WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number: 20180025
OBJECTING PARTY: Employer
REPRESENTED by: Representative
RESPONDENT: Worker
REPRESENTED by: Representative
HEARING: Hearing in Writing
HEARD by: L. Diaz, Appeals Resolution Officer
DATED: June 29, 2018
ISSUE
The employer is objecting to the May 31, 2017 decision which granted entitlement for a medial meniscus tear, rupture of the anterior cruciate ligament, and related surgery.
BACKGROUND
On February 21, 2017, while employed as a Drywall Finisher and Plasterer, the worker was sanding a ceiling with a sanding pole when his right knee banged the guard rail end. The following day, February 22, 2017, while coming down scaffolding, he turned to pivot towards his left side with his right knee planted when his right knee felt weak. He was 41 years old at the time of injury and had been with his employer for two months.
Entitlement was initially accepted for a right knee strain, with loss of earnings benefits paid for February 23, 2017. Effective February 24, 2017, the worker returned to modified duties.
The worker subsequently underwent an MRI for his right knee on April 2, 2017, which confirmed a medial meniscus tear and rupture of the anterior cruciate ligament for which the worker would require subsequent surgical intervention.
In light of the new diagnoses, the worker’s file was referred to an Occupational Medical Consultant (OMC), Dr. Gallimore, to provide an opinion as to whether these diagnoses were compatible with the mechanism of injury.
Case Manager’s decision
Following review of Dr. Gallimore’s opinion, the Case Manager concluded the worker’s diagnosed medial meniscus tear and partial rupture of the anterior cruciate ligament of the right knee were compatible with the reported accident history and entitlement to these diagnoses was accepted as was the September 1, 2017 surgery.
Employer’s position
On behalf of the employer, Ms. C. argued the worker’s reporting of the accident history had been inconsistent, and the action described by the worker which caused his injury would not have resulted in the accepted diagnoses of medial meniscus tear and rupture of the anterior cruciate ligament. As a result, she was of the view entitlement should not have been accepted for these diagnoses or for the September 1, 2017 surgery.
AUTHORITY
Operational Policy Manual document:
11-01-01 Adjudicative Process
11-01-02 Decision-Making
ANALYSIS
I find the worker has entitlement to a medial meniscus tear and rupture of the anterior cruciate ligament and related surgery under the claim. In arriving at this decision, I have had regard for the arguments presented, the relevant file and medical information, and for the applicable Policy.
Accident history reported
In order to determine whether the worker’s reporting of his accident history was consistent, and more importantly, whether it is compatible with the accepted diagnoses recorded on the MRI, I must have regard for the accident history reported, and in particular, for the contemporaneous accident reporting details submitted to file. The following is a list of the more pertinent documents which confirm the accident history details:
the Worker’s Report of Injury records that the worker was sanding a ceiling with a sanding pole when his right knee banged the guard rail end – the following day, February 22, 2017, while coming down scaffolding, he turned to pivot towards his left side when his knee felt weak;
the Employer’s Report of Injury indicates the worker was sanding on the stairwell when he banged his knee on the bottom of a wood rail and didn’t think anything of it – the next day, he was on a scaffold and went down to grab his mud, and as he turned, that’s when his knee felt weak;
the February 22, 2017 Trillium hospital report records “r. knee pain, banged at work yesterday on wooden banister, no pain initially, pain increased today when pivoted on leg”;
the March 12, 2017 clinical note entry provided by the worker’s physician indicated “injured r. knee at work 21feb2017, banged knee in wood railing and next day twisted”;
the Musculoskeletal Program of Care Initial Assessment Report of May 19, 2017 records the following accident history: “Pt was sanding overhead in stairwell and hit inside r. knee on butt end of guardrail, then following day was climbing down from scaffolding, planted and turned on left leg and felt a lot of pain”;
the July 6, 2017 WSIB Specialty Hip and Knee Program report recorded the following: “he hit his knee sharply on a metal guard rail. It is unknown if this was significant. However, the following day, on February 22, 2017, while climbing down from scaffolding he sustained a valgus internal rotation injury to his right planted lower extremity. He developed sharp pain, swelling and stiffness of the right knee”.
Memo 8 recorded by the Eligibility Adjudicator documents the following: “coming up to the corner of where he was standing, he was looking up and not looking down; knee banged into the end of the rail when he put his foot forward, it was the butt end of rail; inner side of right knee made contact with the rail, it was painful but worker didn’t think much of it; it didn’t seem like there was a twist, didn’t really feel the pain until the following day; next day coming down off the scaffold, turned with his right knee and that’s when he felt a pain; iw came off scaffold and pivoted on his right knee; within 5 to 15 minutes iw’s knee was swelling up and it hurt more to drive home to walk”
Having carefully reviewed the above descriptions of injury in the contemporaneous reports, I must respectfully disagree with Ms. C.’s submission and find that the injury description recorded in the various reports is not inconsistent. Rather, I find the worker has been quite consistent in his reporting and description of his accident to his employer, the medical practitioners, and the WSIB.
Although the employer brought attention to the fact that one person had recorded it was a metal rail, and another recorded it was a wooden bannister, in my view, this is an insignificant difference. I find some minor inconsistencies are relatively normal in general, particularly when conveying two separate occurrences on February 21 and February 22 to a number of individuals. Of greater importance is the worker’s account of how he felt pain when his foot was planted when he turned on February 22, 2017 – this important detail remained largely consistent in all of the above reports.
Review of relevant file medical reports
The February 22, 2017 Trillium hospital report recorded the worker had right knee pain. It was noted he banged it at work yesterday on a wooden banister, though he had no pain initially. His knee pain increased on February 22, 2017 when he pivoted on his leg. Mild medial joint line pain was documented. Diagnosis rendered was right knee sprain.
The worker was seen by his physician on March 12, 2017 who documented the accident history. He noted that the x-ray taken at the hospital was normal as was the ultrasound. Impression was ‘rule out degenerative/traumatic meniscal tear’. He requested an MRI.
The April 2, 2017 MRI of the right knee recorded the following impression: “there is a multiplanar tear of the medial meniscus, mild bony contusion of the medial tibial plateau, and a small knee joint effusion. A partial rupture of the anterior cruciate ligament is suspected”.
On June 27, 2017, the worker underwent assessment at the WSIB Specialty Hip and Knee Program, where a detailed accident history was provided and an examination was undertaken. In summary, Dr. Taromi, Orthopaedic Surgeon, confirmed the worker had sustained a valgus internal rotation injury to his right planted lower extremity on February 22, 2017, and developed sharp pain, swelling, and stiffness of the right knee since that time. Diagnoses were confirmed as right-sided knee medial meniscal tear which was traumatic, and based on the mechanism of injury, valgus internal rotation on planted foot. It was noted that further recovery was expected with operative and non-operative management.
In an August 11, 2017 follow-up report, Dr. Taromi recommended right-sided knee arthroscopic-assisted ACL reconstruction and partial meniscectomy and debridement.
The worker underwent surgical intervention for his right knee on September 1, 2017, consisting of the following: 1. Right-sided knee arthroscopic assisted anterior cruciate ligament reconstruction with hamstring tendon autograft; 2. Partial meniscectomy of the medial meniscus; 3. Compartments debridement; and, 4. Right-sided knee arthroscopic lateral release to realign the patellofemoral joint. Post-operative diagnoses were as follows: right-sided knee full-thickness tear through anterior cruciate ligament, complex tear through posterior horn with extension to the posterior aspect of the body of the medial meniscus; and, minimal fraying of cartilage over the medial tibial plateau.
Subsequent WSIB Hip and Knee/Surgical Specialty Clinic reports submitted to file post-operatively confirmed the occupationally-related diagnoses of post right knee ACL reconstruction and medial meniscectomy.
Analysis
All decision-makers use the same criteria for ruling on initial entitlement to WSIB benefits. This system is known as the "five point check system."
An allowable claim must have the following five points
an employer
a worker
personal work-related injury
proof of accident, and
compatibility of diagnosis to accident or disablement history.
The worker’s file was also reviewed by Dr. Gallimore on May 30, 2017, who reviewed the file information and provided the following opinion:
In my opinion, in a previously asymptomatic individual, both workplace incidents could account for all MRI findings. Specifically, the incident on February 21, 2017 was a contusive mechanism of injury and would account for the mild bony contusion of the medial tibial plateau and a small knee joint effusion. The incident on February 22, 2017 was a described pivoting mechanism which would account for a partial ACL rupture and a medial meniscus tear. It is likely that the second workplace incident worsened an undisplaced asymptomatic medial meniscus tear.
Having carefully reviewed the file medical evidence, and having considered the mechanism of injury and Dr. Gallimore’s professional medical opinion, I concur with Dr. Gallimore and conclude the findings noted on the MRI of April 2, 2017 are consistent with the described accident history.
Contrary to Ms. C.’s argument that a torn ACL would have to be the result of a fairly severe trauma such as a football or soccer injury, I find the manner in which the worker described striking his knee on February 21, 2017 is consistent with the findings of ‘mild bony contusion of the medial tibial plateau and small joint effusion’. However, more importantly, the second described incident of February 22, 2017 when the worker pivoted with his foot planted would also be compatible with the ACL tear and medial meniscus tear, particularly as the worker was asymptomatic prior to his injury under the claim and the MRI did not reveal any significant degenerative pathology. Furthermore, Dr. Taromi, who assessed the worker also indicated in his reports that the compensable post-operative diagnoses were right knee ACL reconstruction and medial meniscectomy.
Consequently, having considered the arguments presented, the relevant file medical information, the reported accident history, and the applicable Policy, I find the worker’s diagnosed medial meniscus tear, rupture of the anterior cruciate ligament, and related surgery is compatible with his injury under the claim. As a result, I find the worker was appropriately granted entitlement to these diagnoses and to the September 1, 2017 surgery.
CONCLUSION
I conclude the worker has entitlement to a medial meniscus tear, mild body contusion, rupture of the anterior cruciate ligament, and to the September 1, 2017 surgery under the claim.
The employer’s objection is therefore denied.
DATED June 29, 2018
L. Diaz
Appeals Resolution Officer
Appeals Services Division