Background:

On June 24, 1997, the claimant was participating in a non-violence intervention program when he fell on his left shoulder and arm with a co-worker falling on top of him. The diagnosis reported by the attending physician on November 29, 1997, was a strained left shoulder. The claimant incurred no time loss from work but was referred for physiotherapy for neck and shoulder treatment, which concluded on December 17, 1997. At that time the physiotherapist reported that range of motion was near full with occasional symptoms.

The next progress report was received from the attending physician was dated September 2, 1998. The physician indicated that the claimant had been experiencing ongoing discomfort since his initial injury. The claimant had pain in the left trapezius, neck and shoulder and was referred for additional physiotherapy treatments.

On November 12, 1998, the claimant provided a sworn statement to a Workers Compensation Board (WCB) field representative. The claimant indicated that when he was discharged from physiotherapy in December 1997, there was an improvement with his left shoulder but he didn't quite feel 100%. He would experience numbness and aching in the rotator cuff of the left shoulder and weakness in the left arm. He did not seek medical treatment specifically for his shoulder and neck until September 1998 because he was having other medical problems which were given more priority. Between December 1997 to September 1998, the claimant said he did not complain about his neck and shoulder to anyone at work.

The claimant further stated that he and his wife went for a 20-30 minute bike ride in the summer of 1998. He found that after leaning on the handle bars this made his left shoulder and neck more painful. His shoulder and neck had still been bothering him prior to the ride and after the ride the pain became much worse. He did not sustain any new accident or injury to his shoulder and neck since June 1997.

When he saw his doctor for treatment of his shoulder after the bike ride, the physician suggested that the claimant's shoulder pain was due to the June 1997 incident. He was claiming for physiotherapy costs and the costs of a pillow which had been prescribed by the physiotherapist. The claimant considered that his current shoulder and neck difficulties were related to the June 1997 accident because he did not have any prior problems with his shoulder or neck. "I feel that since my injury in June, 97, that my shoulder and neck seems (sic) to get aggravated by the simplest thing like going for a bike ride."

On December 9, 1998, the WCB notified the claimant that it was unable to accept further responsibility for his current neck and left shoulder problems. Claims Services indicated that the recent referral to physiotherapy would not be a direct result of the compensable injury according to a WCB medical advisor. The claimant subsequently appealed this decision to Review Office.

On February 5, 1999, Review Office denied the appeal. Review Office noted that investigation by the WCB failed to confirm any actual evidence of continuity for the claimant's shoulder and neck complaints between December 1997 and September 1998. The claimant did not seek medical treatment for ongoing complaints in 9 months and, according to the employer, made some mention of injuring his neck and left shoulder while riding a bike during the summer. Taking into account the lack of confirmed continuity of neck and shoulder problems between December 1997 and September 1998 along with basic recovery norms, it was difficult to establish a "probable" causal connection between the problem in September 1998 and the June 1997 accident.

At the request of a union representative, Review Office requested and obtained additional medical information from three treating physicians. Briefly, the reports indicated the following:

• following assessment on December 28, 1998, a sports medical specialist diagnosed the claimant with:
  
  

  "Left AC (acromioclavicular) joint OA (osteoarthritis) and an element of rotator cuff tendonitis with possibility of a small cuff tear; and
  
  Mass left supraclavicular fossa; query lipoma, query cyst. It is quite likely that Mr. [the claimant] suffered an injury to his rotator cuff when he was involved in the fight he told me about. A rotator cuff strain or contusion could have precipitated the tendonitis."

  
   

• on May 3, 1999, an orthopaedic specialist indicated that he saw the claimant for an opinion regarding a left supraclavicular mass. The physician stated that the mass was that of a lipoma. "I am not sure that this is secondary to the original injury but one would surmise so as it appeared according to his history at the same time that he sustained the blunt trauma to the site. If I felt that it is due to the original injury it would only be on the basis of the history that he gives of it appearing about the time of his trauma."
  
  
• on July 21, 1999, a physical medicine and rehabilitation specialist provided the opinion that the claimant's specific history supported a diagnosis of acute muscle strain in the injury of June 28, 1997 with resultant myofascial pain syndrome due to the development of trigger points in the left upper trapezius muscle. The specialist went on to indicate that the nature of myofascial pain syndrome is such that any residual trigger points still present can flare up with increase in physical exertion in the future. This apparently occurred during the episode with the bicycle riding in July 1998. The claimant, between December 1997 and July 1998, indicated that his symptoms were intermittent and not severe enough to seek medical or therapy attention. The physician felt that it was only after the acute flare-up that his symptoms became more persistent.

On July 29, 1999, Review Office wrote to the claimant indicating that it continued to believe the chain of causation between his accident at work in June 1997 and the medical treatments he received after September 1998, had not been supported on a balance of probability. Review Office noted that medical examination findings between June and December 1997 made no reference to a lump, mass or swelling in the left shoulder region and that continuity of symptoms between December 1997 and September 1998 had not been substantiated by medical treatment or complaints to his employer. The onset of the claimant's latest shoulder symptoms apparently started while he was involved in some specific activities out of his employment, and that this was a more probable cause for his injuries.

On November 29, 1999, a union representative appealed Review Office's decision and requested an oral hearing.