1 

### I N THE 

### I NTERMEDIATE 

### C OURT OF 

### A PPEALS OF 

### W EST 

### V IRGINIA

JEFFREY BREWER

, Claimant Below, Petitioner

vs.) No. 23

- ICA -2 50 ( JCN: 2022020832)

ACNR RESOURCES, INC.

, Employer Below, Respondent

MEMORANDUM DECISION

Petitioner Jeffrey Brewer appeals the May 10, 2023, order of the Workers’ Compensation Board of Review (“Board”). Respondent ACNR Resources, Inc. (“ACNR”) timely filed a response. 1 Petitioner did not file a reply. The issue on appeal is whether the Board erred in affirming the claim administrator’s order, which denied the addition of contusion of the abdominal wall, left hip pain, right knee pain, and left flank pain as compensable conditions in the claim

, and denied authorization for an upper endoscopy and colonoscopy

.

This Court has jurisdiction over this appeal pursuant to West Virginia Code § 51

- 11

- 4 (2022). After considering the parties’ arguments, the record on appeal, and the applicable law, this Court finds that there is error in the Board ’ s decision but no substantial question of law. This case satisfies the “limited circumstances” requirement of Rule 21(d) of the Rules of Appellate Procedure for reversal in a memorandum decision. For the reasons set forth below, the Board ’ s decision is affirmed, in part, and reversed, in part.

On April 14, 2022, Mr. Brewer sustained a work

- related injury when a rock fell from the ceiling of the mine where he was working and struck him on the back. Mr. Brewer presented to the emergency room (“ER”) on April 16, 2022, complaining of pain in his back, flank, and ribs. Mr. Brewer denied any nausea, vomiting, or diarrhea, and a CT scan of Mr. Brewer’s abdomen revealed no evidence of acute traumatic injury but did indicate

status post

- cholecystectomy and stable splenomegaly. Mr. Brewer and the ER staff completed an Employees’ and Physicians’ Report of Occupational I njury form , and the physicians’ portion of the form included diagnos e s of a contusion and hematoma of the

back. By order dated May 4, 2022, the claim administrator held the claim compensable for “contusion of unspecified back wall of thorax.”

1 Mr. Brewer is represented by J. Thomas Greene, Jr., Esq., and T. Colin Greene

, Esq. ACNR is represented by Aimee M. Stern, Esq. 

### FILED November 1, 2023

EDYTHE NASH GAISER, CLERK

INTERMEDIATE COURT OF APPEALS

OF WEST VIRGINIA2 About three weeks after the injury, on May 7, 2022, Mr. Brewer under went a CT

scan of his abdomen due to his complaints of abdominal pain, nausea, vomiting , and history

of trauma . The CT scan revealed no acute process. Subsequently, on May 12, 2022, Mr. Brewer sought treatment from Alan Hess, M.D., and complained of abdominal pain, diarrhea, and nausea following his work

- related injury. Dr. Hess noted that the two CT

scans of Mr. Brewer’s abdomen revealed no abnormalities other than chronic splenomegaly. Dr. Hess stated, “ I do not know really what is going on I really cannot explain the continued nausea and generalized abdominal discomfort and particularly I cannot explain the diar rhea either.” Dr. Hess diagnosed Mr. Brewer with abdominal pain of unclear etiology, nausea, vomiting, and a contusion of the back.

Mr. Brewer sought treatment from Mark Johnson, M.D., on May 16, 2022, and reported ongoing, but resolving abdominal pain. Mr. Brewer stated that he continued to have nausea, vomiting, and diarrhea following his work

- related injury. Dr. Johnson expressed concern that Mr. Brewer could have developed gastritis “ as a consequence of his injury, change in habits, and chronic Voltar en use.” Dr. Johnson requested authorization for an upper endoscopy and colonoscopy. By order dated June 2, 2022, the claim administrator denied the request, finding that it was not related to the compensable diagnosis in the claim. Mr. Brewer protested th e order. On June 3, 2022, Mr. Brewer underwent an endoscopy and colonoscopy performed by Dr. Johnson and paid for by his personal insurance . The post

- operative diagnosis was mild gastritis and diverticulosis.

Mr. Brewer returned to see Dr. Hess on June 2 9, 2022, for an annual preventive wellness exam. Mr. Brewer reported that his symptoms were improving and denied any nausea or vomiting. Mr. Brewer saw Dr. Hess again on October 31, 2022. Dr. Hess explained that Mr. Brewer sustained a work

- related injury i n which he was struck by a rock and trapped against a machine, hitting his left flank and left abdominal wall. Dr. Hess added that Mr. Brewer developed swelling and a large hematoma in the area and noted that Mr.

Brewer continued to have pain in the left u pper abdominal wall. Dr. Hess opined, “I am not real sure of the cause of this chronically but suspect it is related to the injury.” Dr. Hess diagnosed contusion of the abdominal wall, left hip pain, right knee pain, and right flank pain, and he completed a Diagnosis Update form requesting to add these conditions to the

claim. By order dated November 8, 2022, the claim administrator denied Dr. Hess’ request to add contusion of the abdominal wall, left hip pain, right knee pain, and left flank pain as

compen sable conditions in the claim. Mr. Brewer protested the order.

In the ensuing litigation, several medical records were submitted into evidence, which detailed Mr. Brewer’s chronic, preexisting gastrointestinal issues. For example, in January of 2016, Mr. Brewer’s medical records indicated a secondary diagnosis of gastro

esophageal reflux disease (“GERD”). Records from August of 2019 indicated that Mr. Brewer sought treatment for vomiting, nausea, and diarrhea, and his secondary diagnoses included diarrhea, fatigue, GERD, long term use of oral hypoglycemic drugs, and other long

- term drug therapy. Records from October of 2019 indicated that Mr. Brewer3 underwent an e sophagogastroduodenoscopy (“EGD”) and a colonoscopy, and the post

operative diagnosis was gastr itis.

On November 10, 2022, Mr. Brewer testified via deposition. Mr. Brewer denied having stomach issues or diarrhea prior to his work

- related injury. He testified that he continued to have issues such as muscle spasms and diarrhea, especially with heavy lifting.

He stated that he developed bruising on his left side an d around his stomach following the

incident and that his abdomen was tender . Mr. Brewer stated that he currently has residual left hip pain and right knee pain due to changing the way he walked following the injury

and tenderness in his stomach

.

Subseque ntly, Prasadarao Mukkamala, M.D., authored a record review report on January 3, 2023. Dr. Mukkamala opined that there was no evidence of injury to the abdominal wall and, as such, a contusion to the abdominal wall did not result from the

work

- related injur y. Dr. Mukkamala also opined that left hip pain, right knee pain, and left flank pain were symptom complexes, not specific conditions, and, further, there was no evidence of injury to those body parts at the time of the compensable injury. Dr.

Mukkamala re commended against authorizing the endoscopy and colonoscopy, noting they were not required because of the compensable injury. Dr. Mukkamala stated that there was no evidence that Mr. Brewer sustained any injury to his abdomen and, therefore, there

was no i ndication for an endoscopy or colonoscopy as it relates to the compensable injury.

By order dated May 10 , 2023, the Board affirmed the claim administrator’s November 8, 2022, order, which denied the addition of contusion of the abdominal wall, left hip pain, right knee pain, and left flank pain as compensable conditions in the claim, and its June 2, 2022, order, which denied authorization for an upper endoscopy and colonoscopy. The Board found that left hip pain, right knee pain, and left flank pain were all properly denied as compensable conditions as they were symptoms and not medical diagnoses. See Whitt v. US Trinity Energy Servs., LLC , No. 20

- 0732

, 2022 WL 577587, at

* 3 (W. Va. Feb. 25, 2022) (memorandum decision) (“This Court has consistently held that pain is a symptom, not a diagnosis.”).

The Board further found that the medical evidence did not support a finding that a contusion of the abdominal wall was causally related to the compensable injury. The Board noted that a CT scan performed following the compensable injury revealed no acute traumatic injury to the abdominal wall, and the ER physician did not diagnose a contusion

to the abdominal wall. The Board noted that Mr. Brewer was not diagnosed with a contusion of the abdominal wall until six months after the date of injury, which also indicated that it was not related to the compensable injury.

Lastly, the Board found that the evidence did not support a findi ng that the endoscopy and colonoscopy were medically necessary treatment s for a contusion of the back wall of the thorax, the only compensable condition in the claim. The Board noted that4 Dr. Mukkamala opined that the request for these procedures was not c ausally related to the compensable injury

. The Board further noted that the record does not contain a compensable gastrointestinal condition. Moreover, Dr. Johnson requested the endoscopy and colonoscopy due to Mr. Brewer’s complaints of nausea, vomiting, and diarrhea, which were symptoms, not diagnoses. These procedures were performed and revealed no evidence of traumatic injury but, rather, showed gastritis and diverticulosis. The Board found that the medical evidence did not contain any evidence linking diverticulosis to the compensable injury and the evidence indicated that a diagnosis of gastritis preexisted the claim. Given the foregoing, the Board concluded that the claim administrator did not err in deny ing the addition of contusion of the abdominal wall, left hip pain, right knee pain, and left flank pain as compensable conditions in the claim, and denying authorization for an upper endoscopy and colonoscopy. Mr. Brewer now appeals.

Our standard of review is set forth in W est Virginia Code § 23

- 5

- 12 a (b) (2022) , in part, as follows:

The Intermediate Court of Appeals may affirm the order or decision of the Workers’ Compensation Board of Review or remand the case for further proceedings. It shall reverse, vacate, or modify the order or decision of the Workers’ Compensation Board of Review, if the substantial rights of the petitioner or petitioners have been prejudiced because the Board of Review’s findings are: (1) In violation of statutory provisions; (2) In excess of the statutory authority or jurisdi ction of the Board of Review; (3) Made upon unlawful procedures; (4) Affected by other error of law; (5) Clearly wrong in view of the reliable, probative, and substantial evidence on the whole record; or (6) Arbitrary or capricious or characterized by abus e of discretion or clearly

unwarranted exercise of discretion.

Duff v. Kanawha Cnty. Comm’n

, 247 W. Va. 550

, 555, 882 S.E.2d 916, 921 (Ct. App. 2022)

.

On appeal, Mr. Brewer raises two assignments of error. Mr. Brewer first argues that the Board erred in affirming the claim administrator’s order which denied the addition of contusion of the abdominal wall, left hip pain, right knee pain, and left flank pain as compensable conditions in the claim. Mr. Brewer states that he de veloped these symptoms and conditions following the compensable injury, and that Dr. Hess completed the Diagnosis Update form and indicated that they were a result of the compensable injury. Mr. Brewer contends that the causal connection between his injuri es and his employment is evident because “the pain and limitations he currently experiences are located in the exact same areas that he suffered a significant contusion and muscular damage to at the5 time of his work injury.” Mr. Brewer acknowledges that pa in is a symptom, not a diagnosis, but claims that they should be added as an “exception to the rule against symptoms” since they most accurately describe his condition. Regarding the contusion to the abdominal wall, Mr. Brewer argues that photographs submi tted into evidence show bruising and support the diagnosis of a contusion to the abdominal wall.

Upon review, we conclude that the Board did not err in denying the addition of left hip pain, right knee pain, and left flank pain as compensable conditions i n the claim as they are symptoms, not diagnoses

. See, e.g., Harpold v. City of Charleston , No. 18

- 0730, 2019 WL 1850196, at *3 (W. Va. Apr. 25, 2019) (memorandum decision) (holding that left knee pain is a symptom, not a diagnosis, and therefore cannot be added to a claim); Owens v. Bundy Auger Mining, Inc. , No. 20

- 0664, 2022 WL 10218876

, at *3 (W. Va. Oct. 18, 2022) (memorandum decision) ( holding that t horacic pain and muscle spasms are symptoms, not diagnoses, and therefore cannot be added to the claim) ; Whitt v. U.S. Trinity Energy Serv.,

LLC , No. 20

- 0732, 2022 WL 577587, at *3 (W. Va. Feb. 25, 2022) (memorandum decision) (holding that because no physician has made a specific diagnosis in regard to the shoulders other than pain, they cannot be added to th e claim).

However, we find that the Board committed clear error in affirming the claim

administrator’s order insofar as it denied the addition of a contusion to the abdominal wall to the claim based upon the photographs submitted into evidence

, which corroborate Dr. Hess’ October 31, 2022, report in which he diagnosed a contusion to the abdominal wall

. We first note that the Board’s findings of fact regarding the photographs submitted into evidence are entirely inadequat e. Other than stating that the photographs were reviewed, the Board completely fails to provide any description of the photographs or its impression

of the contents of the photographs . These photographs were important pieces of evidence given that the y sho wed the contusions/bruising Mr. Brewer sustained as a result of his compensable injury and they warranted more detailed findings than a solitary sentence stating they had been reviewed. Accordingly, we find that the Board’s findings of fact are incomplete as they did not include any summarization of the photographs , leading us to conclude that the Board erroneously failed to consider the photographs in rendering its decision on compensability in this claim.

Upon reviewing the photographs , we conclude that Mr. Brewer sustained a contusion to his abdominal wall in the course of and as a result of his employment. The photographs show a contusion to the back, which was held compensable. However, t he photographs further reveal that the contusion stretches aroun d Mr. Brewer’s side and to the front of his abdomen. While the Board is correct that the ER staff had not diagnosed a contusion of the abdominal wall, a CT scan showed no acute injury to the abdomen, and

Dr. Hess did not diagnose the contusion for approxim ately six months following the injury,

the photographs reveal the true extent of Mr. Brewer’s contusions, which clearly extend to

his abdomen.6 The standard for the addition of a new condition to a claim is the same as for compensability. For an injury to be compensable it must be a personal injury that was received in the course of employment, and it must have resulted from that employment. Barnett v. State Workmen’s Comp. Comm’r , 153 W. Va. 796, 172 S.E.2d 698 (1970). When considering the photographs in c onjunction with Dr. Hess’ October 12, 2022, report, and the fact that the claim has been held compensable for a contusion of the back wall of the thorax, which is seen in the same photographs as the contusion to the abdomen, we

conclude that Mr. Brewer sus tained a contusion to the abdominal wall in the course of and as a result of his employment. Accordingly, we find that the Board clearly erred in affirming the claim administrator’s order and denying the addition of a contusion to the

abdominal wall to the claim.

Turning to Mr. Brewer’s second assignment of error, he argues that the Board erred in affirming the claim administrator’s order which denied authorization for an endoscopy and colonoscopy. Mr. Brewer contends that he immediately developed nausea, vomiting, and diarrhea following his work

- related incident and was appropriately referred to Dr.

Johnson after his treating physician could not determine the etiology of his symptoms

. As noted by Mr. Brewer, Dr. Johnson opined that Mr. Brewer may have dev eloped gastritis “as a consequence of his injury, change in habits, and chronic Voltaren use.” Mr. Brewer argues that Dr. Johnson correctly recommended an endoscopy and colonoscopy to assess whether an injury had occurred to Mr. Brewer’s internal organs that a CT scan had not

identified , and that the Board erred in relying on Dr. Mukkamala’s opinion as opposed to the authorized treatment providers . Mr. Brewer avers that the requested procedures were clearly reasonable and medically necessary and sh ould have been authorized. While Mr. Brewer admits that he has a history of GERD and gastritis, he argues that the last time he sought treatment for either was in 2019 and that he did not experience symptoms again until after his compensable injury. We dis agree.

W e find that Mr. Brewer failed to demonstrate that the Board’s findings and conclusions were clearly wrong with respect to the issue of the treatment he requested . As the Supreme Court of Appeals of West Virginia has set forth, “[t]he ‘clearly wron g’ and the ‘arbitrary and capricious’ standards of review are deferential ones which presume an agency’s actions are valid as long as the decision is supported by substantial evidence or by a rational basis.” Syl. Pt. 3, In re Queen , 196 W. Va. 442, 473 S. E.2d 483 (1996). With this high standard of review in mind, we are unable to conclude that the Board erred in denying authorization for an endoscopy and colonoscopy.

West Virginia Code § 23

- 4

- 3(a)(1) (2005) provides that the claim administrator must provi de medically related and reasonably required sums for healthcare services, rehabilitation services, durable medical and other goods, and other supplies. Here, a contusion to the back wall of the thorax and, as noted above, a contusion of the abdominal

wall are compensable conditions in the claim . The endoscopy and colonoscopy were requested by Dr. Johnson based upon Mr. Brewer’s nausea, vomiting, and diarrhea7 symptoms. However, there are no gastrointestinal conditions that are compensable in the

claim , and there is no evidence that any treatment provider has requested that a gastrointestinal condition be added to the claim . Further, there is no evidence showing a causal connection between Mr. Brewer’s gastrointestinal symptoms and the compensable injury othe r than Dr. Johnson’s brief, unsupported statement that the gastritis could be a “consequence of his injury, change in habits, and chronic Voltaren use.” Dr. Johnson provided no explanation for his statement

, n or did he demonstrate a causal link between

the symptoms and the compensable injury. Moreover, Mr. Brewer has a significant preexisting history of gastrointestinal conditions, including gastritis and GERD. Given the foregoing, we are unable to conclude that the Board erred in affirming the denial of

au thorization for an endoscopy and colonoscopy.

Accordingly, we affirm the Board’s May 10, 2023, order insofar as it denied authorization for an endoscopy and colonoscopy and denied the addition of pain as a compensable condition in the claim

. However, we r everse the Board’s May 10, 2023, order

insofar as it denied the addition of a contusion to the abdominal wall to the claim and find that diagnosis to be compensable.

Affirmed , in part, and R eversed

, in part

.

ISSUED: 

### November 1, 2023

CONCURRED IN BY:

Chief Judge Daniel W. Greear Judge Thomas E. Scarr Judge Charles O. Lorensen