WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number:
20150058
DECISION DATE:
April 16, 2015
OBJECTING PARTY:
Worker
REPRESENTED by:
Worker Representative
RESPONDENT:
Employer
HEARING:
Hearing in Writing
HEARD by:
M. Elliott, Appeals Resolution Officer
ISSUE
The worker is requesting entitlement for:
- A recurrence and Loss of Earnings Benefits effective March 28, 2014. Entitlement to a recurrence was denied in the Case Manager’s decision dated May 9, 2014.
BACKGROUND
On March 5, 2013, this then 45-year-old mechanic was moving the e-test machine probe from the exhaust system and overextended his neck while doing so. The accepted accident date is March 5, 2013. The accepted diagnosis is a neck strain as documented in memorandum #7 dated May 9, 2014. An MRI from March 12, 2013 demonstrated a disc osteophyte complex with a right paracentral disc herniation causing right neural foraminal stenosis at the C6-7 level.
A Medical Consultant for the WSIB reviewed the medical findings and indicated a disc osteophyte complex is a degenerative finding. The mechanism of injury from March 5, 2013, of over-extending the neck while moving an e-test probe, is not compatible with the MRI findings.
Surgery was proposed to treat the worker's degenerative disc impairment; however, entitlement has not been granted for the disc impairment or the surgical process. A recurrence has not been accepted as the condition for which the worker stopped working has been considered unrelated to the original accident history.
AUTHORITY
The following Operational Policy applies:
15-03-01; Recurrences.
ANALYSIS
- Entitlement to the surgical procedure and loss of earnings for the disc impairment.
I find the worker is not entitled to Loss of Earnings Benefits effective March 28, 2014, nor is the worker entitled to treatment for a disc injury. Entitlement in this claim is limited to a soft tissue neck strain. WSIB Policy Document 15-03-01 states that a worker may be entitled to benefits for a recurrence of a work-related injury. To identify a recurrence, the WSIB must confirm that there is clinical compatibility between the original injury and the current condition, or a combination of clinical compatibility and continuity. Similar clinical conditions indicate that the current impairment may be a result of the original injury, whereas dissimilar or unrelated clinical conditions indicate that there is no compatibility, and therefore, no recurrence.
An MRI from March 12, 2013 demonstrated an osteophyte complex with right disc herniation causing severe right neural foraminal stenosis at the C6-7 level. The worker was seen by a specialist December 19, 2013. The neurosurgeon indicated the worker had injured his neck at work in November 2012 while pulling a muffler and since that time, he had neck pain with radiation down the right arm and weakness of the arm. The surgeon indicated that the C6-7 disc herniation was slowly progressing causing C7 radiculopathy. He recognized there was a moderately large C6-7 disc herniation which could be surgically treated.
The worker had a conversation with the WSIB Eligibility Adjudicator on May 1, 2014. The worker indicated he has been off work since March 28, 2014. He confirmed the date of injury was March 5, 2013 and prior to that date, he did not have any concerns with his neck. He was unclear why the doctor reported an injury in November 2012. The worker maintained his only injury was March 5, 2013. The worker stated his neck symptoms had slowly increased to the point where he was losing sleep and experiencing pain and numbness down the right hand. He was awaiting a surgical date which would likely be in June 2014.
The Adjudicator obtained a medical opinion regarding the compatibility of the disc condition and the mechanics of the accident history. The Medical Consultant reviewed the claim May 5, 2014 and indicated the disc condition was degenerative and unrelated to the accident history of overextending the neck while moving an e-test machine probe on March 5, 2013.
Adjudicating cases with degenerative changes is difficult and some understanding of the progression of these changes is an important consideration when ruling on entitlement to a disc impairment as related to a workplace injury. A bulging disc is due to softening of the disc in conjunction with associated degenerative changes in the fibers of the covering annulus of the disc. Bulging is a common finding in the general public and is associated with the natural process of degenerative changes that normally occurs regardless or trauma or injury.
Once degenerative changes begin in a disc, herniations can occur. Continuation of pain in some cases is due to instability resulting from the degenerative disc changes which can cause secondary facet joint impingement. Some pain can also be related to the onset of localized spinal stenosis which is secondary to the effects of degenerative changes having no relationship to trauma.
Neurogenic pain can begin to occur. Neurogenic pain is a term generally accepted to indicate pain symptoms generated by actual pressure against nerve root elements. This phenomenon is often caused by the development of degenerative bone spurs or osteophytes which can exert pressure on the nerve root. The pressure effect is sometimes also seen in conjunction with calcification or fibrotic thickening in a longstanding bulging or herniated disc due to the degenerative changes.
In this case, the worker had an MRI approximately seven days after the workplace incident. The MRI demonstrated a developed osteophyte complex and right disc herniation causing severe right neural foraminal stenosis at the C6-7 level. This represents rather advanced degenerative changes and has no relationship to the incident that occurred in the workplace March 5, 2013. The lost time commencing March 28, 2014 is related to the effects and proposed treatment for a disc impairment. This claim was established for a soft tissue strain when the worker over-extended his neck on March 5, 213. Policy document 15-03-01 states that when there are dissimilar or unrelated clinical conditions at the time of the recurrence, there is no compatibility of the new condition and the basis for which the claim was established and therefore, no allowable recurrence.
CONCLUSION
I conclude the following:
- The diagnosis of a disc herniation and disc osteophyte which required a planned treatment of surgery is not compatible with the mechanism of the accident that occurred March 5, 2013. This claim was allowed for a soft tissue neck strain and a recurrence for symptoms related to the degenerative disc condition in March 2014 is denied.
The worker's objection is, therefore, denied.
DATED: April 16, 2015
M Elliott
Appeals Resolution Officer
Appeals Services Division