Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20150074 Decision Date: April 16, 2015
Objecting Party: Worker Represented by: Worker Representative Respondent: Employer
Hearing: Hearing in Writing Heard by: F. Amorim, Appeals Resolution Officer
Issue
The worker is requesting entitlement for right knee impairment as a secondary condition.
Background
The worker, born [date], injured his left knee on August 2, 2005 when he was pushing a cart and his left foot slipped on a piece of paper, twisted, and slid backwards.
Entitlement was accepted for a medial meniscal tear and surgery was performed in February 2006. The worker returned to work on April 3, 2006.
An Appeals Resolution Officer (ARO) decision dated November 12, 2013 concluded the worker was not entitled to a NEL assessment for his left knee and denied entitlement to a March 1, 2013 recurrence.
On April 29, 2014, the Case Manager (CM) determined the right knee impairment was not related to the left knee injury. In reaching this conclusion the CM found there was a significant delay in the onset of the right knee impairment and no evidence to support the worker had bilateral knee problems between 2007 and 2012.
The worker disagrees with the above decision and has brought the case forward to the Appeals Services Division for further consideration.
Authority
Operational Policy: 15-05-01 – Resulting from work-related disability/impairment
Analysis
For the reasons set out below, I am unable to accept entitlement for the right knee impairment as a secondary condition.
The worker representative (WR) submits the right knee impairment is causally related to the left knee condition which resulted from the compensable injury of August 2, 2005. He also indicated there was no evidence of any new accidents or incidents which may have contributed to the impairment.
The representative submits the April 23, 2010 workplace injury recognized under a subsequent claim may have contributed to the right knee condition.
The WR relies on several medical reports contained in the record to support his position that the right knee impairment should be accepted as a secondary condition.
The worker has entitlement for a left knee condition resulting from a workplace accident in August 2005. The worker is claiming that the right knee impairment is causally related to the left knee impairment.
Policy 15-05-01 states that workers who have sustained a secondary condition that is causally linked to a work-related injury are entitled to benefits to compensate for the new injuries.
A clinical note from the family physician dated April 8, 2010 confirms the worker was assessed for multiple complaints of joint pain which included the right knee. The cause of the pain was not discussed and the physician provided a diagnosis of right knee pain. An x-ray was ordered.
On December 19, 2012 the worker was assessed by a specialist who indicated the worker reported a gradual onset of pain occurring in his shoulders, knees, low back and neck since 2005/2006. The worker attributed the pain to repetitive strain from his employment. The worker reported pain in his groin, low back, right knee, neck, and left shoulder had intensified over the last few years. Upon examination the specialist observed some crepitus in both knees and noted McMurray testing was negative. He was referred for an MRI on his right knee.
An MRI of the worker’s right knee found there was increased signal within the medial meniscus but a surfacing tear was not identified; the lateral meniscus was intact; the anterior and posterior cruciate ligaments were intact; the patellar tendon mechanism was normal; the patella cartilage was unremarkable and there was a small amount of fluid present in the knee joint.
The Worker’s Continuity Report (Form Reo 6) dated December 14, 2012 indicated the worker had restrictions at work for a shoulder and low back problem. The worker also reported having to compensate for his left knee condition with his right knee and that he sought health care for the problem. He also reported taking anti-inflammatory and pain medication for work-related injuries which were masking the pain from all his injuries.
On January 17, 2013 the worker was assessed by an orthopaedic surgeon. The worker reported right knee pain and the surgeon confirmed the results of the December 2012 MRI which found intrasubstance tearing of the medial meniscus with no surface tearing.
On March 25, 2013 the worker was assessed by another physician. The worker described pain in his right knee which he claimed began in September/October 2012 and was due to over compensating for the left knee. The physician noted the December 2012 MRI of the right knee found some meniscal injury with increased signal in a non-specific manner. The physician provided a diagnosis of bilateral knee pain due to a meniscal injury.
On April 2, 2013 the worker’s family physician submitted a report which indicated the worker developed right knee issues in the fall of 2012 and that the issues with the right knee increased following surgery to the left knee. He also reported having no knowledge of any other accidents or incidents which contributed to his right knee issues.
I note the November 12, 2013 ARO decision found the worker’s left knee issues in 2012 and 2013 were not related to the workplace injury in 2005. The ARO also concluded the worker was not entitled to a NEL assessment for the left knee impairment.
When I assess all of the available information, I am unable to accept entitlement to the right knee impairment as a secondary condition. I note that in his submission, the WR suggested the right knee impairment was causally related to the left knee impairment and the April 23, 2010 workplace trauma may have contributed to the condition.
In this particular case, there is a relatively late onset of the worker’s right knee pain. The evidence on file supports the right knee pain started gradually in 2012. This is six years after the worker returned to work and seven years after the compensable injury. During this period, I note the worker saw his family physician on one occasion in 2010 and reported right knee pain. The worker did not relate the pain to overcompensating for the left knee condition and there was no discussion surrounding the cause of the pain.
Subsequent to the 2010 clinical note, there is no medical evidence until December 2012 when the worker is examined by a specialist. The worker reported pain in various parts of his body including the right knee. I note the worker attributed the pain to repetitive strain from his employment.
I find there is no evidence to support the April 23, 2010 work-related incident was a contributing factor in the development of the right knee impairment. No evidence to support this argument was presented by the WR.
I have not afforded the family physician’s report of April 2013 much weight given the worker was treated by several physicians and there is no medical evidence of significance commenting on a possible connection between the worker’s right knee condition and the original workplace injury. In addition, the physician supports the fact that the worker’s right knee problems began in 2012.
I note the ARO decision of November 2013 found the worker fully recovered from the 2005 left knee injury with no evidence of a residual impairment. The ARO also concluded that the left knee issues in 2012 and 2013 were not related to the 2005 injury.
Given the above reasons, I find I am unable to accept entitlement for right knee impairment as a secondary condition.
Conclusion
Entitlement for a right knee impairment is denied as a secondary condition.
The objection is denied.
DATED April 16, 2015
F. Amorim Appeals Resolution Officer Appeals Services Division