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. A hearing was held on February 3, 2026 to consider the worker's appeal.

Issue

Whether or not the worker is entitled to further benefits.

Decision

The worker is not entitled to further benefits.

Background

The worker has an accepted WCB claim for an injury to their right knee that occurred when they slipped on ice at work on April 21, 2023. The claim was initially accepted as a right knee sprain but after an MRI study on August 15, 2023 indicated chondromalacia of the patella, a horizontal tear of the posterior horn/body of the medial meniscus and a short oblique tear of the anterior horn lateral meniscus, the worker’s diagnosis was updated to be a right medial meniscus tear. The other conditions noted on the MRI, including the chondromalacia and the horizontal tear, were determined to be pre-existing and were not accepted by the WCB.

The worker’s treating healthcare providers did not find the worker’s injury required surgery and the worker was conservatively treated with physiotherapy. A July 19, 2023 progress report from the worker’s treating physiotherapist noted the worker’s complaints were that the medial aspect of their right knee was still tender and uncomfortable, with getting up from a squat position and twisting their leg described as difficult and painful. After examining the worker, the physiotherapist indicated the worker had full, pain free range of motion in their knee, with tenderness noted on palpitation over the medial joint line. It was recommended that the worker could return to their full regular duties. The worker missed time from work due to medical appointments and ongoing symptoms but was cleared to return to their regular duties by their treating physician on March 4, 2024.

On January 16, 2025, the WCB received a copy of a report from the worker's treating physician. The report noted the worker's complaints of intermittent swelling to their right knee, with no locking or buckling reported. After examining the worker, the treating physician found a small effusion and some mild suprapatellar edema to the worker's right knee. The physician recommended continued use of a brace while at work, continued physiotherapy and use of a Tensor bandage when the knee was swollen. The physician also placed the worker off work until January 26, 2025, noting they could return to their regular duties on January 27, 2025. The worker attended for a follow-up appointment on February 21, 2025 with their physician reporting a recent minor setback with their right knee starting to swell with no new injury or trauma, and which swelling was self-treated with rest and ice. The physician noted there was no effusion to the worker's right knee, with a small area of suprapatellar edema noted. Normal range of motion and a negative McMurray's test was also noted. The physician again recommended the worker wear a brace while at work and continue with low impact exercises as tolerated. A full return to work was recommended for February 24, 2025.

The worker's file was reviewed by a WCB medical advisor on March 19, 2025. The advisor provided that symptoms of a flare-up of the worker's medial meniscus tear would include medial joint line tenderness and a positive McMurray's test, and noted that the January 16, 2025 report from the worker's treating physician indicated there was no joint line tenderness and the February 20, 2025 report noted the right knee range of motion was intact with no joint line tenderness and McMurray's testing was noted to be negative. As such, the WCB medical advisor opined that the medical evidence did not support the worker's current difficulties were related to the compensable medial meniscus tear. The advisor also provided that patellar chondromalacia could be the cause of intermittent pain and swelling found on the January 16, 2025 and February 20, 2025 medical reports. On April 5, 2025, the WCB provided the worker with a decision letter advising the medical evidence did not support that their right knee difficulties in January and February 2025 were related to the April 21, 2023 workplace accident.

On May 6, 2025, the WCB contacted the worker to discuss their claim. The worker advised the WCB that on April 25, 2025, while walking at their job site, they started to experience swelling in their leg after walking on and off all that day. They noted they did not do much on April 26, 2025 and April 27, 2025 and by April 28, 2025, their knee was so swollen they could not put on their brace. The worker advised they stopped working on April 28, 2025. The worker sought treatment from their chiropractor on May 1, 2025 and was provided with laser treatment. The WCB received a copy of the initial assessment on May 26, 2025 by the worker's treating chiropractor. The worker reported anterior, lateral and meniscal swelling on their right knee, tenderness and painful to the touch and decreased mobility and motion in their right knee to the chiropractor. The chiropractor noted a positive O'Donoghue's test in the medial meniscus and medial collateral ligament areas and indicated the worker could return to their regular duties on May 27, 2025.

The worker's WCB case manager requested an opinion by a WCB orthopedic specialist on June 9, 2025. On June 14, 2025, the WCB orthopedic specialist noted the information on the report from the worker's treating chiropractor was not clear and requested the WCB obtain the chiropractor's chart notes for clarity. The chart notes were received and were reviewed by a WCB chiropractic consultant on July 18, 2025. The consultant provided the report from the worker's treating chiropractor supported a clinical diagnosis of non-specific medial right knee pain, but a more specific diagnosis could not be made based on the information. A further request for an orthopedic opinion was made by the worker's case manager on July 22, 2025, with the orthopedic specialist requesting the case manager obtain chart notes from the worker's treating physiotherapist. After reviewing the chart notes, the WCB orthopedic specialist opined on August 6, 2025, the medical information supported the worker's reported right knee symptoms were related to a diagnosis of right knee arthritis rather than the accepted medial meniscus tear as the physiotherapist report made no mention of any pain to the medial aspect of the worker's right knee. On August 25, 2025, the WCB advised the worker, in a formal decision letter, that they were not entitled to further benefits as it had been determined their current knee difficulties were not related to the April 21, 2023 workplace accident.

The worker requested reconsideration of the WCB’s decision to the Review Office on September 3, 2025. In their submission, the worker noted they had made complaints to their treating healthcare providers of ongoing pain to the inside of their right knee and those providers noted they had arthritis, but it was the tear in the meniscus that continued to be the issue. The worker further noted they had been working reduced hours due to their difficulties and would be returning to full duties on September 8, 2025. The Review Office determined on September 11, 2025 that the worker was not entitled to further benefits. The Review Office accepted and agreed with the opinion of the WCB orthopedic specialist that the worker’s current right knee difficulties were related to their pre-existing degenerative arthritis and not the accepted compensable injury.

The worker filed an appeal with the Appeal Commission on November 4, 2025, and a hearing was arranged.

Reasons

Applicable Legislation and Policy

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

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

The WCB has established Policy 44.10.20.10, Pre-existing Conditions (the "Policy"), which addresses eligibility for compensation in circumstances where a worker has a pre-existing condition. The Policy defines a pre-existing condition as any medical condition the worker had prior to their workplace injury, and notes that pre-existing conditions may contribute to the severity of a workplace injury or significantly prolong a worker's recovery. It is further noted that workplace injuries can impact pre-existing conditions.

A temporary worsening of a worker’s pre-existing condition is considered an aggravation of the pre-existing condition and a permanent worsening of the worker’s condition because of a workplace injury is an enhancement of the pre-existing condition.

The Policy provides that wage loss benefits will cease when a worker has recovered to the point that the injury is no longer contributing to a material degree, to the worker's loss of earning capacity, and the pre-existing condition is not a compensable condition.

Worker’s Position

The worker was present at the hearing and provided an oral submission to the panel. The worker also provided evidence by answering questions posed by members of the panel.

The worker’s position was that they did not have any issues with their knee prior to the workplace accident.

The worker’s evidence is that their treating physician indicated it was their meniscus that was the concern and what was causing the swelling they were experiencing. The worker states that their physician noted to them that the arthritis was not causing the swelling.

The worker stated that their injury took time to heal and their knee is only now getting better.

The worker states that they are entitled to further benefits as they had not recovered from their workplace accident. 

Employer’s Position

The employer did not participate in the hearing.

Analysis

The issue before the panel is whether the worker is entitled to further benefits in relation to their April 21, 2023 workplace accident. In doing so, the panel must decide whether it is more likely than not that the worker’s ongoing right knee difficulties are causally related to the compensable injury.

The evidence is that the worker sustained a compensable injury on April 21, 2023, diagnosed as a right medial meniscus tear. The evidence also establishes that the worker had pre-existing degenerative conditions in the right knee, including chondromalacia and arthritic changes, which were not accepted as part of the claim. The central issue, therefore, is whether the worker’s ongoing symptoms beyond early 2025 are attributable to the compensable meniscus tear or to the pre-existing, non-compensable conditions.

The panel has carefully considered the medical evidence on file, including reports from the worker’s treating healthcare providers and opinions from WCB medical consultants.

Following the initial injury, the worker received conservative treatment and demonstrated functional improvement. Notably, the July 19, 2023 physiotherapy report documented full, pain-free range of motion, with only localized tenderness. At that time, the worker was considered capable of returning to full duties. This evidence suggests a significant recovery from the compensable injury.

Further, by March 4, 2024, the worker’s treating physician cleared them to return to regular work duties. This supports a finding that, on a balance of probabilities, the compensable meniscus tear had largely resolved or was no longer causing significant functional impairment by that time.

The panel places significant weight on the clinical findings from early 2025. The January 16, 2025 and February 21, 2025 medical reports document intermittent swelling but do not identify key findings typically associated with an active meniscal injury, such as medial joint line tenderness or a positive McMurray’s test. Instead, the findings showed the worker had normal range of motion.

The WCB medical advisor opined that the absence of these key findings does not support a flare-up or ongoing pathology related to the compensable medial meniscus tear. The panel finds this opinion to be consistent with the clinical evidence and assigns it considerable weight.

In contrast, the worker’s reported symptoms of intermittent swelling and discomfort are more consistent with degenerative conditions such as chondromalacia or osteoarthritis. This is supported by the WCB medical advisor’s opinion and later by the WCB orthopedic specialist, who concluded that the worker’s ongoing difficulties were more likely related to right knee arthritis.

The panel also considered the chiropractic evidence from May 2025, which noted a positive O’Donoghue’s test and symptoms affecting multiple areas of the knee. However, subsequent review by the WCB chiropractic consultant found that the findings supported only a diagnosis of non-specific medial knee pain and did not establish a clear link to the compensable meniscus tear. Additionally, the WCB orthopedic specialist ultimately concluded that the overall medical evidence did not support ongoing meniscal pathology and instead pointed to degenerative arthritis.

The panel acknowledges the worker’s position that their ongoing symptoms relate to the compensable injury. However, greater weight is placed on the medical findings and expert opinions, which consistently indicate that the worker’s current difficulties are more likely attributable to their pre-existing degenerative condition rather than the workplace injury.

The panel also notes that the worker experienced intermittent flare-ups without any new workplace accident or specific mechanism of injury. These episodes, including the April 2025 increase in symptoms, occurred in the context of normal activities and are more consistent with the natural progression of a degenerative condition.

On a balance of probabilities, the panel finds that the compensable right medial meniscus tear had resolved to the point where it was no longer contributing to the worker’s ongoing symptoms by early 2025. The worker’s current right knee difficulties are more likely related to their pre-existing degenerative arthritis, which is not compensable.

Accordingly, the panel finds that the worker is not entitled to further benefits.

Panel Members

R. Lemieux Howard, Presiding Officer
J. Peterson, Commissioner
M. Kernaghan, Commissioner

Recording Secretary, J. Lee

R. Lemieux Howard - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 2nd day of April, 2026