Title: Thomas Charles vs. Kamco Transport, Inc. (Memorandum Decision)

State: west-virginia

Issuer: West Virginia Supreme Court

Document:

STATE OF WEST VIRGINIA FILED
ay9 300

SUPREME COURT OF APPEALS somaeceunarara
THOMAS CHARLES,
Claimant Below, Petitioner

vs.) No. 20-0277 (BOR Appeal No. 2054802)
(Claim No. 2001050236)

WEST VIRGINIA OFFICES OF
INSURANCE COMMISSIONER,
‘Commissioner Below, Respondent

and

KAMCO TRANSPORT, INC.,
Employer Below, Respondent

MEMORANDUM DECISION

Petitioner Thomas Charles, by Counsel Patrick K. Maroney, appeals the decision of the
West Virginia Workers’ Compensation Board of Review (“Board of Review”). The West Virginia
Office of Insurance Commissioner, by Counsel Melissa M. Stickler, filed a timely response.

The issue on appeal is medical benefits. The claims administrator denied authorization of|
the medication Robaxin on June 20, 2018. On August 1, 2018, the claims administrator denied
authorization for sacroilic nerve blocks. The Workers’ Compensation Office of Judges (“Office
of Judges”) reversed the June 20, 2018, decision and authorized Robaxin in its October 4, 2019,
Order. The claims administrator's August 1,2018, decision was affirmed. The Order was affirmed
by the Board of Review on February 28, 2020."

‘The Courthas carefully reviewed the records, written arguments and appendices contained
inthe briefs, and the ese is mature for consideration, The facts and legal arguments are adequately
presented, and the decisional process would not be significantly aided by oral argument. Upon
consideration of the standard of review, the briefs, and the record presented, the Court finds no

"The only issue on appeal is the denial of sacroiliac joint injections.
1
 

substantial question of law and no prejudicial eror. For these reasons, a memorandum decision is
appropriate under Rule 21 of the Rules of Appellate Procedure.

‘The standard of review applicable to this Court’s consideration of workers’ compensation
appeals has been set out under W. Va, Code § 23-5-15, in relevant part, as follows:

 

() In reviewing a decision of the board of review, the supreme court of appeals
shall consider the record provided by the board and give deference to the board's
findings, reasoning and conclusions.)

(@) If the decision ofthe board effectively represents a reversal ofa prior ruling of
either the commission or the Office of Judges that was entered on the same issue in
the same claim, the decision of the board may be reversed or modified by the
‘Supreme Court of Appeals only ifthe decision isin clear violation of constitutional
or statutory provisions, is clearly the result of erroneous conclusions of law, or is
so clearly wrong based upon the evidentiary record that even when all inferen
are resolved in favor of the board’s findings, reasoning and conclusions, there is
insufficient support to sustain the decision. The court may not conduct a de novo
e-weighing of the evidentiary record. .

  

‘See Hammons v. W. Va. Off of Ins. Comm'r, 235 W. Va, 577, $82-83, 775 S.F.24 458, 463-64
(2015). As we previously recognized in Justice v. West Virginia Office Insurance Commission,
230 W. Va, 80, 83, 736 S.E.2d 80, 83 (2012), we apply a de novo standard of review to questions
of law arising in the context of decisions issued by the Board. See also Davies v. W. Va. Off. of
Ins. Comm'r, 227 W. Va. 330, 334, 708 $.E.2d 524, 528 (2011),

Mr. Charles, a coal truck driver was injured when a tie exploded in his face on Apeil 18,
2001. He was taken to Charleston Area Medical Center after he was found unresponsive on the
Scene. Mr. Charles was diagnosed with closed head injury, blunt chest trauma, bilateral shoulder
contusions, and acute cervical strain. The Employees’ and Physicians’ Report of injury, completed
the following day, indicates Mr. Charles was working on a tre when it exploded, sending him
twenty feet from the truck and knocking him unconscious. The physicians’ section listed the
diagnoses as blunt force trauma, bilateral shoulder contusions, anda cervical stain. An April 20,
2001, cervical MRI showed an increased signal in the soft tissues that was indicative ofa possible
ligament injury. There was no evidence of facture or altered alignment. The claim was held
‘compensable for neck sprain, head injury, shoulder contusion, and post-coneussion syndrome.

 

On January 25, 2002, David Weinswig, M.D., recommended cervical and lumbar MRIs
‘due to low back and bilateral hip pain since the work injury. On August 12, 2002, Mr. Charles
underwent a Functional Capacity Evaluation in which it was recommended that he be treated for
neck, low back, left shoulder, and left knee pain with pain management. Vocational rehabilitation
\was also recommended.
In a January 25, 2010, independent medical evaluation, Louis Loimil, M.D., opined that
Mr. Charles did not need maintenance care for musculoskeletal problems. He assessed 21% whole
person impairment representing 8% for the cervical spine, 8% for the thoracic spine, and 8% for
the lumbar spine.

 

In a June 8, 2018, treatment note, Ms. Rice-Jacobs noted that Mr. Charles was treated for
‘neck, bilateral shoulder, thoracic, and low back pain. Mr. Charles requested something for his pain
other than Tramadol. Nerve blocks were recommended. Ms. Rice-Jacobs diagnosed cervical
spondylosis without myelopathy or radiculopathy, traumatic brain injury, low back pain, and
chronic lumbar sprain/strain. The claims administrator denied authorization for the medication
Robaxin on June 20, 2018, based on Dr. Bowman's evaluation. The decision was reversed by the
Office of Judges and the medication was approved.

 

‘Ahmet Ozturk, M.D., of Cabell Huntington Hospital Pain Management Center, saw Mr,
Charles for a consultation on July 19, 2018, for low back and hip pain that has been present since
his 2001 injury. Dr. Ozturk diagnosed sacroiliac joint dysfunction and myofascial pain syndrome,
He requested sacroiliac nerve blocks. The claims administrator denied authorization for sacroiliac
nerve blocks on August 1, 2018

In its October 4, 2019, Onder, the Office of Judges affirmed the claims administrator's
denial of sacroiliac joint injections. The Office of Judges determined that the claim is not
compensable for sacrolia joint dysfunction or myofascial pain syndrome, the conditions for
Which the injections were requested. The medical teatment was therefore properly denied. The
Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and
aftimed its Order on February 28, 2020.

After review, we agree with the reasoning and conclusions of the Office of Judges as
affirmed by the Board of Review. Pursuant to West Virginia Code § 23-4-1(a) workers’
compensation benefits shall be provided to those employees who have received personal injuries
in the course of and as a result oftheir covered employment. West Virginia Code § 23-4-3(a)1)
provides thatthe claims administrator must provide medically related and reasonably required
sums for healthcare services, rehabilitation services, durable medical and other goods, and other
supplies. Mr. Charles has failed to show by a preponderance of the evidence that sacroiliac joint
jections are medically necessary and reasonably required treatment for a compensable injury.
The treatment was requested due to sacroiliac joint dysfunction and myofascial pain syndrome,
Neither condition is compensable inthis claim, and the requested treatment was properly denied,
‘The decision of the Board of Review is therefore affirmed.

 

  

 

Affirmed,
 

CONCURRED IN BY:

Chief Justice Evan H. Tenkins
Justice Elizabeth D. Walker
Justice Tim Armstead

Justice John A. Hutchison
Justice William R, Wooton