WORKERS COMPENSATION APPEAL TRIBUNAL [PERSONAL INFORMATION] CASE ID# [PERSONAL INFORMATION] WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND

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1 WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: AND: [PERSONAL INFORMATION] CASE ID# [PERSONAL INFORMATION] WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND APPELLANT RESPONDENT DECISION #189 Appellant Maureen Peters, Worker Advisor representing the Worker Respondent Brian L. Waddell, Q.C., Solicitor representing the Workers Compensation Board Place and Date of Hearing January 16, 2014 Loyalist Lakeview Resort 195 Harbour Drive Summerside, Prince Edward Island Date of Decision May 20, 2014

2 WCAT Decision #189 Page 2 of This is an appeal by the Worker of a decision of the Internal Reconsideration Officer (the IRO ) #[PERSONAL INFORMATION] dated April 3, 2013 which upheld a decision of the Workers Compensation Board (the Board ) to close the Worker s claim for temporary wage loss and medical aid benefits effective January 9, FACTS, EVIDENCE AND BACKGROUND 2. On June 17, 2010, the Worker, a cleaner, while at work injured her back lifting a bucket of water. 3. The Board accepted the Worker s claim for back strain which was later amended to right thoracic spine/soft tissue strain with secondary pain. 4. On September 24, 2010 the Case Coordinator requested the Board s Medical Advisor, Dr. Steve O Brien, for his medical opinion as to whether the Worker s ongoing persistent symptoms, of back pain, could reasonably be related to her injury of June 17, 2010 or rather to the Worker s documented non-compensable pre-existing back condition. 5. Dr. O Brien s medical opinion reads in part:... I have reviewed the Worker s file and note her history of injury on June 17, 2010 when, At work I picked up my scrub bucket that had water in it and something snapped in my back- had a hard time to walk and could not stand up straight. The area indicated as injured on the Worker s Report of Injury is the right posterior lumbar area.... On reviewing the physician notes from Dr. Sethi, (the Worker s Family Physician) there are frequent references to a diagnosis of spondylitis, which Dr. Sethi describes as pain in back, an example being July 15, 2009, in which Dr. Sethi diagnoses

3 WCAT Decision #189 Page 3 of 21 spondylitis and states, Pain back since yesterday to right leg. Flexion/extension painful. A re-check on July 31, 2009, the notes state, Improving-walking better. On September 12, 2009, the diagnosis was spondylitis and the note states, Back paindecreased flexion/extension painful. Therefore, there was a history prior to the workplace injury that initiated this claim. An x-ray done November 10, 2008, again well prior to the Workers Compensation Claim, reports, There is a moderate thoracic lumbar scoliosis concave to the left... Dr. Allen Profitt, Orthopedic Surgeon, on June 3, 2009, states, I assessed the Worker who is a pleasant, almost 40 year old female who has known scoliosis. She works as a cleaner and has been having back pain since last fall. X-rays were long standing scoliosis view and she does have a well-balanced curve, around 26 to 30 curvature. Clinically she has some mechanical findings, discomfort with rotational and side bending movements as well as spinal extension... People with scoliosis, the incidences with mechanical low back pain is really not much more that the general population, of course, back pain occurs in 90 percent of the general population. Therefore, from review of this file, it is apparent that the Worker did have a prior history of low back pain. With the history of lifting the scrub bucket and feeling the snap in her back, the initial symptoms under this claim could be reasonably related to the workplace incident and the workplace exacerbation would be expected to have resolved after a 3 month period as the healing time for a soft tissue injury, according to the Disability Duration Guidelines & Expected Healing Times, published by Workers Compensation Board of Prince Edward Island, September 2003, would be 3 months.

4 WCAT Decision #189 Page 4 of 21 To confirm that the Worker did only have a soft tissue injury, it would be appropriate to expedite an appointment with Dr. Allen Profitt, Orthopedic Surgeon On October 18, 2010, Dr. Profitt, examined the Worker and reported to the Board: I know the Worker well from the past... In June of this year she was lifting a bucket with a mop and had a rather sudden onset of pain in the right thoracic spine area. She had to stop work at that time because of the pain. The pain seems to radiate from the medial border of the right scapula down the paraspinal musculature to her lumbar spine. She has in the past had some back pain but this is different. It starts higher in the thoracic spine as described above. The pain really has not improved since it started. She has been going to physiotherapy. She finds any repetitive work to be aggravating. She finds any prolonged walking or sitting also aggravates her pain.... She has marked tenderness to palpate (even to light palpation) over the paraspinal musculatures and also the rhomboid muscles medial to the right scapula. Radiographs are unchanged from previous scoliosis and some mild degenerative changes. The Worker has a soft tissue strain and has developing chronic pain. This is difficult to of course treat. There are no surgical lesions here. I am going to book her for a screening bone scan to ensure that we are not missing any other pathology... I am suggesting that the Worker do a re-conditioning program for the next month and then in four to six weeks time that she attempt an ease-back to work. The longer unfortunately that she is off work the less chance of her successfully returning to work are. I will review

5 WCAT Decision #189 Page 5 of 21 her in six to eight weeks and just given her encouragement today and tried to be positive today that she will have a successful easeback. 7. On November 25, 2010, Dr. Profitt assessed the Worker again and reported to the Board: I assessed the Worker today. The bone scan essentially is normal. There is a little uptake in the thoracic spine but there is no evidence of any fractures, tumors etc. I just told this to the Worker that of course this is good news. She hasn t tried a reconditioning program as of yet. She still is very disabled with her pain. I have just tried to be positive with the Worker and told her that after a month or so of reconditioning that hopefully she will attempt an ease back and be successful. At this point I have left follow up in the hands of Dr. Sethi as there are no surgical indications here. 8. On December 9, 2010, Dr. O Brien wrote to the Case Coordinator: With the localized nature of the pain, which Dr. Profitt describes as being different from her previous scoliosis and degenerative related pain, a referral to Dr. Koshi, Physiatrist in Halifax, with expertise in fluoroscopic injection techniques, may be appropriate under this claim On April 20, 2011, the Worker began an ease back program, with an expected return to work date of May 16, At the end of the ease back program schedule, an extension of a further three weeks was given in order to give the Worker more time to progress to her full duties.

6 WCAT Decision #189 Page 6 of On May 24, 2011, the Worker underwent an MRI of the lumbar spine which showed mild degenerative disc disease. 12. On May 25, 2011, Dr. Profitt assessed the Worker again and reported to the Board: I assessed the Worker who as you know works as a cleaner... In June of 2010 she was lifting a bucket with a mop in it and had a sudden onset of pain in the right thoracic spine area. The pain then seemed to work its way down to her low back and into her right leg. She has been disabled ever since with ongoing pain. She went through extensive physiotherapy and a reconditioning program. She is now attempting an ease-back but she only managed to work a half hour or hour per day and then the pain becomes overwhelming and she can t go any longer.... To examine her today, she walks with an abnormal gait tending to hold her right leg stiff. Even to light touch in the para-spinal muscolature as well as the inferior board of the right scapula, she is hypersensitive. This is rather diffuse hypersensitivity to even light touch. There are no hard neurological deficits that I can detect. The CT scan shows no surgical lesions, the bone scan was essentially normal. The MRI has not been read by the radiologist but reviewing it I don t see any evidence of gross lumbar disc herniations or spinal stenosis. The original area of pain where she has persisting pain is more in the thoracic spine area so I feel that we should get a screening MRI of the thoracic spine to ensure that we are not missing a thoracic disc herniation although this is a rare entity to leave no stone unturned I felt that we should have an MRI of the thoracic spine as well.

7 WCAT Decision #189 Page 7 of 21 If this turns out to be normal which there is a good chance it will, essentially we will be dealing with a chronic pain syndrome and this does not bode well for her returning to her previous work. I will see her in follow up after the MRI of her thoracic spine On June 10, 2011, the Worker was informed that her easeback schedule was being extended again, and that her new return to work date would be July 4, However, on July 11, 2011, the Worker s family physician, Dr. Sethi, recommended that she discontinue her ease back until after the MRI and a further follow-up with Dr. Profitt. 15. On July 6, 2011, Dr. Profitt assessed the Worker a final time and reported to the Board: I reviewed the Worker today and went over the MRI of her thoracic as well as her lumbar sacral spine. This does not show any surgical lesions. There is no evidence of thoracic or lumbar disc herniations, spinal stenosis, etc. She states that she continues to have the pain 24/7 and can not continue with her work... They tried to get her at the cash or do bagging but she felt that the pain was too bad for her to focus or do that job. Essentially she has developed a chronic spinal pain syndrome and she does not feel capable of returning to work. I just suggested that the Board sit down with her and discuss her options. I will leave this to your discretion as to whether or not a pain management clinic would be indicated. 16. On October 18, 2011, at the request of Dr. O Brien, Dr. Edvin B. Koshi, a specialist in Physical Medicine and Rehabilitation, assessed the Worker.

8 WCAT Decision #189 Page 8 of Dr. Koshi s report reads in part: The Worker presented with significant pain behavior, which was so extreme that it made the physical examination impossible for the most part. The pain pattern that she presented with and many findings in the physical examination were in non-anatomical distribution, difficult to explain medically and not consistent with any medical condition that I know of and they are difficult to explain medically.... The Worker describes her pain as sharp, throbbing, shooting, burning, and deep. It is present constantly. When asked how many flare-ups she has during a day, she indicated, All day. When asked what time of the day her pain is at its worst, she indicated, Mornings and afternoons.... On inspection, she presented with significant pain behavior. She walked in the office with a very abnormal gait, using a cane on the right. She refused to perform many of the range of motions. She screamed of pain when I lightly touched her skin lateral and to the right of the spinous processes of the T7 vertebra. A few minutes before that, she touched the same area herself much deeper, as she was trying to find the spot that hurt the most.... Based on today s history and physical examination, and the medical information available for my review, I cannot determine a diagnosis for the Worker s pain complaints. Her pain distribution and pain character and the physical examination findings are not consistent with any medical condition that I know of or can identify. I do not recommend further diagnostic testing be it radiological, haematological, or electrodiagnostic. I do not have further recommendations for her pharmacological treatment.

9 WCAT Decision #189 Page 9 of 21 I do not recommend physical therapy or chiropractic treatment. I do not recommend spinal injections or soft tissue injections. In my opinion the best treatment for the Worker is a frank discussion regarding the diagnosis and prognosis. I told her that I cannot identify any sinister diagnosis, such as a nerve impingement, discs moving out, spinal stenosis, spinal instability, soft tissue injuries, or other conditions that could explain her pain. I told her that although physicians sometimes cannot pinpoint the source of the pain, they are usually able to determine whether there is a sinister diagnosis. I told her that fortunately, this is not the case. I told her that hurt does not mean harm and she is not going to harm herself if she returned to any activity that she wants to do, including work. This was met with a lot of resistance on her part. She insisted that her pain is unbearable and there is not much that she can do. She is worried about what WCB was going to say when they read my report that I could not find a cause for her pain. The prognosis for returning to function and work is not going to depend on physical barriers. Individuals with the same injuries (an un-witnessed injury, which resulted after lifting a bucket of water) return to work in a very short period of time. There are no medical restrictions based on risk that apply to her activities of daily living or work activities. In other words, she is not going to harm herself by doing so. In my opinion, the main barriers for returning to work are psycho social. 18. On November 3, 2011, the Case Coordinator again requested Dr. O Brien s diagnosis and whether the Worker s pain symptoms were related to her injury of June 17, 2010 or other factors.

10 WCAT Decision #189 Page 10 of Dr. O Brien s medical opinion of November 3, 2011 reads in part: th Dr. Koshi, in his consultation report of October 18, 2011, states, She reported a work-related injury on June 17, She was lifting a bucket of water. She heard a pop and experienced pain in the midback area. Dr. Koshi did an extensive review of the development of the Worker s symptoms, and consultations and investigations since her date of injury. Dr. Koshi does note that Dr. Profitt s report of June 3, 2009, a year prior to the Worker s workplace injury, indicated, the Worker had back pain for a year prior to this appointment. There were no radicular symptoms. Dr. Profitt recommended an Obus Forme and physiotherapy. She was not a candidate for surgery. Dr. Koshi also noted Dr. Profitt s report of October 18, 2010 when he diagnosed soft tissue strain. This would be the diagnosis applicable to the Worker and the workplace incident that occurred on June 17, Under Diagnostic Impression, Dr. Koshi states, based on today s history and physical examination, and the medical information available for my review, I cannot determine a diagnosis for the Worker s pain complaints. Her pain distribution and pain character and the physical examination findings are not consistent with any medical condition that I know or can identify.... Under Prognosis, Dr. Koshi states, The prognosis for returning to function and work is not going to depend on physical barriers. Individuals with the same injuries (an un-witnessed injury which resulted after lifting a bucket of water) return to work in a very short period of time. There are no medical restrictions based on risk that apply to her activities of daily living or work activities. In other words, she is not going to harm herself by doing so. In my opinion, the main barriers for returning to work are

11 WCAT Decision #189 Page 11 of 21 psycho social. Therefore, Dr. Koshi is stating that the barriers for returning to work are psycho social and that her pain is not explainable on the basis of her workplace injury, and therefore, the Worker s ongoing symptoms are not reasonably related to the workplace incident of June 17, With the diagnosis of soft tissue strain, according to the Disability Duration Guidelines and Expected Healing Times, published September 2003 by the Workers Compensation Board of Prince Edward Island, the expected healing times for soft tissue injuries is listed as 3 months. This publication was based on the Medical Disability Advisor-Workplace Guidelines for Disability Duration, by Presley Reid, MD, Second and Third Editions. 20. On December 13, 2011, the Case Coordinator wrote to the Worker informing her that her claim would be closing for Temporary Wage Loss and Medical Aid benefits effective January 9, 2012 on the basis that the Worker s continuing pain symptoms could not be reasonably related to her workplace injury on June 17, On March 14, 2012, the Worker filed a Request for Internal Reconsideration of the Board s decision of December 3, On May 8, 2012, the IRO denied the Worker s request for internal reconsideration finding that there was no objective medical evidence to support the Worker s current pain symptoms as being reasonably related to the workplace injury that was accepted under her claim. 23. On June 7, 2012 the Worker appealed the IRO s decision of May 8, 2012 to the Workers Compensation Appeal Tribunal ( WCAT ).

12 WCAT Decision #189 Page 12 of Subsequent to the decision of the IRO and the Worker s appeal to WCAT, two reports were received by the Board from Dr. John Campbell, Orthopaedic Surgeon, dated July 5, 2012 and October 4, 2012 relating to the Worker s file. 25. Dr. Campbell s report of July 5, 2012 reads in part: The Worker presents to orthopaedics today for consultation. She is a pleasant woman who is quite distressed by her current state. The Worker is a previously healthy woman who had a workplace injury in June She was lifting a bucket of water with Javex and she felt pain at her back in the mid-thoracic lumbar region. This has progressed to a state where she has chronic constant pain in her back both in her upper thoracic low lumbar, which she claims radiates to her right arm and right leg.... Currently to examine her today she moves with quite a bit of discomfort. She uses a cane at the right side to help with mobility. Her physical examination is severely limited by the range of motion at her right side at both the upper and lower extremities. In her lower extremities she is able to straight leg raise when sitting on the examining table. When I straight leg raise her laying flat she can raise it to about 70 degrees. She is stopped by pain in her back and this is not neurogenic type pain. Her reflexes are essentially normal. When I examine her upper extremity she is only able to lift this to 90 degrees. When I push this further she complains of pain in her upper thoracic mid-spine region. I did review her films today and she has some degenerative changes in her back, some hypertrophic facets at L4-5 and L5-S1, and there is a thoracolumbar scoliosis that is old and predates her injury. It is my impression that this woman has severe muscular back pain

13 WCAT Decision #189 Page 13 of 21 likely instituted by her injury that she sustained. The thoracic lumbar scoliosis is not related to the incidents of back pain. A back injury is no higher in scoliotic patients then non-scoliotic patients. Prior to injury she had not had pain coming from this.... I do believe that this is work related and I do believe her rehabilitation and strengthening should be covered by Worker s Compensation. Although she does have thoracolumbar scoliosis and does have some element of degenerative changes in her lumbar spine, I do not feel these changes are what is causing her ongoing pain issues. 26. On July 24, 2012, the Case Coordinator again requested Dr. O Brien to review the Worker s file and particularly Dr. Campbell s report of July 5, 2012 and advise whether the new information would cause him to change his medical opinion of November 8, Dr. O Brien s medical opinion of July 31, 2012 reads in part: On the July 5, 2012 report from Dr. Campbell he stated, It is my impression that this woman has severe muscular back pain likely instituted by her injury that she sustained. However, Dr. Campbell does not explain why he comes to that conclusion, and apparently, in fairness to Dr. Campbell, he did not have the complete medical dossier to review as he did not make note of Dr. Profitt s June 3, 2009 comment regarding her back pain in the year prior to that appointment and also made no mention of the assessment with Dr. Koshi, a Specialist in the field of Physical Medicine & Rehabilitation, who concluded, I told her that I cannot identify any sinister diagnosis, such as nerve impingement, discs moving out, spinal stenosis, spinal instability, soft tissue injuries, or other conditions that could explain her pain.... Dr. Koshi also stated, Her pain distribution and pain character and the physical examination

14 WCAT Decision #189 Page 14 of 21 findings are not consistent with any medical condition that I know or can identify. Therefore, Dr. Campbell s report on July 5, 2012 would not cause me to change my medical opinion as expressed in my memo of November 8, Dr. Campbell s later report of October 4, 2012 reads: The Worker presents to orthopaedics today for follow-up regarding her back pain. She finds that with physiotherapy and acupuncture that she has been receiving since I saw her last she has improvements in her mobility but she still finds she has significant pain. I reviewed her most recent MRI from 2011 and although it only reviews the lumbar spine there was some suggestion that in the lower thoracic spine there may be some problems in the central canal. On that report the radiologist had suggested reviewing an MRI of the thoracic and cervical spine. We are going to make arrangements to do this and I will follow-up with her when this is completed. In the meantime I think she should continue with physiotherapy and acupuncture. 29. On November 28, 2012, the Case Coordinator wrote to the Worker s Advisor and informed her that the new evidence of Dr. Campbell did not change the Board s decision to close the Worker s claim effective January 9, On February 21, 2012, the Worker filed another Request for Internal Reconsideration of the Board s latest decision of November 28, 2012.

15 WCAT Decision #189 Page 15 of On April 3, 2013, the IRO issued a second decision denying the Worker s request deciding that the Worker s ongoing pain symptoms were not caused by the injury of June 17, The Worker subsequently appealed the IRO s decision of April 3, 2013 to WCAT by way of Notice of Appeal dated May 3, ISSUE 33. The issue is whether the Board s decision to close the Worker s claim for temporary wage loss and medical benefits effective January 9, 2012 is appropriate? ANALYSIS/DECISION 34. WCAT is a creature of statute, having been created pursuant to provisions of the Workers Compensation Act, R.S.P.E.I. 1988, Cap. W-7.1 as amended (the Act ). 35. Section 56(17) of the Act states that WCAT is bound by the Act and its regulations as well as the policies of the Board. 36. The proper standard of review by WCAT is that of correctness, ie. an incorrect decision by the Board may be corrected by WCAT. 37. Pursuant to Section 6(1) of the Act, the Board shall pay compensation to any worker who suffers personal injury by accident arising out of and in the course of employment.

16 WCAT Decision #189 Page 16 of Section 40(2) of the Act provides that wage loss benefits are payable until the earlier of the date the Board determines that the loss of earnings capacity is ended or no longer results from the injury. 39. Board Policy POL-68, Weighing of Evidence, is also relevant to deciding this appeal. 40. When adjudicating claims for compensation, Policy POL-68 states: 1. The decisions of the Workers Compensation Board are made in accordance with the real merits and justice of the case and the Workers Compensation Board is not bound to follow strict legal precedent. In determining the merits and justice of each case the Workers Compensation Board must give consideration to: - all relevant information relating to the case in order to establish the facts and circumstances relating to the case; -relevant provisions of the Workers Compensation Act and Regulations; and -relevant Workers Compensation Board policies. 2. In making decisions related to compensation benefits, the Workers Compensation Board will examine the evidence to determine whether it is sufficiently complete to allow a decision to be made. If the Workers Compensation Board determines more information is required to make a decision, the Workers Compensation Board will work with the worker, employer and health care providers to obtain the necessary information. The Workers Compensation Board will gather, review, and weigh all relevant evidence as part of the decision making

17 WCAT Decision #189 Page 17 of 21 process. However, the Workers Compensation Board will give greater weight to evidence that is factual and objective when making a decision. 3. The Workers Compensation Board will assess and weigh all relevant evidence and make decisions based on a balance of probabilities a degree of proof which is more probable than not. 4. Decision makers must assess and weigh all relevant evidence. Conflicting evidence must be weighed to determine whether it weighs more toward one possibility than another. Where the evidence weighs more in one direction then that shall determine the issue. 5. If the evidence is weighed in favour of the worker, the claim shall be allowed and compensation benefits provided. 41. Conflicting medical information is addressed in POL-68 as follows: 9. Where there is conflicting medical information on a claim, the Workers Compensation Board will analyze the information objectively, using the following criteria: The expertise or degree of specialization of the health care provider giving the opinion; The relevance of the clinical expertise of the health care provider giving the opinion to the medical question being addressed; The accuracy of the information relied upon by the health care provider; Objective versus subjective medical information; The relevance of any research referenced by the health care provider; and

18 WCAT Decision #189 Page 18 of 21 Any issues of bias or objectivity. 42. Objective medical information and subjective medical information are defined in POL-68 as follows: 2. Objective medical information means information that can be quantified or measured and is usually presented through documentation including clinical notes, physical examinations, consultations, hospital records, admission and discharge summaries, notes on operations, pathologies and lab test reports, and reports on special tests and diagnostic procedures. 3. Subjective medical information means opinions that are not based on information that can be quantified or measured. These opinions are based on intuitions or impressions of a health care provider(s) and are usually presented through symptoms described by the worker that are not supported by objective medical information. 43. The Panel does not find any issues of bias or objectivity but does find conflicting medical information on the Worker s claim. 44. The Panel has taken into account that Dr. Profitt, Dr. Koshi and Dr. Campbell examined the Worker, while Dr. O Brien did not. 45. The Panel has also taken into account that Dr. Profitt and Dr. Campbell are Orthopaedic Surgeons, that Dr. Koshi specializes in Physical Medicine and Rehabilitation and that Dr. O Brien has training in Occupational Medicine. 46. The primary medical information corroborating the Worker s claim that her continuing pain symptoms are a result of her June 17, 2010 workplace injury is Dr. Campbell s medical report of July 5, 2012.

19 WCAT Decision #189 Page 19 of In Dr. Campbell s report he uses words such as impression and likely which may indicate his opinion is based more on intuitions or impressions from symptoms described by the Worker rather than supported by objective medical information. 48. Although Dr. Campbell states that the Worker s ongoing back pain is likely instituted by her injury of June 17, 2010, he does not reference the Worker s prior history of back pain dating back to the fall of 2008 as reported by Dr. Profitt or give any reasoning for this statement. 49. Furthermore, Dr. Campbell does not reference or refute Dr. Koshi s report of October 18, 2011 wherein he stated he could not identify any condition that could explain her pain. 50. It is not clear from Dr. Campbell s report of July 5, 2012 whether he had seen and taken into account these earlier reports of Dr. Profitt and Dr. Koshi when he wrote his report. 51. Dr. Profitt s report of October 18, 2010 states that the Worker had a soft tissue strain but was developing chronic pain (later report of July 6, 2011 described as chronic spinal pain syndrome ) and that while the Worker had some back pain in the past she was now stating that the new pain was different and started higher in the thoracic spine. 52. Dr. Profitt s opinion is based more on a subjective medical assessment than an objective one, ie. The subjective descriptions of the location, degree and constancy of pain as described by the Worker.

20 WCAT Decision #189 Page 20 of In weighing the evidence, the Panel gave considerable weight to the medical evidence of Dr. Koshi as contained in his report of October 18, Dr. Koshi s report is based on the Worker s medical history and a review of the Worker s diagnostic tests, medical reports (including Dr. Profitt), and the physical examination and tests performed by Dr. Koshi. 55. Dr. Koshi could not determine a diagnosis for the Worker s pain complaints, her pain distribution and pain character and his physical examination findings were not consistent with any medical condition that he knew or could identify. 56. Dr. Koshi could not find any source or condition that would explain the Worker s alleged back pain. 57. In other words, Dr. Koshi found no objective medical evidence to support the Worker s claim and was of the opinion that the Worker could return to any activity that she wanted to do, her barrier for returning to work being psycho social. 58. Dr. O Brien s medical opinions of November 3, 2011 and July 31, 2012, based on a review and analysis of the medical evidence on file, including the reports of Dr, Profitt, Dr. Koshi and Dr. Campbell, further support the Board s position that the Worker s alleged ongoing back pain is not related to her workplace injury of June 17, After weighing all the evidence, the Panel finds, on the balance of probabilities, that the Worker s pain symptoms are not related to her workplace injury of June 17, 2010 and that the Board s decision to close the

21 WCAT Decision #189 Worker s claim for temporary wage loss and medical benefits effective January 9, 2012 was appropriate. 60. Accordingly, the Worker s appeal is dismissed. 61. The Panel wishes to thank Counsel for both the Worker and the Board for their well presented submissions, both written and oral. Dated this 20th day of May, John L. Ramsay, Q.C., Vice-Chair Workers Compensation Appeal Tribunal Concurred: Donald W. Cudmore, Employer Representative A. J. Gordon Huestis, Worker Representative