APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20250039
OBJECTING PARTY: WORKER
REPRESENTED by: WORKER REPRESNTATIVE
RESPONDENT PARTY: EMPLOYER
HEARING: VIDEOCONFERENCE
HEARD by: KELLY GORDON, APPEALS RESOLUTION OFFICER
ADDITIONAL ATTENDEES: OBSERVERS
ISSUE
The worker, through their representative, is objecting to the Occupational Disease (OD) Adjudicator’s decision dated March 2, 2023, and the Eligibility Adjudicator’s (EA) decision dated March 29, 2023. Specifically, the worker objects to the denial of initial entitlement to their left foot injury.
BACKGROUND
On January 23, 2023, this truck driver got out of their truck to make a delivery at a customer’s location when they stepped in a puddle that they thought was water. The worker did not think anything of it, until the end of their shift, when they took off their steel toe shoes and socks. It was at this time that they noticed their foot was covered in blood, and their skin came off with the sock. The only thing the worker could relate their left foot condition to was stepping in the puddle while making a delivery earlier that day. The worker did not feel any left foot burning or sensation at the time they stepped in the puddle as they have neuropathy in their feet from pre-existing diabetes. On January 24, 2023, the worker reported the injury to their employer, and they sought medical attention. As the injury prevented the worker from performing their regular job duties, the worker went off work.
On February 1, 2023, initial entitlement was allowed for health care benefits only for the left foot injury. As the worker was claiming a chemical in the puddle caused their left foot injury, the claim was referred to the OD department for further adjudication of the worker’s lost time from work and ongoing entitlement.
Upon receipt of further information from the employer, and after considering the medical information submitted to file, the OD Adjudicator determined there is no evidence of a chemical exposure. Therefore, in their decision dated March 2, 2023, the OD Adjudicator denied entitlement to health care and loss of earning (LOE) benefits related to a chemical exposure. The claim was referred back to the EA who also reviewed the updated evidence submitted to file, and determined there is no causal relationship between the accident history reported, and the diagnosis on file. Therefore, in the decision dated March 29, 2023, the EA overtured the prior decision that allowed initial entitlement to the left foot injury.
The worker representative submitted the Appeal Readiness Form (ARF) dated October 4, 2023, confirming their objection to the OD Adjudicator’s March 2, 2023 decision, and the EA’s March 29, 2023, decision that denied initial entitlement to the left foot injury.
The worker’s objection to the denial of initial entitlement to a left foot injury forms the basis of this appeal.
AUTHORITY
Sections 2(1) and 15 and Regulations 3 and 4 of the Workplace Safety and Insurance Act, 1997 (the Act)
Operational Policy Manual
Published
15-02-03 Pre-existing Conditions 11-01-01 Adjudicative Process 15-02-05 Recurrences
November 3, 2008 November 3, 2008 April 9, 2021
ANALYSIS
For the reasons that follow, I find the worker does have initial entitlement to a left foot chemical burn. I also find the worker has secondary entitlement to the left leg below the knee amputation. In reaching this decision, I have carefully considered all the available information on file, the worker’s testimony, the legislation, and the relevant operational policies.
The employer did not participate in this appeal, and no submissions have been provided for my review.
During the appeal hearing, the worker representative confirmed they are requesting initial entitlement to a chemical burn as the cause of the worker’s left foot injury. They are also requesting secondary entitlement to the worker’s left leg below the knee amputation.
The worker testified that when they were in their early 30s, they were diagnosed with diabetes. Although they were first diagnosed with type one diabetes, it was later determined they had type 2 diabetes. As such, they were taken off insulin, and prescribed Metformin. The worker stated that prior to the
January 23, 2023, incident, their diabetes was under control, they played sports, and they went for walks. The worker stated they were very active. The only prior issue they had was in May 2021, when a screw went through their left boot into their baby toe while they were working. It took a couple of weeks for the injury to heal. However, the worker did not require stitches, and after a Tetanus shot and antibiotics, the injury fully healed. The worker did not miss time from work for this injury.
In terms of the left foot injury in this claim, the worker testified that on Sunday night (January 22, 2023) they left home to do a long-haul trip to another province. The worker arrived at the customer’s location early Monday morning. The worker stated that this customer’s location is very clean, and they do not relate their injury to any exposures at this location. After making this delivery, the worker was re-routed to a customer in City A. The City A customer is a recycling company, and the worker had never been to this customer’s location before. This customer recycles both plastic, and paper. The worker described the loading dock where the worker picked up their load, and stated it is beside a pile of recycled plastic. A recycling truck dumps their load of recycled plastic in this pile.
The worker testified that the recycling pile is approximately five feet from the loading dock, and in the pile, they could see both commercial and household cans, bottles and plastic. Specifically, the worker testified they saw commercial cans (they did not know what they contained), old bottles, paper, laundry detergent, soap bottles, cleaners, and bleach bottles. The worker stated the whole facility had a chemical smell, and they could see that chemicals had spilt out of the open bottles and cans that were in the pile. The worker could see the chemical marks on the cement.
The worker testified that on January 23, 2023, when they went to the recycling facility, the ground was wet from melted snow, and there were puddles on the ground. The worker parked at the loading dock, they got out of their truck, walked to the back, and opened the back truck doors. They then got back into their truck and backed the truck up. After the tuck was loaded, they walked to the back of the truck to close the doors. This is when the worker stepped into the puddle, and the puddle was in close proximity to the pile of recycled plastic. The worker stated that the puddle was in a pothole, so the puddle was deep, and covered their whole left shoe. They only stepped in the puddle with their left foot, not the right foot. They knew their shoe was soaked as their sock above the top of the shoe got wet. The worker closed the truck doors and left. The worker then drove for about six hours and stopped in City B where they were staying for the night. When they got to their room, the worker took off their shoe, and they noticed their shoe was filled with blood. When they took off their sock, their skin came off with the sock. The worker stated that they have always had neuropathy in their left foot, and that is why they did not feel anything until they took off their sock. The worker stated they were in shock as nothing like this had happened to them before, and they phoned their wife who made an appointment with their doctor for the next day when they got home. The worker called their employer the next day, as they were not able to work.
The worker testified that they did nothing else that would have caused their left foot injury. Although the worker was wearing shoes that were somewhat new, they had been wearing the shoes for a couple of months with no issues, and they confirmed they had no open sores or blisters on their left foot. In addition, the worker stated that they had no issues with their right foot, so they stated their left foot problem was not due to the shoes. The worker confirmed they did not step in the puddle with their right foot, and they cannot relate the left foot injury to any other cause than a chemical exposure at the recycling facility. The worker testified that the pile of open recycled cans and plastics contained chemicals, and that the chemicals must have gotten into the puddle of water that the worker stood in with their left foot. This was the worker’s only left foot exposure as they were on a long-haul trip, and they were only driving and loading their truck. Nothing else happened to their left foot.
The worker testified that although the outside of their safety shoe was not damaged due to a chemical exposure, the inside of their left shoe had markings, and it was discoloured, after the exposure at the recycling facility. Although the worker is of the opinion that there were chemicals in the puddle that they stepped in, they have no idea what chemical they were exposed to. The worker stated that Dr. H, the worker’s family doctor was also of the opinion that the left foot injury was from a chemical burn.
The worker stated the left foot wound would not fully heal, and they continued to develop infections. As such, Dr. H referred the worker to Dr. L who advised the worker they needed surgery. Although the worker underwent the surgery, the left foot would still not heal, and continued to get infected. The left foot then went gangrene which led to the amputation below the knee.
The worker testified that they lost time from work due to the injury, and in June 2023, their boss told them that they cannot work any longer. The worker asked the employer to provide them with modified duties, but the employer advised them that they cannot. The worker applied for sick and accident benefits, and these benefits were allowed for 26 weeks. The sick benefits end the beginning of
March 2025.
The worker testified they are currently receiving rehabilitation to learn how to walk with their prosthetic leg. The worker believes they can return to driving/regular duties after rehabilitation, and they are hoping to return to work in April 2025.
I find it important to note here that the worker is claiming a chemical burn, and chemical burns are adjudicated as an occupational disease. As such, I refer to Section 2 (1) and Section 15 of the Act, and by regulation in Schedules 3 & 4 of the Act. If the disease is not listed in the Schedules and a relevant policy has not been developed, entitlement to benefits and services is determined based on the merits and justice of the case. It must be established that it is more probable than not that the circumstances of the worker’s employment and exposure history significantly contributed to the development of the medical condition being claimed. In this case, the worker relates their left foot condition to occupational exposures while performing their job duties as a truck driver. As chemical exposures are not listed under Schedule 3 or 4 of the Act, and noting there are no specific WSIB policies for this condition, entitlement in this claim will be based on the merits and justice of the individual case. As this is an occupational disease claim, the evidence must show that the workplace exposures significantly contributed to the development of the left foot condition.
As this appeal addresses initial entitlement, I also refer to Policy 11-01-01 that states a claim created by the WSIB for a workplace accident/disease is adjudicated based on entitlement principles, and the facts of the case. 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 an employer, a worker, a personal work-related injury, proof of accident, and compatibility of the diagnosis to the accident or disablement history. After considering all the evidence, I find all criteria in Policy 11-01-01 has been met.
The worker submitted the Worker’s Report of Injury, Form 6 dated February 9, 2023. The worker states that on January 23, 2023, they were making a delivery to a customer, and while there, they stepped in a puddle that they thought was water. That night when they removed their shoe and sock, the skin on their left foot came off. The worker did not notice the injury until they took off their shoe. The worker reported the injury, and they sought medical attention the next day.
As per the memorandum dated February 9, 2023, the worker contacted the EA. The worker stated they are a truck driver, and on January 23, 2023, they drove to a customer in City A. When they got out of the truck at the customer’s location, they noticed the driveway was wet with puddles. The worker stepped in a puddle that covered their shoe. The worker thought they stepped in water, and they did not think anything of it. Therefore, the worker loaded the truck, closed the truck doors, and they left the premises. The worker then drove for six hours. At the end of their shift, they took their shoes off to change their socks, and noticed that whatever they stepped in, had taken the skin off their left foot. The only thing they could think of as the cause was that there must have been a chemical in the puddle that they stepped in. However, the worker reported that their shoe was not eaten by acid. They reported they have diabetes and due to neuropathy, they have no feeling in their left foot. As such, they did not feel any burning or sensation in their left foot. The worker reported they sought medical attention when they got back home on January 24, 2023.
In the February 9, 2023, memorandum, the worker also states they have been going to Clinic A for their foot treatment. The worker is off work as their left foot injury prevents them from performing their regular job duties, and the employer has not offered them modified duties.
The employer submitted the Employer’s Report of Injury, Form 7 dated February 1, 2023. The employer states that on January 26, 2023, the worker reported that while working on January 23, 2023, they found their foot covered in blood after their shift. The worker believes they must have stepped into a substance that caused a burn to their foot. The worker reported that the incident occurred while at a customer’s location, and that the worker had sought medical attention.
As per the memorandum dated February 9, 2023, the EA contacted the employer, and advised them that the claim was allowed. The employer stated they would be appealing the allowance of initial entitlement as the place the worker delivered to on January 23, 2023, does not use acid. The employer also noted that the worker’s shoe was not eaten by acid. Therefore, the employer questioned the cause of the worker’s left foot injury.
In my review of the medical evidence on file, I note Dr. H completed a Health Professional’s Report of Injury, Form 8 dated January 26, 2023. Dr. H states the worker was wearing improper footwear, and that the worker developed significant desquamation of the skin of the foot secondary to a large blister that developed, background of neuropathy. The diagnosis provided is desquamation/large blister reaction to the foot.
Dr. H submitted clinical notes for the worker’s visits pertaining to their left foot injury. In the note dated January 24, 2023, Dr. H states the worker wore some shoes for work over the weekend, and they ripped the skin over their left foot. The skin was observed to be off the heel and off another part of their foot. The worker reported no pain, but Dr. H states the worker has neuropathy. The foot was cleansed and bandaged, and Dr. H provides a diagnosis of left foot injury. When seen on January 26, 2023,
Dr. H notes the worker requested a Form 8 be completed as the injury occurred at work due to their new work boots. No significant change in their foot was reported, and the worker had not yet called Clinic A. As the worker is a truck driver, and that they do not use their left foot to drive, Dr. H states the worker can return to work. Dr. H also states that when they removed the bandage, there was desquamation, skin removal to the entire heel, and to the arch of the foot as well as to the fifth toe. No obvious signs of infection.
The worker saw Dr. M at Clinic B on January 30, 2023. As per the notes submitted, the worker presented in the emergency complaining of left foot ulcerations with skin sloughing due to chemical burn from an unknown chemical a few days prior. The worker saw their family doctor who prescribed antibiotics for skin infections. The worker had multiple skin ulcers, and Dr. M states a CT scan showed superficial cellulitis. The worker was prescribed Tiazocin, and they were referred to Clinic A.
When seen on January 30, 2023, the worker reported to Nurse Practitioner (NC) P, that while driving on January 23, 2023, to City A, they stepped several times in standing water. When they inspected their left foot several hours later, they noticed a large amount of sanguinous discharge, and open blisters. The worker was referred to the emergency department.
When seen on February 2, 2023, Dr. H notes that they clarified the accident history. Although, the worker reported they were wearing new footwear, the worker advised that they stepped into a puddle that they thought was water but was concerned it was a chemical. Dr. H states a chemical burn is much more consistent with their injury.
Also in the February 2, 2023, note, Dr. H states the worker recently started to experience more systemic symptoms over the weekend with fever, and on Monday they were seen in the emergency room. The worker was started on antibiotics and fluids. The fever resolved, and the worker is off work. The diagnosis provided is chemical burn. In the note dated February 9, 2023, Dr. H states that Clinic A commented that there remains quite a bit of heat, and some drainage. Overall healing is well. The worker was reassessed, and Dr. H states the worker is fit to return to their regular job duties as a truck driver starting February 13, 2023.
In the clinical note dated February 14, 2023, Dr. H states the worker was initially seen for a workplace injury on January 24, 2023. Dr. H initially misunderstood the injury to be related to a large blister that developed due to new workplace footwear. However, upon follow up, the worker described stepping into a puddle of unknown substance, and likely suffered a chemical burn. Dr. H states this is much more consistent with the initial presentation, and Dr. H submitted a corrected Form 8 clarifying the accident history provided. Dr. H includes a diagnosis of chemical burn.
In the clinical note dated February 28, 2023, Dr. H again diagnosed the worker with a left foot chemical burn, and they state the worker continues with wound care. Dr. H advised that they clarified the injury on the Form 8 that they sent to WSIB. Given the degree of blistering, Dr. H states it certainly is consistent with a chemical burn. On August 25, 2023, Dr. H states it is their opinion that the injury suffered is most in keeping with a chemical exposure, and the worker provides a history of exposure to a puddle while at work. While the worker does have a history of diabetes which has prolonged healing and led to some complications, the original injury, in Dr. H’s opinion would not have occurred in the absence of the exposure. The worker was unable to work on several occasions due to the injury.
On October 4, 2023, the worker underwent a left plantar heel wound ulcer to calcaneus. The procedure was complex muscle excision/debridement of the left foot, elevation, and transfer of major neurovascular island flap-pedicled medial plantar artery flap, split-thickness skin graft for closure of the large complex plantar foot defect. Although the medical evidence indicates the left foot wound healed, the left foot condition later worsened resulting in a left below the knee amputation on June 28, 2024.
The EA referred this claim to an Occupational Medical Consultant (OMC) at the Occupational Health Hub (OHUB) and requested a medical claim review. The EA asked the OMC to provide a medical opinion as to whether the natural progression of the underlying diseases and chronic left foot ulcer lesion would have resulted in a below the knee amputation.
In response, Dr. D, orthopaedic surgeon submitted their review dated November 19, 2024, and they provided the following opinion:
This worker has a chronic history of diabetes mellitus and peripheral neuropathy in bilateral lower limbs/feet. There is a pre-DOI history of a chronic left foot ulcer; however, the most recent previous mention of this complaint in the provided medical was in May 2021, with no continuity of complaint between that time and the new complaint in January 2023. The ulcer in May 2021 was also noted to be on the plantar aspect at the 5th metatarsal area, rather than the heel and arch areas which were the primary areas affected in January 2023. The worker reports stepping in a puddle of unknown liquid with his left foot and then noticing the skin sloughed off his left foot when he removed his boot several hours later. The worker questions whether he sustained a chemical burn to his foot and his family physician, Dr. H has suggested in their February 2023 clinical note that a chemical burn better explains the appearance of the foot. The worker also reported that he had obtained new boots recently prior to the DOI which perhaps could have resulted in abnormal rubbing and the onset of foot lesions, however, this does not explain the unilateral presentation, nor the substantial sloughing off of the skin. In my opinion, based on the provided medical, it appears the initial left heel and arch wounds can reasonably be causally related to the reported mechanism of injury, likely having arisen from an unknown chemical burn. Unfortunately,
due to the worker’s’ pre-existing chronic diabetes mellitus and peripheral neuropathy, the worker experienced significant delayed healing and infection which progressed to the point where a below the knee amputation was necessary. As such, the below the knee amputation is compatible with the claim, on the background of pre-existing diabetes mellitus and peripheral neuropathy.
The worker submitted pictures of their foot that show the skin removed at the heal and in the area under their toes. The worker also submitted pictures of their shoes that show no outside damage to the shoes. I find it important to note that the safety shoe the worker was wearing was not a boot that covered their foot up to the calf. Instead, the shoe is similar to a running shoe that only covers the foot.
Medical diagnosis
Dr. H first diagnosed the worker with a left foot injury. They specifically note a left desquamation/large blister reaction to the foot. Upon further investigation, and after confirming the accident history with the worker, Dr. H changed their diagnosis to a left foot chemical burn. The worker continued to seek medical attention with Dr. H, and in the clinical notes submitted, Dr. H continues to provide a diagnosis of chemical burn. I specifically note that in the reports submitted, Dr. H states the degree of blistering on the left foot is consistent with a chemical burn, and although the worker has a history of diabetes which prolonged the healing of the chemical burn and led to some complications, the original left foot injury, would not have occurred in the absence of the chemical exposure. Dr. D, the OMC also provides the opinion that based on the provided medical, it appears the initial left heel and arch wounds likely arose from an unknown chemical burn.
Based on my review of the medical evidence, I accept the opinion as provided by Dr. H and Dr. D. I find that Dr. H had the benefit of examining the worker’s left foot injury multiple times starting the day after the injury, and Dr. D had the benefit of reviewing all medical evidence on file prior to providing their medical opinion. As Dr. H and Dr. D are in agreement that the diagnosis is a chemical burn and noting that there are no medical opinions on file that argue this diagnosis, I accept the evidence supports the diagnosis is a left foot chemical burn.
Occupational Exposure
Based on my review of the evidence, I find it is more probable than not that the worker’s left foot was exposed to a chemical when they stepped in the puddle at the recycling facility on January 23, 2023. In coming to this conclusion, I have placed weight on the testimony as provided by the worker. Specifically, I have placed weight on the worker’s description of the pile of recycled plastic bottles and cans five feet from where the worker was standing when they were opening the doors of their truck. I also find it significant that the worker testified that in this pile of recycled plastic, they saw open plastic bottles and cans that contained chemicals such as, bleach, cleaners, and laundry detergent. In addition, the worker described the cement ground as having markings from where the chemicals had spilled. While I agree that the actual chemical the worker was exposed to cannot be confirmed, I find the worker’s proximity to the pile of plastic containers that had once held different chemicals, and that the worker stepped in a puddle that was also in the proximity of the pile of plastics, makes it more probable than not the worker’s left foot was exposed to a chemical while they were at the facility. In addition, the worker testified there were no intervening causes for the left foot injury. I have no reason not to accept this as the evidence supports the worker was driving their truck on the day of injury, and they only got out of the truck to open the truck doors. The worker did not arrive home from the overnight long-haul trip until the next day.
While I have also considered the evidence that supports the outside of the worker’s left safety shoe was not damaged, I accept the worker’s testimony is consistent with the information in the claim file.
Specifically, that the puddle the worker stepped in was deep, and that their whole shoe was submerged. As the worker was wearing a shoe and not a boot, I find it reasonable to accept that the worker’s sock above the shoe got wet when it was submerged in the puddle, and that this is how the worker’s left foot was exposed to the chemical. I also find it significant to note that the worker testified only their left foot stepped in the puddle, and that this would explain why the worker’s right foot was not injured.
As the employer did not participate in the hearing, and that the employer provided no submissions for my review, I have no reason not to accept the testimony as provided by the worker.
For the reasons stated above, I accept the evidence supports it is more probable than not that the worker’s left foot was exposed to a chemical in the puddle of water that they stepped in while at the recycling facility on January 23, 2023.
Does the evidence support it is more probable than not that the worker’s occupational exposure significantly contributed to the left foot injury?
As noted above, I accept the evidence supports the worker was diagnosed with a left foot chemical burn. I also find the evidence supports the worker’s left foot was exposed to a chemical when they stepped in a puddle while at the recycling facility. Therefore, I find it is more probable than not that the occupational exposure significantly contributed to the left foot injury. For this reason, I find the worker does have initial entitlement to a left foot chemical burn.
Pre-existing diabetes
In this case, the evidence supports the worker has a pre-existing condition. Specifically, the worker has pre-existing diabetes. As per Policy 15-02-03, entitlement for a work-related injury/disease will not be denied due to the existence of a pre-existing condition. Once initial entitlement is established, the decision-maker considers the impact, if any, of pre-existing conditions on the worker’s ongoing impairment. As noted above, I have established that initial entitlement has been accepted for a left foot chemical burn. Therefore, in this appeal, I have considered the impact of the worker’s pre-existing condition on the worker’s ongoing entitlement.
Policy 15-02-03, goes on to state that the presence of a pre-existing condition does not necessarily mean it is a cause of the worker’s impairment or that the impairment is no longer work-related. When a
pre-existing condition is evident, or becomes evident, the work-relatedness of the ongoing impairment must be monitored. If the pre-existing condition is not impacting the worker’s impairment, there is no effect on the worker’s benefits. If the pre-existing condition is impacting the worker’s impairment, benefits will generally continue as long as the work-related injury/disease continues to significantly contribute to the worker’s impairment.
I have reviewed the medical evidence, and I accept the medical reports as provided by Dr. Hill and the medical opinion obtained from Dr. D support that the worker’s pre-existing diabetes prolonged the recovery from the chemical burn. I also accept the pre-existing diabetes caused significant complications in the recovery of the work-related left foot injury, including the ongoing infections after the initial injury.
Therefore, I find the worker’s pre-existing diabetes impacted the worker’s ongoing left foot impairment. Does the evidence support entitlement to the left below the knee amputation?
For the reasons that follow, I find the worker has entitlement to the left below the knee amputation.
Policy 15-02-05 states that a worker may be entitled to benefits for a recurrence of a work-related injury/disease if the worker experiences a significant deterioration that:
does not result from a significant new incident/exposure, and
is clinically compatible with the original injury/disease.
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.
To establish that the significant deterioration is clinically compatible with the original injury/disease, the WSIB must determine that:
the body parts and/or functions affected now are the same as, or related to, those affected by the original injury/disease, and
there is a causal link between the significant deterioration and the original injury/disease.
In addressing the worker’s entitlement to a recurrence for the surgery that involved the amputation below the left knee, I have placed weight on the medical opinions as provided by Dr. H, Dr. D, and Dr. S.
In their consultation report dated August 25, 2023, Dr. H provides the opinion that although the worker has a history of diabetes which has prolonged healing, and led to some complications, the original injury, in Dr. H’s opinion would not have occurred in the absence of the occupational exposure. Dr. H also confirms the worker continued to develop left foot infections, and complications that are casually related to the January 23, 2023, injury.
I also find Dr. D’s November 19, 2024, medical opinion significant as Dr. D provides the opinion that the below the knee amputation is compatible with the claim, on the background of
pre-existing diabetes mellitus and peripheral neuropathy.
In the medical note dated May 23, 2024, Dr. S, Vascular Surgeon states the worker was seen for a left heel deep wound. Prior to this visit, the worker was seen in November and December 2023, and in October 2023, the worker underwent a skin graft to close the left heel defect. Dr. S states that unfortunately the wound fell apart again in the spring, when it was reinfected, and the worker received several rounds of antibiotics. At the time of the visit, Dr. S noticed that the left lower leg extremity revealed a rocker-bottom deformity in the left foot in keeping with advanced Charcot’s arthropathy.
Dr. S states the most definitive way to eliminate the recurrent foot infections is with a below the knee amputation, and they recommended a below the knee prosthesis. The worker underwent the recommended surgery to amputate below the knee on June 28, 2024.
Based on my review of the medical evidence, I find the worker suffered a significant deterioration in their left foot injury. I find this is supported by the multiple left foot infections that followed the work-related injury, and these infections ultimately led to the below the knee amputation on June 28, 2024. In coming to this conclusion, I have placed significant weight on the medical opinions as provided by Dr. H, Dr. D, and Dr. S. I find these opinions all support that although the worker’s pre-existing diabetes caused significant complications for the recovery of the work-related injury, had it not been for the work-related injury, the worker would not have suffered multiple left foot infections. In addition, these medical opinions support that the infections led to the left below the knee amputation. Therefore, I find the evidence supports the worker suffered a significant deterioration in their left foot injury, and that the left below the knee amputation is clinically compatible with the original injury. As such, I find the worker has entitlement to the June 28, 2024, left below the knee amputation as a recurrence in this claim.
CONCLUSION
I find the worker does have initial entitlement to a left foot chemical burn.
I also find the worker has entitlement to the June 28, 2024, left below the knee amputation as a recurrence in this claim.
I ask the operating area to determine further entitlement flowing from this appeal decision. This includes but is not limited to the worker’s entitlement to loss of earning benefits, and a Non-Economic Loss assessment.
The worker’s objection is allowed.
DATED FEBRUARY 27, 2025
Kelly Gordon
Appeals Resolution Officer Appeals Services Division