Workplace Safety and Insurance Board
Appeals Resolution Officer Decision
Decision Number: 20150098 Decision Date: March 10, 2015
Objecting Party: Worker (Self Represented) Respondent: Employer (Not Participating)
Hearing: Hearing in Writing Heard By: S. Johnson, Appeals Resolution Officer
Issues
The worker objects to the Case Manager’s (CM) decision letter dated September 24, 2014 that concluded:
- The worker fully recovered from her work-related left shoulder injury as of the end of her medical treatment program on October 7, 2014.
- Entitlement to further health care benefits beyond October 7, 2014 was denied.
Background
On October 9, 2013 this then 44 year old security guard attempted to restrain an agitated patient with five co-workers approximately three times during the course of one hour when she developed a sudden sharp pain in her left shoulder region. In the Worker’s Report of Injury/Disease (Form 6) dated November 12, 2013 the worker documented that she attempted to hold the patient’s leg in a retracted position during the restraints when she developed a sharp pain in her left shoulder region.
The worker reported the incident immediately to her employer on the date of the event. She did not lose time from work and returned to work to modified duties with no wage loss performing sedentary work duties that included paperwork, telephone calls, parking tickets and safe keeping for the patients.
The worker received first medical treatment on October 10, 2013. In the Health Professional’s Report (Form 8) dated October 10, 2013 Dr. “Z” prescribed conservative medical treatment for the worker’s left shoulder injury that included medications, physiotherapy and functional restrictions avoiding climbing, lifting, operating heavy equipment, pushing, pulling, use of the upper extremities and to avoid use of the left arm for seven days.
The worker commenced physiotherapy treatments for her left shoulder strain injury on November 26, 2013 (Memo 1).
The worker’s left shoulder symptoms did not significantly improve despite extensive physiotherapy treatments and workplace modifications to accommodate her functional restrictions. The Operating Area made arrangements for the worker to be seen at the Sunnybrook Shoulder and Elbow Specialty Clinic to assist with her recovery and return to work outcomes. In the Sunnybrook Shoulder and Elbow Specialty Clinic report dated March 25, 2014 Dr. “H”, orthopaedic surgeon, concluded that the worker sustained a left shoulder sprain type of injury arising from the work accident of October 9, 2013; the worker was partially recovered from her left shoulder sprain injury and that further recovery was expected over the next three to four month period of time with on-going home physiotherapy treatments and a home-based therapy program.
In a medical report dated August 18, 2014 Dr. H concluded that the worker was partially recovered from her left shoulder sprain injury and that she required temporary functional restrictions for a period of four to six weeks.
In a decision letter dated September 24, 2014 the CM concluded that the worker was able to return to her full regular work duties as a security guard as of September 29, 2014 and that she fully recovered from her left shoulder injury as of October 7, 2014. In this decision letter, the CM also denied entitlement to further health care benefits beyond October 7, 2014. In a reconsideration decision letter dated December 10, 2014, the CM affirmed the previous conclusions reached in the decision letter dated September 24, 2014.
These are the issues for determination.
Authority
Operational Policy 11-01-05 – Determining Maximum Medical Recovery (MMR) (published July 18, 2008)
Section 2(1) – Workplace Safety and Insurance Act
Analysis
In my review I have had regard for the available information, relevant policies and legislation. In arriving at my decision I have considered all of the evidence and the following is a summary of my decision.
1. Maximum Medical Recovery (MMR) For Left Shoulder Strain Injury
I find that the worker reached MMR from her work-related left shoulder sprain injury as of October 7, 2014 and that there is no evidence of a permanent impairment in accordance with the Operational Policy Manual (OPM) Document No. 11-01-05 – “Determining Maximum Medical Recovery (MMR)” (published July 18, 2008) – that sets out workers reach a plateau in their recovery and it is not likely that there will be any further significant improvement in their medical impairment.
According to Section 2(1) of the Workplace Safety and Insurance Act (WSIA), “impairment” means a physical or functional abnormality or loss (including disfigurement) which results from the injury and any psychological damage arising from the abnormality or loss. This section defines “permanent impairment” as an impairment that continues to exist after the worker reaches maximum medical recovery (MMR). A worker reaches MMR when it is not likely that there will be any further significant improvement in his or her medical condition.
In the Appeal Readiness Form dated December 4, 2014 the worker advanced that she has not fully recovered from her work-related left shoulder sprain injury. In support of this position, the worker documented several factors as follows:
- She has not been able to return to her regular job duties as a security guard.
- Her employer has provided her with modified work duties on an indefinite basis.
- She disputes the information documented by the Nurse Consultant (NC) in the case review dated August 18, 2014 (Memo 18) that observed the worker had returned to her regular work duties as a security guard.
The worker relied upon the Functional Abilities Form (FAF) dated October 9, 2014 that documented she required on-going modified work duties for her left shoulder injury.
I am persuaded by the weight of the medical evidence that does not reasonably conclude that the work accident of October 9, 2013 made a significant contribution to the worker’s on-going left shoulder problems beyond October 7, 2014. In support of this finding, I accord significant weight to Dr. H’s medical reports dated March 25, 2014 and August 18, 2014. I have taken particular note of the following:
In a medical report dated March 25, 2014 Dr. H concluded that the worker sustained a left shoulder sprain injury at the time of the work accident of October 9, 2013; the worker required on going temporary limitations for the next 12 weeks that included avoid heavy lifting, carrying, pushing, pulling, above-chest level work and repetitive use of the left arm away from her body. Dr. H documented that the worker reported she, “has improved 70%; her pain is aggravated by activity such as cross-country skiing and heavy repetitive work; and she does not have any night pain.” Dr. H’s clinical examination of the worker’s left shoulder region observed that her range of motion was near equal to the opposite right shoulder with stress tenderness on these movements and a mildly positive painful arc.
In a medical report dated August 18, 2014, Dr. H documented that clinical examination of the worker’s left shoulder ranges of motion were full; her rotator cuff strength had improved; axillary and distal neurological examination was normal; she is “somewhat” weaker on the left than the right and that she had some pain with testing of the supraspinatus region. Dr. H concluded that the worker had now partially recovered; further recovery was expected over the next four to six weeks; no further follow-up was recommended or required and that the worker was provided with education on “hurt versus harm” with strategies to help her with pain management and improved function.
I find that the work accident of October 9, 2013 was a factor that contributed in some way to the worker’s subsequent temporary left shoulder sprain disability. However, I cannot accept that the work accident of October 9, 2013 was a factor which contributed in a significant way to the worker’s on-going left shoulder problems beyond October 7, 2014. In support of this finding, I accord significant weight to Dr. H’s medical reports that observed normal findings with subjective reports of some pain on movements of the worker’s left shoulder region.
Dr. H is an orthopaedic surgeon with expertise in upper extremity injuries. He is a trained medical expert who had the opportunity to assess the worker’s left shoulder region including all diagnostic studies; document her complaints and record her physical findings on clinical evaluation. In the report dated August 18, 2014 Dr. H observed that there was no objective evidence of an on-going impairment in the worker’s left shoulder region related to the left shoulder sprain injury of October 9, 2013.
In my view, the significance of the worker’s pre-existing left shoulder tendinopathy with associated degenerative changes outweighs the contribution from the work accident of October 9, 2013. In support of this finding, I attach the greatest amount of weight Dr. “R”’s medical review dated November 17, 2014 (Memo 22). In this review, Dr. R concluded that the left shoulder MRI report dated December 3, 2013 observed chronic changes in the worker’s left shoulder region including tendinopathy and osteoarthritic changes with subcortical cysts; these findings are chronic in nature and not medically compatible with the work accident of October 9, 2013; the worker fully recovered from her left shoulder rotator cuff strain injury and that her on-going left shoulder symptoms, dysfunction, and limitations are directly attributable to the pre-existing non-work related changes.
Dr. R is a trained health professional with expertise in examining the issue concerning the relationship between a work accident and resulting injury; he had the opportunity to complete a comprehensive assessment of the worker’s entire medical brief including all diagnostic studies. In addition, Dr. R’s medical review and conclusions reached are grounded with appropriate medical resource materials that strongly suggest the worker fully recovered from her work-related left shoulder sprain injury and that her on-going problems are directly attributable to the pre-existing non-work related changes.
I find that the worker fully recovered from her work-related left shoulder sprain injury at the end of her medical treatment program on October 7, 2014 with no evidence of a permanent impairment. Accordingly, the worker is not entitled to on-going benefits or services under the insurance plan beyond October 7, 2014 relating to her work accident on October 9, 2013.
Conclusion
I conclude:
- The worker fully recovered from her work-related left shoulder sprain injury as of October 7, 2014 with no evidence of a permanent impairment.
- Entitlement to on-going health care benefits and services beyond October 7, 2014 is denied.
The objection is denied.
DATED March 10, 2015
S. Johnson Appeals Resolution Officer Appeals Services Division