Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
DECISION NUMBER: 20100116
OBJECTION BY: The Worker
EMPLOYER: Participating
HEARING DATE: June 08, 2010
PARTICIPANTS: Worker, Worker Representative, Employer, Employer Representative
ISSUES
The worker requests:
Recognition that his right-sided plantar fasciitis arose from his work duties for the employer on July 15, 2008.
The re-instatement of benefits for health care previously provided.
The payment of additional benefits for health care and loss of earnings (LOE) since March 2009
HOW THE ISSUES ARISE
The operating area established this claim when the employer reported on September 16, 2008 that the worker had experienced problems with his right foot since an incident in the workplace on July 15, 2008. He saw his family doctor about these problems on September 15, 2008 and the doctor diagnosed a possible plantar fascia tear and right peronal tendon strain. The family doctor prescribed physiotherapy treatment and recommended workplace precautions on standing, walking and lifting.
The operating area initially accepted that the worker's right foot condition arose from the incident in the workplace and it approved benefits for the associated health care. The employer's safety manager questioned the work-relatedness of the worker's right foot condition when an ultrasound on November 13, 2008 identified he had plantar fasciitis.
The operating area arranged for him to attend an assessment at a regional evaluation centre (REC) on February 26, 2009 to review the work-relatedness of the plantar fasciitis. The REC team verified that the worker has plantar fasciitis; he should continue home exercises and use semi-rigid orthotics for his work boots. A foot specialist assessed the worker on March 26, 2009; he identified bilateral flat feet and recommended a gauntlet brace for his work boots to provide better support.
The operating area reviewed the worker's case with the REC team assessment and it concluded that the worker's right plantar fasciitis is not work-related. It advised the workplace parties of this decision on March 9, 2009. The worker's representative objected to this decision on March 14, 2009 and he submitted an objection form on April 23, 2009. The operating area referred the issues to the Appeals Branch June 18, 2009.
AUTHORITY
Operational Policy Manual documents:
- 11-01-01 Adjudicative Process
- 11-01-02 Decision-Making
- 11-01-15 Aggravation Basis
- 15-02-01 Definition of an Accident
- 15-02-02 Accident in the Course of Employment
- 17-01-02 Entitlement to Health Care
- 18-03-02 Payment of LOE Benefits
EXHIBITS
Exhibit # 1: A medical report dated July 16, 2009 from Dr. Ted Haines, McMaster Medical Centre.
ASSESSMENT OF THE EVIDENCE
The worker provided testimony at the hearing about:
- Working as a carpenter in the construction industry before September 11, 1995.
- Being employed with the employer, a steel fabricator since September 11, 1995 and performing work duties as a multi-machine operator on July 15, 2008.
- Having problems with the arches of his feet in the late 1990s as he was on his feet all day and his family doctor prescribing orthotics to use.
- Not being away from the workplace because of these foot problems.
- Producing steel plates as a multi-machine operator that weigh 20 to 30 pounds or much more; using wedges and pry bars to separate the steel plates produced and climbing up onto his machine only as required.
- Generally being on his feet throughout his shift and the plant floor being made of porous concrete.
- Hooking up a steel plate while standing on a burning table on July 15, 2008; stepping down from the table onto a raised, uneven surface below.
- Feeling a stretching sensation in his right foot and ankle at the point of contact, pain and discomfort immediately and some swelling at home later that night.
- Reporting the incident immediately; thinking the condition would clear up shortly and it deteriorating to the point he could hardly walk by September 2008.
- Deciding to see his family doctor about the condition and advising the employer to report the matter as work-related as of September 15, 2008.
- His family doctor telling him he had strained a tendon in his right ankle; he had also hurt the plantar fascia of his right foot and he required accommodated work duties.
- The employer providing these until after the operating area denied his claim in March 2009 and requiring him to undertake work duties without any accommodations as of April 1, 2009.
- Applying for short term disability (STD) benefits under the employer's insurance carrier plan; these being approved and also receiving long term disability (LTD) benefits until his further return to work on November 30, 2009 using the brace prescribed for his work boot by the specialist.
- The foot specialist telling him he has flat feet on a congenital basis.
- How ultimately, neither the orthotics nor the ankle brace have resulted in the eradication of his foot problems.
- Rest, reduced weight bearing in the workplace and weight loss having contributed more to his recovery, his return to the workplace and continuing in it t date.
The worker's representative submits that the worker's testimony reaffirms the causal connection between the incident in the workplace on July 15, 2008 and the worker's subsequent problems with his right heel and brevis tendon of the right ankle. The worker had stepped down from a burning table before; however, the landing surface had been even and it was not so on this particular date.
When the worker placed his weight on the raised, uneven landing surface with his right lower extremity, he felt a stretching sensation in his right ankle and heel. His health care practitioners diagnosed a strain of the right brevis tendon and plantar fascia; an ultrasound on November 13, 2008 confirmed the diagnosis and they recommended precautions for the worker.
The worker's representative notes that REC assessment on February 26, 2009 confirmed the diagnosis of plantar fasciitis and the need for temporary workplace precautions. The employer provided such work duties until the operating area reversed the acceptance of the worker's claim.
The employer then returned him to work duties without any accommodations; he had to leave the workplace and has collected benefits from the employer's insurance carrier. The insurance carrier approved his claim for benefits and arranged for a transitional return to work plan. As all of these circumstances point to a workplace accident occurring on July 15, 2008, the worker's representative asserts that the operating area decision should not stand.
The employer's representative submits that the question to consider is whether the worker's plantar fasciitis arose from the workplace activity on July 15, 2008. The medical evidence confirms he has flat feet, a congenital condition that results in thickening of the plantar fascia and it is unlikely this would occur within the three to five months following the workplace event. As such, the worker's plantar fasciitis is clearly a pre-existing condition.
Furthermore, the medical reporting confirms the worker has a rigid right foot condition that is also congenital in nature and this increases the possibility of developing associated foot problems. Most interesting of all, the physical therapy and orthopaedic devices have effected no improvement for the worker. Only rest, exercises, reduced weight bearing and weight loss have had any positive results for him.
The employer's representative asserts that the worker will likely experience further foot problems in the future because of his congenital conditions. He may recall his foot problems in the past relating only to his arches and not his ankle or heel but this is not likely correct. The employer's representative notes that the ultrasound did not confirm a tear of either the plantar fascia or brevis tendon and he submits that this proves the worker's problems relate entirely to his pre-existing foot conditions. As such, he requests confirmation of the operating area decision made.
The worker recalls that he felt a pulling sensation in the lateral part of his right ankle and into his heel. These symptoms are quite consistent with the mechanics of his descent from the burn table onto a raised, uneven surface, causing his toes to hyperextend and his heel to fall. Such movements would clearly place stress on the right peronius brevis tendon (lateral side of ankle) and heel.
Based on the worker's continuing symptoms in these areas, the health care practitioners suspected a possible tear of the fascia and strain of the tendon. The ultrasound of November 13, 2008 identified a thickened right plantar fascia near to the calcaneus (heel) suggestive of a plantar fasciitis. The technician also scanned the left foot for comparison and did not identify a similar finding there.
The REC team concurred with the diagnosis, as did the foot specialist who assessed the worker on March 26, 2009. The foot specialist agreed that the worker had congenital flat feet but noted that the right side was extremely rigid and the condition was resistant to correction, as a result. He did not believe that surgery would help his situation noting these factors. The worker also saw an orthopaedic specialist on July 16, 2009 for a second opinion about his foot conditions.
This orthopaedic specialist received an accurate history of the worker's case, based on his report of the assessment (Exhibit # 1). This specialist agreed with the observations made by REC team and the foot specialist regarding the worker having bilateral flat feet (right worse than left) and found other significant abnormality of the right foot. He provided a diagnosis of strain of the right lateral collateral ligament and long plantar ligament with plantar fasciitis. Lastly, the specialist believes that the worker's right foot and ankle injuries are clearly work-related.
I have considered the arguments put forth by the representatives and reviewed the medical evidence available to me in the claim file and submitted by the worker's representative. There is no doubt that the worker has congenital conditions of bilateral flat feet (pes planus) and more rigid on the right. It is then not surprising to learn that he has had foot problems requiring the use of orthotics before 2008. However these underlying conditions presented no problems for the worker in the performance of his work duties until the July 15, 2008 incident.
Noting the immediate onset of symptoms, their continuation post-incident and the need for treatment, I am satisfied that a causal relationship between the work activity on July 15, 2008 and the diagnosis of a brevis tendon and plantar fascia strain is established. The operating area will re-instate any health care benefits rescinded prior to March 9, 2009. The worker will receive benefits for the health care expenses he has incurred since March 9, 2009. The worker will also receive full LOE benefits from April 1, 2009 until his return to work on November 30, 2009, having regard for insurance carrier benefits received.
CONCLUSION
I conclude that:
There is no doubt that the worker has congenital conditions of bilateral flat feet (pes planus) and more rigid on the right.
Noting the immediate onset of symptoms, their continuation post-incident and the need for treatment, I am satisfied that a causal relationship between the work activity on July 15, 2008 and the diagnosis of a brevis tendon and plantar fascia strain is established.
The operating area will re-instate any health care benefits rescinded prior to March 9, 2009.
The worker will receive benefits for the health care expenses he has incurred since March 9, 2009.
The worker will also receive full LOE benefits from April 1, 2009 until his return to work on November 30, 2009, having regard for insurance carrier benefits received.
The worker's objection is allowed.
DATED July 23, 2010
L. J. Vaccarello Appeals Resolution Officer Appeals Branch