WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100188
OBJECTION BY: Worker
PARTICIPANTS: Worker, Worker’s representative
HEARING DATE: N/A
ISSUE
The worker is objecting to the July 27, 2009 decision which denied entitlement to a left calcaneus fracture and a related pension assessment.
HOW THE ISSUE ARISES
On September 21, 1979, while employed as an upholsterer, the worker was lifting a sofa with a co-worker when he injured his lower back. He was approximately 30 years of age at the time of injury and had been employed with a furniture company since April 1979.
The worker’s claim for a low back strain was accepted for health care and wage loss benefits. It was subsequently determined he had sustained a permanent impairment and was granted a 15 per cent pension in 1982. In 1987, the pension quantum was increased to 20 per cent. Although section 147 supplementary benefits were initially granted to the worker in 1989, they were discontinued in 1992, further to the inconsistencies noted in the file related to the worker’s employment. On October 18, 2007, the worker’s pension was increased to 22.5 per cent.
On February 10, 2009, the worker contacted the adjudicator to report that on January 24, 2009 he was outside his home when his left leg gave way and he fell, fracturing his heel. He advised he was assessed on January 25, 2009 at St. Joseph’s emergency.
According to the July 27, 2009 decision, the accident history recorded was that the worker was going down the stairs on December 26, 2008 when his left leg gave out. On January 24, 2009, the worker once again indicated his left leg had given way, causing him to fall and injure his left foot and ankle. The adjudicator denied entitlement to a left heel fracture on the basis a left leg condition had not been accepted under the claim. Furthermore, the initial hospital report indicated the worker had slipped on ice, and struck his left shin.
The worker objected to the above decision. Upon receipt of the worker’s completed Objection Form, the decision to deny entitlement to the left calcaneus remained unchanged and the worker’s file was referred to the Appeals Branch for further review.
AUTHORITY
Operational Policy Manual documents:
11-01-01 Adjudicative Process
11-01-02 Decision-Making
15-05-01 Secondary Conditions Resulting From Work-Related Disability
RESOLUTION METHOD AND PROCESS
The worker’s representative concurred with a decision based upon the file information.
ASSESSMENT OF THE EVIDENCE
In considering this objection, I have had regard for the evidence on file, the applicable law and policy and for the arguments presented.
A review of the medical information submitted to file confirms the worker was first seen on December 26, 2008 at St. Joseph’s Health Care Centre for injury to his left tibia and fibula. The accident history recorded was that the worker ‘slipped on the ice & struck his left shin’. Abrasions and bruising were observed on the left tibia. The diagnosis rendered was hematoma and contusion to the tibia.
An undated Emergency Registration sheet was submitted to file by the same emergency physician who noted “he states his left leg became weak and “gave out” and this was why he had fallen”.
The worker was next seen at St. Joseph’s Health Care Centre on January 24, 2009. The emergency report, though somewhat difficult to decipher, appears to indicate the worker fell. Similarly, the hospital triage report of January 25, 2009 indicates the worker fell in the morning with an injury to his left ankle which looked swollen. He also complained of pain in his left buttock.
A CT scan of the lumbar spine performed on February 26, 2009 revealed degenerative disc disease without central canal stenosis.
The worker’s physician submitted a March 25, 2009 Health Professional’s Report which diagnosed the worker with lumbar pain and a fractured left foot. He indicated the worker’s injury occurred as a result of weakness to his left leg, causing his leg to often give way, resulting in loss of balance, with the worker falling down the stairs on January 24, 2009, fracturing his left foot. Despite the previous medical reports submitted to file, I note this is the first time a physician has recorded the worker fell down the stairs – this was two months following his injury.
The worker claimed his left leg gave way, causing him to fall and fracture his left heel. The accident history provided by the worker appears inconsistent with his diagnosis as the general medical literature supports that a fracture to this particular area of the body most commonly occurs with falls from heights, usually six feet or greater, or with impact on a hard surface while running or jumping, given the density of the calcaneus. Logically, one would presume that if the left leg gave way, the worker would fall either forward, injuring his front, i.e. bilateral knees or hands, or sideways, injuring either side of his body. It is unclear how the worker could fracture his left heel if his left leg gave way as reported, given the degree of impact required for such an injury.
Policy 15-05-01, Secondary Conditions Resulting From Work-Related Disability, records that entitlement for any secondary condition is accepted when it is established that a causal link exists between it and the work-related impairment.
Regardless of the accident history reported, entitlement has not been granted under the claim for a left leg condition. In addition, the CT scan of February 2009 did not support evidence of spinal stenosis. Consequently, I have been unable to establish that a causal link exists between the worker’s back impairment and his left calcaneus fracture. Entitlement to his left calcaneus fracture and a related pension assessment is therefore denied.
CONCLUSION
I conclude a causal link between the worker’s back impairment under the claim and his left calcaneus fracture has not been established.
The worker’s objection is therefore denied.
DATED November 30, 2010
L. Diaz
Appeals Resolution Officer
Appeals Branch