “as the board considers necessary to cure and provide relief from an injury resulting from an accident.”

Worker’s Position

The worker appeared in the hearing represented by a worker advisor. The worker advisor made an oral submission on behalf of the worker, and the worker provided testimony in response to questions posed to them by the worker advisor and by members of the appeal panel.

The worker advisor confirmed in their submission that they wished to limit their appeal only to the worker’s entitlement to further benefits in relation to their ongoing eye issues, and that the worker specifically reserved their right of appeal in relation to the other entitlements and issues arising from the October 26, 2022 decision of Review Office.

The worker’s position is that the worker’s double vision or diplopia, blurred vision and headaches arose out of the injuries sustained in the compensable workplace accident of June 5, 2019 and that the evidence confirms that the worker continued to experience symptoms related to these eye conditions beyond January 6, 2021 when the WCB determined that they were recovered from the physical injuries sustained in that accident. Therefore, the worker should be entitled to further benefits in relation to their ongoing eye issues.

The worker advisor outlined the evidence that supports the worker’s position and noted the absence of evidence of any pre-existing diagnosis or symptoms related to fourth nerve palsy, double vision or dry eyes. The worker advisor referenced a medical article submitted in advance of the hearing as confirmation that injury to the fourth cranial nerve can cause the superior oblique muscle to be paralyzed, which commonly results in double vision, and that the most common cause of fourth nerve palsy in adults is trauma by whiplash or concussion. The worker advisor clarified that their position is that this condition was either a primary injury or secondary condition arising from the concussion. They further submitted that there is no evidence from any of the treating specialists to support the opinion of the WCB neuro-ophthalmologist that the worker’s dry eyes were age-related and not related to the compensable workplace accident.

The worker advisor noted the worker was not assessed in relation to their double vision until seen by a neuro-ophthalmologist, on referral from the neurologist. The worker advisor noted that the WCB medical advisor recorded the worker’s report of double vision when looking to the left or downward, in the October 9, 2019 call-in examination, but the medical advisor did not assess the worker in relation to that complaint. The treating neurologist, on September 25, 2020 also noted the worker’s double vision issues. The December 18, 2020 vestibular physiotherapy report also identified that certain testing resulted in double vision and the physiotherapist noted that this should be discussed with the neurologist. The worker was assessed by the neuro-ophthalmologist who diagnosed dysfunctional tear syndrome, which they related to the accident, and left hypertropia, indicating that the fourth nerve palsy was likely traumatic and arising from the concussion sustained.

The worker advisor indicated that the worker disagreed with the April 16, 2021 opinion of the WCB neuro-ophthalmology consultant that the reports of the treating neurologist and treating neuro-ophthalmologist were “discordant” and further noted that there is no evidence outlined by the WCB neuro-ophthalmology consultant to support their opinion that the worker’s mechanism of injury does not support the diagnosis of traumatic nerve palsy. The worker advisor noted that the treating neuro-ophthalmologist also disputed the opinion of the WCB neuro-ophthalmologist, noting the absence of any discrepancies between the referenced reports of the treating neurologist and treating neuro-ophthalmologist and confirmed their diagnosis and that the worker did not have symptoms of either condition prior to the workplace injury.

The worker advisor further noted that the treating medical professionals are aware of the worker’s double vision and have not determined that this represents a safety concern in terms of the worker’s driving, and that the fact that the worker is able to drive is not relevant to the question of whether the worker’s condition is related to the workplace accident.

The worker testified in response to questions posed by their representative that prior to this workplace injury, they had some issues of blurred vision but otherwise their eyes were fine. The worker confirmed that they did not have double vision before the accident, but afterward they noted double vision, blurred vision and headaches from their eyes. The worker stated that they first noticed double vision when they went for physiotherapy and recalled mentioning this to the treating physiotherapist. The worker described experiencing double vision symptoms when they look to the left or to the right and that they have learned strategies to deal with these symptoms from their treating neuro-ophthalmologist. The worker noted that their double vision does not affect them when driving because they turn their head fully to look to the right or left when driving and the symptoms only occur when looking to either side out of the corner of their eye.

In response to questions posed by members of the appeal panel, the worker confirmed that they were involved in a motor vehicle accident in approximately May 2022 which resulted in damage to their vehicle and “some sore muscles in the back” which were treated with physical therapy. The worker further confirmed that they manage their eye symptoms using the strategies recommended by the treating neuro-ophthalmologist, including use of a humidifier, blinking exercises, warm compression, and use of an eye gel. The worker testified that they continue to experience post-concussion symptoms, including headaches. They noted that they believe that their double vision first developed immediately after they were injured, but that because of all the other symptoms and injuries, it wasn’t initially noted but that they recall noticing double vision when they went for physiotherapy at the outset of the claim.

In sum, the worker’s position is that the evidence supports a finding that their eye issues including double vision resulting from fourth nerve palsy and dry eyes, are more likely than not the result of the traumatic head injury causing concussion, which was sustained in the workplace accident and as such are compensable injuries, which were not resolved and required further treatment beyond the date when the WCB determined the worker was no longer entitled to benefits in relation to the workplace accident. Therefore, the worker’s appeal should be granted.

Employer’s Position

The employer was represented in the hearing by its workers compensation coordinator who made a submission on behalf of the employer. The employer’s representative confirmed that the employer did not dispute the limitation of the question on appeal as proposed by the worker’s representative to dealing only with entitlement to further benefits in relation to the worker’s ongoing eye issues.

The employer’s position, as outlined in the representative’s submissions, is that the evidence supports the WCB’s determination that the worker was recovered from the physical injuries sustained in the workplace accident and that the worker’s ongoing eye issues are not related to the workplace injury of June 5, 2019.

The employer’s representative provided a chronological summary of the claim, noting that the WCB medical advisor found in their 2019 examination of the worker that they were recovered from their various physical injuries at that time, and that the first mention of left eye difficulties was not made until several months post-injury.

The employer’s representative relied on the April 16, 2021 opinion of the WCB neuro-ophthalmology consultant that the diagnosis of left fourth nerve palsy as the cause of the left hypertropia is not supported by the documented clinical findings of the treating neuro-ophthalmologist from January 14, 2021. The employer’s representative also noted that the worker’s dry eye symptoms are accounted for in relation to the worker's age rather than in relation to the workplace injury.

The employer’s representative also queried whether the worker sustained their injuries in a motor vehicle accident, noting a number of references to the worker having been involved in such an event within the file documents.

In sum, the employer’s position is that the weight of the evidence supports a finding that the worker’s ongoing eye issues are not related to the June 5, 2019 workplace injury and therefore, the worker’s appeal should be dismissed.

Analysis

The question for the panel to determine in this appeal is, as narrowed by the worker in their submissions, whether the worker is entitled to further benefits in relation to their ongoing eye issues. For the worker’s appeal to be successful, the panel would have to determine that as a result of the injuries sustained in the workplace accident of June 5, 2019, the worker developed eye conditions which they continue to experience and for which the worker requires medical aid or as a result of which the worker has experienced a loss of earning capacity. As detailed in the reasons that follow, the panel was able to make such a finding and therefore the worker’s appeal is granted.

In considering the evidence before us, the panel noted that the worker experienced blurred vision prior to the workplace accident and reported blurred vision following the accident; however, we also note the evidence that the worker subsequently also experienced double vision and what they described as headaches from their eye. The worker testified that they first noted double vision during their initial physiotherapy treatments, post-injury, and the panel noted that the initial physiotherapy took place from September 3 – October 3, 2019. The panel also noted that when the worker was discharged from physiotherapy as of November 7, 2019, the physiotherapist recorded that the worker had ongoing “concussion symptoms, sensitivity to light, headaches, dizziness” which symptoms were “aggravated with visual and audio stimulation”, but the report does not specifically reference any double vision or dry eye symptoms. 

On initial assessment by the treating neurologist on October 3, 2019, the worker reported visual symptoms of “short lasting blurry vision” and an inability to watch spinning objects or tennis. The neurologist recorded findings of 20/20 visual acuity in both eyes without correction, intact visual field, normal fundoscopy, full EOM (extraocular muscle function), no nystagmus and no INO (internuclear ophthalmoplegia). The panel also considered the evidence from the WCB call-in examination of the worker of October 9, 2019. At that time the worker reported they experience double vision if looking to the left or downward and noted their physiotherapy included eye exercises. There is no indication in the examination notes of any specific testing in relation to the worker’s double vision although the panel noted that the medical advisor indicated “Cranial nerves II-XII were normal.”

The panel noted similar visual findings on September 25, 2020 when the worker was assessed by a concussion clinic neurologist, who recorded findings of normal fundoscopy, full extraocular movements, no nystagmus, smooth pursuit, and normal saccades, but also noted “left hypertropia with worsening with right gaze”. At that time the worker reported symptoms including diplopia that is “binocular vertical worse with left gaze” and “worse with looking close” as well as photophobia and intermittent blurred vision. The panel noted that the neurologist’s findings of left hypertropia worsened with right gaze, as well as the other clinical findings, were confirmed by the neuro-ophthalmologist on January 14, 2021. The neuro-ophthalmologist noted their clinical impressions as follows:

1. Dysfunctional tear (dry eye) syndrome, I discussed the pathophysiology of the disease with the patient, Concussion, Post-concussion syndrome and occipital neuralgia 

2. Left hypertropia indicating left 4th nerve palsy likely traumatic and from [their] concussion. 

The panel also considered the April 16, 2021 opinion provided by WCB neuro-ophthalmologist consultant who reviewed the worker’s file including the opinion of the treating neuro-ophthalmologist. The panel considered the WCB consultant’s concern that the worker’s report of their diplopia to the treating neurologist on September 25, 2020 and to the treating neuro-ophthalmologist of January 14, 2021 are “not concordant and…in fact irreconcilable” but noted that the two specialists assessed the worker for different purposes and may have therefore asked different questions leading to discrepant answers. Further, the panel considered that the noted discrepancy is based on the worker’s subjective reports, but the WCB neuro-ophthalmologist did not highlight any difference in the clinical findings reported by the treating specialists. The panel further noted the WCB consultant’s conclusion that:

“The diagnosis of a traumatic left 4th nerve palsy as the cause of the left hypertropia is not supported by the clinical findings documents in the…report dated January 14, 2021. Hypertropia has many causes. The metrics described in the same…report are insufficient to diagnose a left 4th cranial nerve palsy. In addition, the mechanism of injury…does not support the diagnosis of a traumatic 4th nerve palsy.”

Although the WCB neuro-ophthalmology consultant went on to conclude the diagnosis was not supported, and that the worker’s dry eye was also not accounted for in relation to the workplace accident but the result of the worker’s age, the panel noted that the WCB consultant did not note an evidentiary basis for either conclusion. The WCB consultant found the clinical findings did not support the diagnosis of traumatic left 4th nerve palsy but did not outline what specific clinical findings or evidence was missing or not in support of the diagnosis. Further, the WCB consultant also did not detail the evidentiary basis for their conclusion that the worker’s dry eye was age related and not related to the workplace injury.

The panel further considered the May 26, 2021 report and opinion of the treating neuro-ophthalmologist who indicated “…there is literature supporting the fact that dry eye syndrome can be caused by head trauma and concussion. Given that [the worker] was asymptomatic before the accident, the cause or trigger of [their] dry eye is likely [their] concussion.” The neuro-ophthalmologist went on to confirm that the clinical findings supported a diagnosis of 4th nerve palsy “likely traumatic and from [the worker’s] concussion” noting that the worker did not have any double vision prior to the accident and brain imaging did not reveal any other cause for the left 4th nerve palsy; therefore, “the cause of [the] left 4th nerve palsy in my opinion is the head trauma and concussion.” The neuro-ophthalmologist also expressed disagreement with the WCB consultant’s opinion that there was any discrepancy between the findings of the neurologist and the neuro-ophthalmologist.

The panel acknowledges that the conclusions of the treating neuro-ophthalmologist and the WCB consulting neuro-ophthalmologist diverge in relation to the causation of the diagnoses of dry eye and 4th nerve palsy and specifically, the relationship between those diagnoses and the injuries sustained in the workplace accident. Taking into account that the worker’s symptoms were first reported within a few months of the injury and the possible causal relationship between these diagnoses and a diagnosis of concussion, which the WCB accepted as compensable, as well as the additional opinion provided by the treating neuro-ophthalmologist on May 26, 2021, the panel is satisfied that the worker’s eye issues as identified in the January 14, 2021 report more likely than not are causally related to the compensable workplace injury sustained on June 5, 2019. Where there is a divergence in the medical opinions provided in respect of the worker’s eye issues, we prefer and rely upon the opinions of the treating professional who examined and provided direct treatment to the worker.

The panel noted that the treating neuro-ophthalmologist also made a number of treatment recommendations to the worker in their January 14, 2021 and May 26, 2021 reports and that the worker testified to following up on those recommendations as they are able to do so. The panel accepts and relies upon those treatment recommendations as supporting a finding that further medical aid is required to provide relief from the worker’s eye conditions and, given our finding that those issues can be causally related to the compensable workplace injury, find that the worker is entitled to benefits in relation to their eye issues, the nature and scope of which is yet to be determined and adjudicated by the WCB.

On the basis of the evidence before the panel, and on the standard of a balance of probabilities, we are satisfied that the worker is entitled to further benefits in relation to their ongoing eye issues. Therefore, the worker’s appeal is granted.

Panel Members

K. Dyck, Presiding Officer
J. Peterson, Commissioner
S. Briscoe, Commissioner

Recording Secretary, J. Lee

K. Dyck - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 8th day of June, 2023