Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20100092
Objection By: Worker
Employer: Not Participating
Hearing Date: May 20, 2010
Participants: Worker, Worker’s Representative, Observer
Issues
The worker objects to the:
reduction in loss of earnings (LOE) benefits to partial LOE benefits as of September 23, 2009.
denial of entitlement to high blood pressure as a condition in this claim.
The decision letters are dated October 27, 2009 and December 4, 2009.
How the Issues Arose
On June 25, 2002, the worker was injured while he was a passenger in his employer’s van.
Entitlement was accepted in this claim with the Workplace Safety and Insurance Appeals Tribunal (WSIAT) Decision 777/07 where the worker was determined to be a worker at the time of the accident and his right to sue his employer was barred. Following the WSIAT decision, entitlement was accepted for the worker’s neck injury in this claim.
The worker was scheduled to participate in a Functional Restoration Program (FRP) in September 2009 but could not due to his uncontrolled high blood pressure. The worker’s high blood pressure was determined to be non-compensable and the worker could not participate in the FRP. As a result, the worker’s full LOE benefit entitlement was adjusted to partial LOE benefits in September 2009.
The worker objects to the denial of high blood pressure entitlement in this claim and to the reduction of benefits to partial LOE benefits.
Authority
Operational Policy Documents:
15-05-01 – Secondary Condition Resulting from Work-Related Disability;
15-05-04 – Secondary Condition – Non-Work-Related Condition – Reduction or Suspension of Benefits.
Assessment of the Evidence
In arriving at a decision in this claim, the worker’s testimony and the worker representative’s information were reviewed and considered with the file evidence.
The worker claimed that the condition of high blood pressure was related to this claim, related to the stress of the claim and his dealings in the claim.
A worker’s level of compensation may be affected by the presence of a non‑work‑related condition.
If any non‑work-related condition is preventing a worker from undergoing treatment for a work‑related injury, compensation benefits may be reduced or suspended until the worker is available for the treatment of the work-related injury.
The worker claims that his high blood pressure (HBP) developed due to increased stress related to the claim circumstances. The worker denied any prior history of HBP or stress issues. Recently, as indicated in the November 9, 2009 report from his family physician, the worker was referred for assessment by a cardiologist and the report has been received.
The medical reports submitted since September 2009 note the following information:
November 9, 2009 – The family physician stated “ Mr Gherman developed HBP recently- most likely due to increased stress”. There was no indication as to what recently caused the worker’s increased stress.
January 28, 2010 report – the worker was assessed in November 2009 with no evidence of infarction but he was diagnosed with reactive hypertension and high blood pressure.
February 12, 2010 Pain clinic report – the worker was seen for cervical pain to both shoulder, cervical pain to the occipital area, chronic neuralgia, occipital nerves, burning pain in the upper thoracic, depressive symptoms, post-traumatic stress disorder (PTSD), nightmares and it was indicated that the worker is not suited for labour market re-entry (LMR) or for FRP. In this medical report there were no physical findings to provide information as to why he was not suited for LMR or for the FRP.
The worker’s pre accident medical reports submitted to file indicate that the worker was previously, prior to his accident, seen by his family physician in 2000. At that time a hiatus hernia was indicated, the worker had had eye surgery in the past and the worker had a two year history of abdominal pain from approximately 1998 with the physician speculating that the condition may have been irritable bowel syndrome. The worker was stressed, he had lost his job and was on Employment Insurance (EI) benefits. The doctor commented that the stresses experienced may have something to do with the abdominal pain.
The pre accident medical confirms stomach medication was given and the worker was diagnosed with chronic GERD, then had vague rectal symptoms, had a previous fractured hand, two surgeries to the left eye, Hepatitis A, Hiatus Hernia, low and mid back pain issues. The family history as compiled in the file evidence also indicated that the worker’s mother died of a myocardial infarction.
The clinical notes in September 2000 indicated the abdominal pain was worse and the worker was also experiencing family stresses, tension and the worker’s mother was sick in Romania.
The medical report dated February 21, 2008 from Dr. Mayer (Neurologist) noted the assessment showed submaximal effort on the worker’s part, inconsistent responses and functional overlay was noted.
The worker attended a Functional Restoration Initial Assessment Program. At the time he was noted to have uncontrolled high blood pressure. This was the first medical indication of HBP.
The FRP report received in this claim provided the history of the worker emmigrating to Canada from Romania in 1995. The worker indicated he had little support, was pessimistic and fatalistic in nature. He was able to dress and conduct activities of daily living. He continued to drive a car; however, it was difficult to turn. He was able to sit for 30 to 60 minutes and walk for 30 minutes.
The worker, through his testimony:
denied any pre- accident stress issues,
claims severe damage related to the MVA accident with ongoing pain in his head, shoulders, neck, upper arms and thoracic spine,
relates the HBP solely to the MVA and the resulting neck injury and to nothing else. He states that it developed due to his compensable condition,
claims an inability to work or attend and participate in the FRP,
states that all of his physicians concur that he cannot participate in the FRP
The worker representative stated that the worker’s stress resulted from his serious neck injury and the lack of Canadian medical treatment available to him necessitating that he seek treatment out of the country. This treatment, although improved his overall daily functioning ability, it did not cure him. He maintains that the worker is unemployable due to the MVA injury and the HBP. Although the worker was willing to attend the FRP, he stated that this was against medical advice. The representative requests reinstatement of full LOE benefit entitlement as of September 2009 and entitlement be extended for the condition of HBP.
Analysis
The worker claims that the HBP was related to the stresses that he experienced as a result of this accident. Entitlement for the HBP in this claim was denied.
Blood pressure is the force of the blood pushing against artery walls. Blood pressure tends to rise with age, is linked to obesity, is more prevalent in men and certain race groups, is related to a family history and is associated with risk factors including high sodium diets, alcohol consumption, lack of regular exercise, smoking and a potassium deficient diet. Stress is a part of everyday life. Long lasting stress can also be a factor. Although stress can cause the blood pressure to spike temporarily, there is no confirming evidence to indicate that stress can cause long term HBP.
The worker had previous pre accident non compensable stress issues documented by his treating practitioner predating the accident – general family stress issues, financial and job stress issues and non compensable illness issues.
There was a family history documented by the family physician in that the worker’s mother died of a heart attack.
The worker’s compensable accident and the aftermath is not accepted as a precipitating factor in the onset of HBP in this worker. Stress is one of the many factors in HBP but it is not the only one. The worker had many other stressors present and predating the accident as documented in the file evidence and it is not accepted that the MVA of June 2002 and the events that followed caused the onset of HBP in 2009.
The worker’s request for HBP entitlement in this claim is denied.
The worker’s request for the reinstatement of the full LOE benefits from the time of termination was also considered.
As part of the worker’s treatment, the FRP was recommended. The worker attended the initial assessment but was unable to participate due to his out of control HBP. The worker was referred back to his family physician and to a cardiologist for evaluation and treatment of the HBP.
The medical information received since September 2009 indicate that the blood pressure was now under control, but the testimony of the worker contradicted this information as he has a home machine and monitors the blood pressure on his own. When asked when he obtained the machine, he indicated it was after the HBP diagnosis was made. The worker testified that, although the blood pressure is mainly under control, it continues to be high.
The worker and the worker representative state that he is not fit to participate in the FRP and that all of his physicians indicate this. A review of the most recent medical information notes that the pain clinic physician did state this; however, the cardiologist did not and the family physician’s note expressed agreement with the cardiologist.
The worker’s referral to the FRP in September 2009 was terminated due to the non compensable, out of control HBP. The blood pressure now appears to be under control with medications and the last report from the cardiologist indicated that it was normal and outlined what the worker is to avoid. There is no medical information to substantiate that the worker cannot attend the FRP or substantiate his claim of total impairment and unemployability. The worker has made no contact to again participate in the FRP and maintains an inability to return to the FRP. As the worker maintains an inability to proceed with the FRP due to the non compensable HBP, entitlement to full LOE benefits as of September 2009 remains denied.
Conclusions
The worker’s request for high blood pressure entitlement in this claim is denied.
The worker’s objection to the reduction of LOE benefits to partial LOE benefits is denied.
The worker’s objection is therefore denied.
Dated: June 8, 2010
N. Grunenko
Appeals Resolution Officer
Appeals Branch