Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20100153 Objection By: Employer Worker: Not Participating Employer: Canada Post
Issue
Entitlement to left hip replacement surgery
How the Issue Arose
On March 1, 2005 this letter carrier slipped and fell on a driveway while he was delivering mail. He landed on his left hip on the snow covered ice.
He saw his family doctor on March 7, 2005 and was diagnosed with a soft tissue injury to his left hip.
The worker did have surgery in the form of a left total hip arthroplasty on December 3, 2007.
The Adjudicator allowed the hip surgery as a result of the work injury.
The employer appealed this decision and the case has been referred to the Appeals Branch.
Authority
Operational Policy Manual (OPM)
15-03-01 Recurrence
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.
I did contact the employer representative. He did not have any additional information to submit, but requested that the comments made in the Objection Form be taken into consideration.
Assessment of the Evidence
In policy, a recurrence may result from an insignificant new accident, or may arise when there is no new accident. To identify a recurrence, the WSIB must confirm that there is clinical compatibility between the original injury or disease and the current condition, or a combination of clinical compatibility and continuity.
Policy also states that a worker is entitled to benefits under the insurance plan to such health care as may be necessary, appropriate, and sufficient as a result of the injury.
File Documentation
The worker saw a specialist for his left hip pain on July 20, 2006 and in summary the worker had precocious osteoarthritis of his left hip. Surgery, in the form of a hip replacement was discussed but in view of his age, it was suggested that the worker wait as long as possible.
The worker called the Adjudicator on May 18, 2007 to advise that he had been off of work as a result of this injury since December 7, 2006 and he was scheduled for a hip replacement.
The worker saw a second specialist on June 20, 2007 who had the same suggestion concerning a hip replacement.
The Adjudicator referred the case to the Medical Consultant (MC) asking for an opinion on the compatibility of the proposed hip replacement to the work injury. The MC was of the opinion that the hip replacement was not related to the injury.
Taking into consideration this MC opinion, the Adjudicator sent a decision letter on April 4, 2008, denying entitlement for the recurrence and proposed surgery.
The worker’s representative sent in a letter on September 2, 2008 appealing this decision and providing additional medical information to support this objection.
The operating surgeon expressed the opinion that a “significant fall and impaction of the articular cartilage” can ultimately lead to degenerative changes. The worker had denied any symptoms prior to his work injury.
The MC reviewed the case again with the additional medical information. He reviewed the specialist report and opinion that the work injury could have accelerated the hip osteoarthritis. The MC was of the opinion that the surgery is related to his work injury.
Taking into consideration this additional medical opinion the Adjudicator allowed entitlement for the hip replacement, as documented in the decision letter of February 12, 2010.
The employer submitted an Objection Form. They noted that the worker returned to his regular job on March 2, 2005 and there was no continuity of complaint until September 19, 2005. They were of the opinion that the accident was minor in nature and should not result in surgery in the form of a hip replacement.
Analysis
The medical documentation on file confirms that the worker has bilateral hip osteoarthritis.
However, the employer’s report of injury and the physician’s first report do not make reference to prior problems.
The specialist’s report of July 20, 2006 documents that the worker had no symptoms prior to his work injury.
The family doctor of over 15 years confirmed that there were no visits for hip pain prior to March of 2005.
From the evidence in the file I find that the worker was asymptomatic in his left hip prior to the injury of March 2, 2005.
The employer has a concern with respect to there being a lack of continuity of complaint until September 19, 2005 and is of the view that the injury, being minor in nature, should not result in a hip replacement.
The medical evidence in the file does not support this position.
The specialist’s report of July 20, 2006 documents that the worker has had problems in his left hip since the work injury.
The most compelling medical evidence is the advancement in the worker’s left hip osteoarthritis since the work injury.
On March 14, 2005, 12 days after the injury, an X-ray examination revealed that the worker had mild osteoarthritis in the bilateral hips with no bone injury seen.
When the worker saw the specialist on July 20, 2006 the X-rays revealed significant degenerative changes in the left hip with osteophytes, subchondral sclerosis and bone to bone contact.
When he saw a different specialist on June 20, 2007 the radiographs demonstrated advanced bone to bone arthritic changes in the left hip.
Also of significance is the fact that the worker was diagnosed with bilateral hip osteoarthritis on March 12, 2005, but went on to have ongoing symptoms only in his left hip. The report of July 20, 2006 clearly states that the worker has no other specific joint complaints.
Having weighed all of the evidence in this case I find that the worker has had ongoing symptoms since his March 12, 2005 injury and the injury was significant enough to accelerate the worker’s left hip osteoarthritis.
I also find that the left hip replacement of December 3, 2007 was a necessary and appropriate surgical procedure resulting from the work injury of March 2, 2005.
Conclusion
I agree with the Case Manager’s decision to allow entitlement for the left hip replacement surgery.
The objection is denied.
Dated October 14, 2010
P. Dardarian
Appeals Resolution Officer
Appeals Branch