Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
DECISION NUMBER: 20090007
OBJECTION BY: Worker
EMPLOYER: Not Participating
HEARING DATE: N/A
ISSUE
The worker objects to the denial of entitlement to the medication Celebrex and Synvisc.
HOW THE ISSUE ARISES
On December 12, 2006, this rock truck driver was 49 years of age. On that date, he was operating the rock truck, and hit a bump. This made him slide forward in his seat, striking the steering column with his right knee.
He reported the incident immediately to his supervisor. The worker first sought medical attention on January 24, 2007. The initial diagnosis was traumatic tendonitis right knee. There was no lost time from work.
In September 2007, the worker contacted the claims adjudicator and requested entitlement to medication for his right knee. Noting the request was almost one year post accident, the claims adjudicator requested medical information from the treating physician prior to ruling on entitlement.
Upon receipt of the medical documentation in December 2007, the file was reviewed. It was noted that the worker had bilateral osteoarthritis in the knees. As well, his treating physician had prescribed Celebrex to the worker.
It was determined that the Celebrex prescribed was not related solely to the injury of December 12, 2006. Therefore, entitlement to medication Celebrex was denied. This decision was outlined in the letter dated April 3, 2008. This is the issue under objection.
AUTHORITY
Operational Policy #17-01-02, Entitlement to Health Care
RESOLUTION METHOD AND PROCESS
The objection was addressed through a file review of the documentation currently on file.
ASSESSMENT OF THE EVIDENCE
I have reviewed this claim in its entirety and the following is my assessment of the evidence on record.
The medication Celebrex is an anti-inflammatory-analgesic. This medication is used for relief of symptoms associated with osteoarthritis and adult rheumatoid arthritis. It is also used for short-term (less than 7 days) management of moderate to severe acute pain in adults for conditions of musculoskeletal and or soft tissue trauma including sprains, post-operative orthopaedic pain, and pain following dental extraction.
The worker’s injury occurred on December 12, 2006. The request for this medication was in September 2007, ten months post-accident. X-ray findings from April 2007 showed bilateral osteoarthritis being diagnostically proven. This is a degenerative process involving both knees, not just the right knee and unrelated to the compensable accident of December 12, 2006.
Following the initial right knee injury, the worker was seen by the treating physician on February 7, 2007. At that time the knee was reported to be better. In April 25, 2007, there was 100% full range of motion of the knee.
Based on the medical documentation on file, I find that the compensable right knee tendonitis had resolved and the ongoing symptoms to both knees related to the osteoarthritis. Therefore, the medication Celebrex was prescribed for the management of the osteoarthritis. As such, there is no entitlement for the medication Celebrex in this claim.
CONCLUSION
Entitlement to Celebrex is denied.
The worker’s objection is denied.
DATED May 27, 2009
M. St-Hilaire
Appeals Resolution Officer
Appeals Branch