WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20170005
DATE: March 22, 2017
OBJECTING PARTY: Worker
REPRESENTED by: Professional Corporation
RESPONDENT: Employer (participating)
REPRESENTED by: Representative
HEARING: Hearing in Writing
ISSUE
The worker is seeking entitlement for a recurrence of an ongoing right knee injury on April 10, 2015, including a medial meniscal tear, denied on April 29, 2015.
BACKGROUND
The worker was employed as a law enforcement officer. On March 15, 2014 he slipped on ice while entering work and injured his right knee. He was 54 years old at the date of injury. He was initially diagnosed with a fractured patella, but a CT scan on March 21, 2014 detected no fractures and found he had tricompartmental osteoarthrosis and thickening of the medial collateral ligament. Full loss of earnings (LOE) benefits were paid up to May 15, 2014, then closed once the CT scan confirmed there was no fracture, as the worker was fit to return to modified work. He resumed full regular duties on June 10, 2014.
On April 10, 2015 the worker stopped work because of a flare up of right knee pain with no new incident.
Decisions
On April 29, 2015 entitlement for a recurrence on April 10, 2015 was denied because there was no continuity from June 2014 to April 2015 and the new diagnosis was not clinically compatible with the workplace accident.
The denial of the recurrence was confirmed on reconsideration on October 28, 2015 and August 23, 2016.
The Worker’s Position
The worker’s representative provided a submission dated July 20, 2016, arguing that the worker had no history of right knee problems prior to the workplace injury, the MRI findings were the result of the fall and the workplace injury accelerated osteoarthritis.
The Employer’s Position
The employer’s representative provided a submission dated February 8, 2017 and argued there was no medical attention for the right knee between June 2014 and April 2015 and noted that the orthopaedic specialist’s opinion in April 2015 was that the worker had recovered well from the workplace fall. The employer’s representative argued that the worker’s right knee problems in April 2015 are age-related.
AUTHORITY
Operational Policy
15-02-05 Recurrences
ANALYSIS
I have considered all of the available information, legislation and relevant operational policies in reaching this decision and find there is no entitlement for a recurrence of right knee problems. My reasons are explained below.
According to Operational Policy 15-02-05, a worker may be entitled to benefits for a recurrence of a work-related injury if he experiences a significant deterioration that:
does not result from a significant new incident, and
is clinically compatible with the original injury.
A significant deterioration refers to a marked degree of deterioration in the work-related impairment that is demonstrated by a measurable change in the clinical findings. Indicators of a significant deterioration may include:
the need for active (non-maintenance) clinical treatment
a change in functional abilities, or
a change in the ability to perform a job or suitable occupation.
The decision-maker may also consider whether a worker has experienced continuing symptoms since the original injury. Generally, continuing symptoms are an indicator of a causal link, though they are not required to establish a causal link.
Indicators of continuing symptoms may include
continuing clinical treatment
continuing workplace accommodations, or
evidence that continuing symptoms were reported to health care providers, supervisors or co-workers on an ongoing basis.
Although the worker returned to full regular duties on June 10, 2014, it is his position he continued to have symptoms with his right knee, which included pain, difficulty rising from a seated position, problems straightening his right knee, intermittent swelling, a limp and an inability to get up from kneeling. He submitted letters from three co-workers to support his position.
A letter from a colleague dated May 15, 2015 noted he was aware of the worker’s injury early in 2014 and that he complained of his knee hurting after he came back to work.
A letter from another colleague dated May 19, 2015 indicated that since his return to regular duties in June 2014, the worker had complained of pain and swelling in that knee from time to time. In February 2015 they did four days of training together and he noticed the worker had problems shooting on the firearm range from a kneeling and prone position and had to be assisted by instructors several times when getting down on his knee or getting back on his feet after shooting. The colleague had also noticed him walking with a slight limp.
A third colleague provided a letter dated May 20, 2015 noting he had seen the worker limping on his right leg, having problems straightening his right leg after sitting for more than 15 minutes and he often complained of right knee pain.
While co-workers were aware of some complaints, his condition wasn’t significant enough for the worker to seek medical attention for his right knee between June 24, 2014 and April 2015. This evidence also is not sufficient to establish entitlement for a recurrence, as the evidence must also show the right knee problems in April 2015 were compatible with the original injury.
Entitlement in the claim was accepted for a sprain/strain of the worker’s right knee. I find that decision was appropriate, based on the medical evidence. Although a fracture was initially suspected, it was not confirmed on the CT scan of March 21, 2014. What the CT scan showed was tricompartmental osteoarthrosis, which is a degenerative finding that would not have been caused by the workplace injury just one week earlier. The MRI done on May 24, 2014 confirmed the worker had mild degenerative changes in his right knee and no meniscal tears were evident.
The worker sought further medical treatment for his right knee in April 2015. Based on the medical reports from April 2015 and beyond, the worker had developed a new diagnosis in his right knee that was not present following the initial injury. The report from the orthopaedic specialist dated April 14, 2015 noted the worker had symptoms consistent with the possibility of a medial meniscal tear. The worker’s orthopaedic surgeon provided another letter dated April 25, 2016. The letter indicated a second MRI of the right knee on June 27, 2015 showed ongoing osteoarthritis with a new radial tear involving the posterior horn of the medial meniscus, secondary to joint arthropathy. The letter also noted it was unlikely the worker sustained a significant displaced meniscal tear at the time of the initial workplace injury, noting the MRI findings of May 26, 2014.
The orthopaedic surgeon’s letter of April 25, 2016 suggested the worker had a significant, dramatic, rapid deterioration in his knee, including advancement of his osteoarthritis and suggested the unusual rate of deterioration was likely the result of the workplace incident and lead to degenerative tearing of the medial meniscus.
I have considered the opinion offered by the orthopaedic specialist in his report of April 25, 2016 that suggested there was a connection between the workplace injury and the new findings in April 2015, but I find it is not corroborated by other evidence. The evidence shows that the worker did not sustain the medial meniscal tear in his right knee as a result of the original workplace injury. The medial meniscal tear was not suspected until more than a year later. I also note that the opinion offered by the orthopaedic specialist in the April 25, 2016 letter is not consistent with his previous clinical notes. When the worker saw the specialist on June 24, 2014 his clinical note indicated the worker was recuperating fairly well and the plan was for him to get back to full activity soon. His clinic note dated April 14, 2015 indicated he had previously seen the worker for his right knee injury and he had recovered well after the fall. That note also indicated there was undoubtedly some underlying degenerative changes in the worker’s knee.
Furthermore, there is little evidence to support the orthopaedic specialist’s contention that the worker had a significant acceleration of the degenerative condition in his right knee as a result of the workplace injury. A leg length study on April 14, 2015 noted the worker’s left leg was 1.6 cm longer than his right, with minor narrowing of the medial joint spaces bilaterally, suggesting there were likely some degenerative changes in both the worker’s knees. I also note there are other clinical records in the claim file indicating he has osteoarthritis in both his shoulders, which suggests the worker has experienced degenerative conditions in other joints.
Because the medial meniscal tear was not diagnosed until more than a year after the workplace injury, the worker had pre-existing degenerative changes in his right knee and noting the lack of objective medical evidence to demonstrate the workplace accident accelerated the degenerative process in his right knee, I find there is no entitlement for a recurrence on April 10, 2015. Entitlement is limited to a right knee sprain/strain, as the medial meniscal tear is not compatible with the original injury.
CONCLUSION
I conclude there is no entitlement for a recurrence of his right knee injury on April 10, 2015. Entitlement is limited to a right knee sprain/strain. The medial meniscal tear is not compatible with the original injury.
The objection is denied.
DATED March 22, 2017
H. Shaw
Appeals Resolution Officer
Appeals Services Division