DECISION NUMBER:

20220129

OBJECTING PARTY:

WORKER

REPRESENTED by:

SELF

RESPONDENT:

EMPLOYER (NOT PARTICIPATING)

HEARING:

HEARING IN WRITING

HEARD by:

DATED:

M. RODRIGUES, APPEALS RESOLUTION OFFICER

SEPTEMBER 15, 2022

ISSUES

The worker is objecting to the following decisions:

1. A decision of October 22, 2021 by the case manager that determined the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by December 7, 2020 with no permanent impairment.

2. A decision of November 3, 2021 by the nurse consultant that denied entitlement to the reimbursement of health care equipment for ankle weights, a massager and a cane.

PRELIMINARY ISSUES

In the Appeals Readiness Form (ARF) of June 27, 2022, the worker did not identify the dates of the decision letters they objected to in this claim. However, they identified the issues in dispute as ongoing pain to their right hip, low back, left leg and left ankle, including prescriptions from their doctor. I noted the case manager ruled on ongoing entitlement and determined those areas of injuries fully resolved in the October 22, 2021 decision. In the ARF of February 9, 2022, the worker objected to the decision of November 23, 2021. That decision confirmed entitlement to the reimbursement of health care equipment for ankle weights, a massager and a cane remained denied. I noted the nurse consultant reviewed the new information provided and upheld the original decision of November 3, 2021. As such, for this appeal, I will review the issues of ongoing entitlement under the October 22, 2021 decision and reimbursement of health care equipment under the November 3, 2021 decision.

BACKGROUND

On September 30, 2020, this seasonal general labourer injured their right hip and right thigh when a lift truck backed into them. The worker immediately reported their injuries to the employer. They did not lose time from work and resumed their regular duties. Their seasonal contract ended on October 3, 2020. The worker sought health care on October 5, 2020. Initial entitlement was accepted for health care benefits for sprains to the right hip and right thigh.

Updated medical information came to file in December 2020, indicating the worker injured their left ankle and left leg. On December 15, 2020, the claim was denied. The eligibility adjudicator was unable to establish if the worker sought health care for right hip and right thigh sprains. Entitlement to left hip, left thigh and left ankle/foot injuries were denied because there was insufficient evidence to support how those areas of injury were related to the September 2020 workplace accident.

On August 30, 2020, the eligibility adjudicator reconsidered and accepted initial entitlement to health care benefits for the right hip, low back, left lower leg and left ankle soft tissue injuries. On September 23, 2021, the worker requested reimbursement for ankle weights, a massager and a cane.

In a decision letter of October 22, 2021, the case manager determined the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by December 7, 2020 with no permanent impairment. The case manager found the clinical evidence did not support the ongoing issues the worker was experiencing in their left leg and left ankle were related to the workplace accident. The decision was reconsidered on December 6, 2021, but the original decision was upheld.

In a decision letter of November 3, 2021, the nurse consultant denied entitlement to the reimbursement of health care equipment for ankle weights, a massager and a cane. The nurse consultant determined the ankle weights and massager were not medical items, nor necessary or appropriate to aid in the worker’s recovery. The nurse consultant found the cane was not necessary for the worker’s recovery, as it was obtained after their injuries had fully resolved. The decision was reconsidered on November 23, 2021 and June 1, 2022, but the original decision was upheld.

The worker disagreed and objected to the decisions of October 22, 2021 and November 3, 2021.

AUTHORITY

Operational Policy Manual

Published

11-01-05 Determining Permanent Impairment

November 3, 2014

17-07-06 Health Care Equipment and Supplies

April 6, 2009

ANALYSIS

I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision.

Issue #1 – Did the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolve by December 7, 2020?

For the reasons that follow, I find the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by February 23, 2021 with no permanent impairment.

Worker position

In the Intent to Object Form of November 19, 2021, the worker stated they continued to have ongoing leg pain and had not fully recovered from their work-related injuries. They indicated they have ongoing pain when lifting and putting weight on their left leg to get dressed, along with performing some personal care activities. The worker stated they spoke with their doctor about it as well.

Employer position

The employer chose not to participate in this appeal and did not provide any submissions for my review.

Policy

In order to determine if a worker has fully recovered from his/her work-related injury, the information needs to show whether an ongoing work-related impairment exists. This is detailed in policy 11-01-05 (Determining Permanent Impairment). The policy states an impairment means a physical or functional abnormality or loss, including disfigurement, which results from an injury and any psychological damage arising from the abnormality or loss.

Recovery from the work-related injury is considered to have been made if there is no evidence of an ongoing work-related impairment at the time maximum medical recovery (MMR) is reached. MMR means that a plateau in recovery has been reached and no further significant improvement is expected. To determine if MMR is reached, decision-makers consider whether recent clinical evidence indicates any change in the work-related injury, the worker is receiving or will receive treatment that is likely to improve the work-related injury, or the worker is receiving treatment or using medication to maintain the current level of recovery. Once MMR has been determined, decision-makers consider whether there is an ongoing impairment based on the clinical evidence.

Findings

I do not accept the worker’s position that ongoing entitlement for their work-related injuries is in order. I find the available clinical evidence supports the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by February 23, 2021 with no evidence of a permanent impairment. I found the x-ray results of October 19, 2020 and November 5, 2020, clinical notes of November 2 and 9,

2020 and December 7, 2020, physiotherapy medical note and discharge report of December 9, 2020 and February 25, 2021 and absence of clinical evidence from March 2021 to May 2022 be persuasive in reaching my conclusion.

On October 19, 2020, the worker had an x-ray taken of their lumbar spine, pelvis, hips and sacroiliac (SI) joints. It revealed mild to moderate degenerative changes in both hips and SI joints. There was no evidence of a fracture or dislocation. Moderate facet disease was present at L3-L4, L4-L5 and L5-S1 levels, along with mild anterolisthesis of L4 on L5 and mild disc space narrowing at L4-L5 and L5-S1 levels. In the clinical note of November 2, 2020, the family doctor indicated the worker’s leg pain could be the result of severe disc degenerative disease (DDD) at the L5 level of the spine and SI joints, causing poor posture.

I interpreted the x-ray report and clinical note to mean the worker’s leg pain may be the result of the degenerative changes in their low back. I also noted the doctor did not order any further tests for the worker’s low back following the x-ray findings.

On November 5, 2020 the worker had an x-ray taken of their left ankle. The findings were unremarkable for the tibia, fibula and alignment. There was no fracture or dislocation present. There was no evidence of significant joint effusion or soft tissue swelling. The doctor reviewed the x-ray findings and discussed the results with the worker on November 9, 2020, indicating it was normal. As such, I interpreted the x-ray report and clinical note to mean the worker’s left ankle soft tissue injury had fully resolved.

Of significance, on December 2, 2020, I noted the worker had an arterial Doppler ultrasound taken on their left leg. On December 7, 2020, the family doctor called the worker to discuss the results, stating the

Doppler results were normal. The worker asked that an MRI be taken of their foot, as they were having pain since the workplace accident. The doctor reviewed prior investigations, noting the worker had DDD starting from L3-S1 and in both SI joints, and noted they had some left knee issues as well. While the worker felt this happened after the date of injury, the doctor opined there was a possibility it was triggered, but that it could be related and it was radiating to the lower leg as the nerves were involved.

I interpreted this clinical note to mean the worker had degenerative changes in their low back, which may be the cause of their leg pain. However, I noted that in a medical note of December 9, 2020, the physiotherapist clarified the areas of injury. The physiotherapist noted the worker complained of pain from their left hip to toes. The pain was concentrated along the outer aspect and posterior aspect of the left leg into the left hip joint and from the knee to the left hip joint. In my view, this supports the worker continued to experience pain in their left leg and attend physiotherapy beyond December 7, 2020.

The physiotherapy discharge report of February 25, 2021 indicated the worker attended treatment between November 24, 2020 and February 23, 2021. The worker’s pain in their left ankle, left calf, left upper thigh and left hip resolved. They used a cane due to their antalgic limp, but now had no limp or pain. The physiotherapist opined the worker was fully functional and indicated they could return to unrestricted activity. Of note, the report did not mention a right hip injury.

I afforded significant weight to the physiotherapy discharge report of February 25, 2021. I interpreted this to mean the worker had no restrictions for their low back, right hip, left lower leg and left ankle injuries. I find the discharge report supports the work-related injuries fully resolved by February 23, 2021 with no evidence of a permanent impairment. This is further supported by a physiotherapy clinical note of February 25, 2021, which indicated that modalities helped settle the worker’s acute pain and inflammation. It was recommended the worker continue with their home program for at least one-year post-date of injury.

Noting policy 11-01-05 (Determining Permanent Impairment), I find the available clinical evidence supports the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by February 23, 2021 with no permanent impairment. I find it compelling that no further treatment was recommended after the worker was discharged from physiotherapy in February 2021. I noted the family doctor completed a Functional Abilities Form on June 9, 2022 for the worker’s hip, low back, leg and left ankle. No return to work was recommended at that time. However, I find there is insufficient clinical evidence to support ongoing entitlement to the work-related injuries given the absence of clinical notes or medical reports in the case record between March 2021 and May 2022.

As such, I am satisfied the lack of available clinical evidence and restrictions beyond February 23, 2021 is persuasive evidence of a full recovery. I find there is insufficient clinical information to support that a permanent impairment arose out of the worker’s low back, right hip, left lower leg and left ankle injuries. Thus, I find the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by February 23, 2021 with no permanent impairment.

Issue #2 – Is entitlement to health care equipment in order for ankle weights, massager and a cane?

For the reasons that follow, I find entitlement to ankle weights, a massager and a cane remains denied.

Worker position

In the Intent to Object Form of November 19, 2021, the worker stated their physiotherapist recommended they get ankle weights, a massager and a cane. They opined their doctor also supported the

physiotherapist’s recommendation. In the ARF of February 9, 2022, the worker opined that due to the COVID-19 pandemic, it took time to obtain a prescription and indicated their claim was not closed. They argued they continued to have ongoing pain due to the September 30, 2020 workplace accident.

Employer position

The employer chose not to participate in this appeal and did not provide any submissions for my review.

Policy

The WSIB may authorize the purchase of one or more health care products that fall into the category of health care equipment/supplies when an injured worker requires the health care product(s) as a result of a work-related injury/disease. This is outlined in policy 17-07-06 (Health Care Equipment and Supplies). The policy states the WSIB may authorize health care equipment/supplies prescribed by a health professional when

• the claim is allowed and there is ongoing entitlement to benefits and/or services, and

• recent health care reports provide objective clinical findings, confirm the need for the health care equipment/supplies, outline treatment goals including duration of use and need, and

• the health care equipment/supplies are required as a result of a work-related injury/disease, and

• the health care equipment/supplies are used to treat and/or alleviate the effects of the work- related injury/disease, or are used to improve or maintain the worker’s independent living.

Findings

In order to consider entitlement to health care equipment for ankle weights, a massager and a cane in this claim, I weighed the available evidence and am not persuaded that all the policy requirements are met as outlined in policy 17-07-06 (Health Care Equipment and Supplies).

The first requirement is that the claim is allowed and there is ongoing entitlement to benefits and/or services. However, I do not find that requirement is met. While the claim was allowed for initial entitlement to low back, right hip, left lower leg and left ankle soft tissue injuries, I previously denied ongoing entitlement to those areas of injury. I determined the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by February 23, 2021 with no evidence of a permanent impairment.

Furthermore, I noted the worker submitted three prescriptions from the family doctor, each dated January 31, 2021, in regards to their request for health care equipment. While I acknowledge the prescriptions came to file prior to the MMR date of February 23, 2021, I find there is insufficient clinical evidence to support the remaining requirements are met. I noted the clinical information surrounding the need for the health care equipment is sparse.

I do not find the available clinical reports in the case record confirm the need for the health care equipment, nor the treatment goals, or duration for the use and need of the equipment. I am not satisfied the ankle weights, massager or cane were required as a result of the work-related injuries, or that the health care equipment would be used to treat or alleviate those injuries.

In the prescription for the ankle weights, the doctor indicated it was for rehabilitation after the left leg injury per the physiotherapist. However, I find there is insufficient clinical evidence to support why ankle weights were required for the work-related injuries and how they were used to treat or alleviate the effects of those injuries, or improve or maintain the worker’s independent living. There is a lack of

available clinical evidence from the doctor and physiotherapist to support why ankle weights were needed.

In the prescription for the massager, the doctor recommended a back massager for chronic pain. However, as I previously noted, the x-ray findings indicated the worker has degenerative changes in their low back. There are no clinical reports with findings to support or confirm the need for that health care equipment. I find there is insufficient clinical evidence from the doctor or physiotherapist to support why the massager was needed to treat or alleviate the work-related injuries in this claim.

In the prescription for the cane, I noted the doctor indicated it was ambulation due to the left leg injury. I also reviewed the discharge physiotherapy report of February 25, 2021, as it stated the worker had an antalgic limp and used a cane. Upon discharge, the physiotherapist indicated the limp was no longer present and the worker was fully functional.

I acknowledge the worker experienced pain in their left leg when lifting and putting weight on it to get dressed, along with performing some personal care activities. I also noted they indicated it took time to obtain the prescriptions for the health care equipment. However, I find there is insufficient clinical evidence to support the need for a cane and how it would assist the worker in regards to their work- related injuries. At the time of the prescription, there is no clinical information in the case record to support the worker’s gait was altered, or that they were limping, by the doctor or physiotherapist. In my view, there is a lack of clinical evidence to tie the cane to the work-related injuries.

Noting policy 17-07-06 (Health Care Equipment and Supplies), I do not find the use of ankle weights, a massager and a cane to be necessary, appropriate and sufficient for the work-related injuries in this claim. I do not accept the explanation provided by the family doctor in regards to how the ankle weights, massager and cane would assist the worker with their work-related injuries. I find there is insufficient clinical evidence to support how the need for the ankle weights, a massager and a cane were used to treat or alleviate the effects of the work-related injuries, or used to improve or maintain the worker’s independent living. In addition, I previously determined there was no ongoing entitlement in this claim for the worker’s low back, right hip, left lower leg and left ankle soft tissue injuries. I found those injuries fully resolved by February 23, 2021 with no permanent impairment. Thus, I find entitlement to ankle weights, a massager and a cane remains denied.

CONCLUSION

As outlined in the above decision, I conclude:

1. The worker’s low back, right hip, left lower leg and left ankle soft tissue injuries fully resolved by February 23, 2021 with no permanent impairment.

2. Entitlement to ankle weights, a massager and a cane remains denied.

The worker’s objection is denied.

DATED September 15, 2022

Ms. M. Rodrigues

Appeals Resolution Officer Appeals Services Division