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 STATE OF WEST VIRGINIA 

SUPREME COURT OF APPEALS 

 

SAMUEL A. ROBINSON, 

Claimant Below, Petitioner 

vs.) No. 16-1217 (BOR Appeal No. 2051396) 

 (Claim No. 2000045824) 

WEST VIRGINIA OFFICE OF 

INSURANCE COMMISSIONER, 

Commissioner Below, Respondent 

and 

 

EASTERN ASSOCIATED COAL, LLC, 

Employer Below, Respondent 

MEMORANDUM DECISION 

 Petitioner Samuel A. Robinson, by Patrick K. Maroney, his attorney, appeals the decision 

of the West Virginia Workers’ Compensation Board of Review. The West Virginia Office of the 

Insurance Commissioner, by Henry C. Bowen, its attorney, filed a timely response.

The issue on appeal is whether a lumbar CT scan should be authorized. The claims 

administrator denied Timothy Deer, M.D.,’s request for a lumbar CT scan on July 15, 2015. The 

Office of Judges affirmed the decision in its June 9, 2016, Order. The Order was affirmed by the 

Board of Review on December 1, 2016. The Court has carefully reviewed the records, written 

arguments, and appendices contained in the briefs, and the case is mature for consideration. 

 This Court has considered the parties’ briefs and the record on appeal. 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 substantial question of law and no prejudicial error. For these reasons, 

a memorandum decision is appropriate under Rule 21 of the Rules of Appellate Procedure. 

 Mr. Robinson, a brakeman, suffered a lower back lifting injury in the course of his 

employment on March 5, 2000. The report of injury indicates he was diagnosed with low back 

strain injury or a herniated disc. The diagnostic codes provided were lumbar sprain/strain and 

FILED 

September 15, 2017 

RORY L. PERRY II, CLERK 

SUPREME COURT OF APPEALS 

OF WEST VIRGINIA
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overexertion and strenuous and repetitive movements or loads. The report stated the injury 

aggravated a chronic or prior injury, noting Mr. Robinson had a history of low back injury. The 

claim was held compensable for lumbar sprain on April 11, 2000. A claims administrator decision 

dated January 25, 2006, listed the compensable diagnoses as lumbar sprain; lumbosacral joint 

ligament sprain/strain; reaction to spinal or lumbar puncture; depressive disorder; major depressive 

disorder; unspecified neuralgia, neuritis/radiculitis; other/unspecified disorder of lumbar region; 

and lumbosacral neuritis or radiculitis. 

In an August 15, 2001, independent medical evaluation, George Orphanos, M.D., found 

that Mr. Robinson sustained a musculoligamentous type injury involving the lumbar spine as a 

result of a work-related accident superimposed on pre-existing spondylosis at L5. Dr. Orphanos 

noted that he had pre-existing spondylosis at L5 and also noted degenerative bulging discs at L4-

5 and L5-S1. Mr. Robinson was found to be stable and at maximum medical improvement. 

In a treatment note dated July 29, 2009, Rajesh Patel, M.D., assessed lumbar sprain, spinal 

stenosis, lumbar disc protrusion, facet arthropathy, and spondylosis bilaterally at L5. Dr. Patel 

explained to Mr. Robinson that the stenosis at L4-5 could be causing some of the leg symptoms; 

however, without a myelogram or MRI it would be difficult to determine the exact amount of 

stenosis. Dr. Patel noted that Mr. Robinson had an allergic reaction to dye in the past so an MRI 

was not possible. He recommended decompression at L4-5 without fusion. He explained that the 

fusion would have to be two levels and may not be in his best interest. If Mr. Robinson continued 

to get adequate pain relief from the pain pump, he recommended holding off on fusion. 

Prasadarao Mukkamala, M.D., performed an independent medical evaluation on August 9, 

2013, in which he diagnosed lumbar sprain and found that Mr. Robinson had reached maximum 

medical improvement. It was noted that his recovery was delayed by naturally occurring 

degenerative spondylosis and disc degeneration. 

Mr. Robinson testified in a deposition on November 14, 2014, that he was injured at work 

while lifting. He experienced severe back pain and was taken to Raleigh General Hospital by 

ambulance. He had severe pain in his lower back and burning pain down both legs into the feet. 

Mr. Robinson asserted that he had none of these symptoms prior to the injury. He testified that he 

has a spinal cord stimulator which helps with the back pain but not the leg and feet pain. He 

explained that Dr. Deer wants him to have surgery to install a larger implant or paddle stimulator. 

The claims administrator denied Dr. Deer’s request for a lumbar CT scan on July 15, 2015. 

The Office of Judges affirmed the decision in its June 9, 2016, Order. It found that the claim is 

now over sixteen years old. Mr. Robinson has been found to be at maximum medical improvement 

several times over the years including in 2001 by Dr. Orphanos and in 2013 by Dr. Mukkamala. 

He has even been granted a 12% permanent partial disability award. Dr. Mukkamala found in his 

independent medical evaluation that Mr. Robinson required no further treatment other than a home 

exercise program. Dr. Mukkamala opined that his ongoing symptoms are the result of degenerative 

changes, noting naturally occurring degenerative spondylosis and disc degeneration. The Office 

of Judges determined that the request for a lumbar CT scan is far beyond the treatment guidelines 

of West Virginia Code of State Rules § 85-20 (2006). The Office of Judges concluded that Mr. 
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Robinson failed to provide sufficient evidence to show that treatment beyond the guidelines should 

be authorized. The Board of Review adopted the findings of fact and conclusions of law of the 

Office of Judges and affirmed its decision on December 1, 2016. 

After review, we agree with the reasoning and conclusions of the Office of Judges as 

affirmed by the Board of Review. Mr. Robinson failed to show by a preponderance of the evidence 

that the requested CT scan is medically related and reasonably required treatment for his 

compensable injury. 

For the foregoing reasons, we find that the decision of the Board of Review is not in clear 

violation of any constitutional or statutory provision, nor is it clearly the result of erroneous 

conclusions of law, nor is it based upon a material misstatement or mischaracterization of the 

evidentiary record. Therefore, the decision of the Board of Review is affirmed. 

 Affirmed. 

ISSUED: September 15, 2017 

CONCURRED IN BY:

Chief Justice Allen H. Loughry II 

Justice Robin J. Davis 

Justice Margaret L. Workman 

Justice Menis E. Ketchum 

Justice Elizabeth D. Walker