Highlights of Noteworthy Decisions

Decision 1701 18
25/10/2021
J. Frenschkowski
  • Health care (medical aid) (drugs)
  • Myofascial pain syndrome
  • Neuralgia (occipital)

The 45-year-old worker was employed as an HVAC apprentice when he sustained multiple work-related injuries on March 4, 1998. He was repairing an air-conditioning unit located in the ceiling of a commercial property when he received an electric shock of between 300-600 volts. The worker was unable to let go of the unit and was hanging by his arms until he was able to free himself about 10-20 seconds later. Upon release from the unit, the worker fell approximately 10-12 feet to the ground, landing on his back.

In this appeal the worker was seeking entitlement for injuries to his neck and shoulder girdle, including entitlement for a permanent impairment and NEL award, on an organic basis; ongoing entitlement for headaches/head pain, including entitlement for a permanent impairment and NEL award, on an organic basis; and entitlement to health care benefits, in particular, trigger point injections and injections into his occipital nerve, as well as reimbursement for travel expenses associated with this treatment.
With respect to the injuries to the neck and shoulder girdle, and for headache/head pain, the Vice-Chair found that the compensable injuries sustained in the workplace accident led to a chronic myofascial pain syndrome which had, itself, caused greater occipital neuralgia, and that there was an ongoing impairment due to these compensable conditions.
In reviewing Tribunal decisions, the Vice-Chair found that there was some consensus that myofascial pain syndrome was to be considered an organic condition, unless the severity of the pain was, or became inconsistent with the organic findings of the compensable injury, in which case the criteria for entitlement under the Board's policy on chronic pain disability would have to be satisfied.
The worker sustained traumatic injuries to his neck and shoulder girdle as a result of electric shock, hanging from the air-conditioning unit, and then falling to the ground. His ongoing pain was explicable on an organic, musculoskeletal basis, and there was no indication that the level or severity of the worker's pain was inconsistent with the organic findings. The worker therefore had entitlement for these areas as myofascial pain syndrome on an organic basis. The worker also had entitlement for occipital neuralgia, which was also an organic condition. The Board was directed to assess this condition for the purposes of determining the level of permanent impairment, noting that these conditions are not specifically rated in the AMA Guides as well as the complexities of the worker's conditions in this case, all of which were to be taken into account in the assessment.
With respect to entitlement for health care, the Vice-Chair found that the evidence with respect to the benefit from and effectiveness of the injection therapy was equivocal. When the frequency of the trigger point and greater occipital nerve injections was considered in light of the benefits, it had not been demonstrated that the treatment was appropriate or sufficient. As the evidence did not demonstrate that the treatment via trigger point and greater occipital nerve injections was necessary, appropriate and sufficient, health care benefits for same were denied.
The appeal was allowed in part.